臺灣新生兒聽力篩檢之現況

Current Status of Newborn Hearing Screening in Taiwan

先天聽障幼兒如能早期診斷及治療，將來可以達到較正常之語言和其他身心發展。因此全面性嬰幼兒聽力篩檢有其重要性。美國之新生兒聽力篩檢始於1990，至今所有州已立法要求施行全面性新生兒聽力篩檢。台灣之新生兒聽力篩檢計畫則始自1998，本論文之目的，在了解臺灣地區新生兒聽力篩檢之過去與現況。衛生署國民健康局於91年10月發文全國16家醫學中心及64家區域醫院。以問卷調查各家醫院施行新生兒聽力篩檢之情形。80家醫院全部回收問卷。目前台灣地區實施新生兒聽力篩檢計畫的醫院共有21家，佔26%（21/80）。受檢新生兒佔總出生嬰兒數的10%。篩檢計畫之負責醫師，有12家醫院由小兒科醫師負責，另有9家醫院為耳鼻喉科醫師負。執行初篩人員，有10家為護士，另有10家則由聽力師執行。使用之初篩工具，20家是耳聲傳射，1家為自動聽性腦幹反應。各醫院嬰兒接受篩檢之比率差異非常大，>60%者有11家醫院，<60%者有10家醫院。至於初篩未通過之轉介率差異亦大，<10%有17家，另有4家>10%。21家聽力篩檢醫院，均為自費，絕大多數醫院（20家）之聽力篩檢費用在500元-800元之間。目前，臺灣地區新生兒聽力篩檢的整體普及率仍低，且嬰兒接受篩檢之比率和初篩未通過之轉介率在各醫院間的差異均非常大，為達到符合成本效益的嬰幼兒聽障早期診斷及治療的目標，期待臺灣之耳鼻喉科醫學會、小兒科醫學會及聽語學會之共同努力，早日制定標準的新生兒聽力篩檢指引手冊，不但可供全國所有醫學中心、醫院及診所參考，並可提供政府衛生主管部門參考，以便推廣全面性新生兒聽力篩檢。

Abstract: Newborns with hearing disability can still have normal language and other behavior development if early identification and early intervention of hearing disability are conducted before they are six months old. The first program of newborn hearing screening was conducted in 1990 in U.S.A. At present, the universal newborn hearing screening is conducted in nearly all states. Newborn hearing screening has been performed since 1998 in Taiwan. The purpose of this study is to survey the current status of newborn hearing screening in Taiwan. In late 2002, Bureau of Health Promotion investigated the status of newborn hearing screening by sending questionnaires to 80 major hospitals in Taiwan. Among 80 hospitals investigated, 21 hospitals (26%) conducted newborn hearing screening programs. The rate of screened babies was about 10% (25 thousands/250 thousands). There were 12 programs organized by pediatricians whereas 9 by ENT doctors. Newborn hearing screenings were performed by nurses at 10 hospitals and by audiologists at the other 10 hospitals. Otoacoustic emission was used as the screening tool at 20 hospitals, and automatic auditory brainstem response for only 1 program. The coverage rate of screened babies was greater than 60% at 11 hospitals and less than 60% at the rest 10 hospitals. The referral rates of hearing screening were less than 10% at 17 hospitals and greater than 10% at the other 4 hospitals. The cost of screening test per baby was between 500-800 NT dollars. Among hospitals, great variety was revealed in coverage rate as well as referral rate of newborn hearing screening programs. In order to achieve the cost effect of early identification and intervention of infants with hearing disability, guidelines for universal newborn hearing screening should be established as early as possible by cooperation of Otolaryngological, Pediatric and Hearing-Speech Societies in Taiwan.