Audiology assistant Jeannette Frederiksen has been screening babies ever since the screening program started up at Hilleroed Hospital in January, 2005. The Audiology department screens high-risk and NICU infants as well as re-screening referrals from the PKU/hearing testing performed by biomedical analysts in another part of the hospital.
How did you get involved with baby screening?
”Originally, I qualified here at Hilleroed as an audiology assistant and came back from the University Hospital in Copenhagen before the screening project was implemented here. I am part of the team that tests kids, and that’s how come I got into the screening program. Just before I left the University Hospital, GN Otometrics presented the new test instrument AccuScreen, which was going to be part of the PKU screening."
What was your initial impression of the AccuScreen?
”It was great that it was so small that you can hold it in one hand – bear in mind that I was used to rolling a lot of equipment around the hospital. It was also easy to figure out and easy to use. There weren’t many questions that day as we tried it out on some older kids we were examining and so there weren’t any problems getting them to sit still. Everything worked fine.”
So you tried it out on kids who definitely had impaired hearing?
”Yes, so that confirmed that the instrument worked correctly!”
Does your work normally include testing kids?
”Yes, we give them a full audiometric workup just like adults and including play audiometry – we can also use AccuScreen if there’s any doubt as to where the problem is, especially with small kids.”
So you don’t do the first screening of a baby?
”No, the newborns have to undergo a PKU test – a blood test taken from the heel in the Lab., where they also perform the hearing screening. Those who don’t pass the test get referred to us. But we also get directly all those from the neonatal ward as well as the prematurely born.”
In connection with the PKU test – if there’s a ”refer” on one ear, do they send the baby up to you immediately?
”If we have time, they do, otherwise they get given an appointment for a few days later – there might still be a little vernix left inside the ear canal so it can be a good idea to wait a few days.”
The PKU test happens after 5 days so the baby must have already been discharged?
”Yes.”
You evidently didn’t have time to get to know the new instrument in Copenhagen – how did you learn how to use it?
”I had a little training at the University Hospital, so I did know a little about it. Screening Coordinator Eva Christensen knew a lot about it, and so she has taught us. The instrument itself is easy to use so not much training is required. Actually, it’s extremely easy to use and it’s great it’s so small and handy. The eartips are also really good at fitting in the ear canal – and staying there. There aren’t that many functions in the device itself, so it’s not at all confusing. It’s nice and simple.”
What about the probe?
”I think it’s good because, if it isn’t tight enough or there’s vernix, it tells you there’s an error. Then you can take it out and check the ear again, or fit it tighter, and that usually solves the problem.”
Do you change the probe tip after each baby?
”Yes.”
What can you tell us about daily use of the AccuScreen?
”Of course, it can be a little bothersome if you’re going to use it many times in a row and then you have to change the probe tip many times. You just have to clean it and change it again. There haven’t been any cases we couldn’t test – unless there was too much noise. Some of the babies have a lot of vernix or very small ear canals, but then you just have to be patient and ensure a proper fit. In a few cases, we’ve had to hold the probe against the ear because the tip can’t sit by itself, for example, with premature infants. There have also been a few who’ve been too unsettled, so we’ve had to wait until they slept.”
What information do the parents get in advance?
”We’ve made a little brochure they get while pregnant which explains everything and informs what might happen if the baby doesn’t get screened. They get another brochure when they come for the PKU test. There are three all together, one for those born prematurely, one they get before the PKU test and one they get if they have to come up to us.”
How often do you use AABR?
”Quite often in fact. It’s used for all those born prematurely and all NICU babies. And for all OAE refers.”
How long does it take?
”Assuming that the ears are OK [i.e. clear of obstructions], first we screen with OAE, which is usually very quick. Of course, we always spend a little time talking to the parents, showing them what we’re going to do so that they feel comfortable. Then we start testing, and a few seconds later the display reads out ”pass” or ”refer”. Then we switch to AABR, which can take anything from a few seconds to 20 minutes – even if the baby is quiet.”
What happens if you get a refer?
”Then the parents have to talk to our consultant because the baby will have to come back for a full workup. They get to see the consultant immediately so that they won’t have to go home and worry.”
”If we get a ”refer” with both AABR and OAE re-screening, there’s a risk that something’s wrong. It’s just not possible to say what degree of hearing loss there is at that point.”
Do you know how many you’ve identified so far?
”We’ve found six babies with bilateral hearing loss so far, and they’ve been fitted with hearing aids.”
What about the number of refers?
”Yes, we’ve had a few cases which have been due to the condition of the ear canal, or where the baby has been too unsettled and we’ve had to give up and ask them to come back another time.”
Is AABR easy to use?
”Yes, but the electrodes can be difficult to fasten properly because of all those tiny fine hairs, or the skin can be fatty, but otherwise I find it easy to use.”
How do the parents react to AABR? It’s not as straightforward as just putting a tiny little thing in their baby’s ear?
”Of course, they react to those big stickers their little baby is getting on its tiny head, but I haven’t come across anyone who objected. I’ve had a few who thought it was funny and took photos of it. We also let them hold the electrodes so that they can feel how soft they are, not like a Band-Aid that has to be pulled off. They’re fine with that.”
How do you and your colleagues feel about baby screening?
”I think it’s exciting to be a part of it and up here, we’re glad to be involved because it’s here, after all, that they get fitted with hearing aids, if that’s what’s required. Of course, it’s not pleasant having to send them in to the consultant, but that’s part of the program. And it’s thrilling afterwards to see them with their hearing aid(s), and follow them over time, and know that they’re developing better [than they would without intervention].
Have you heard anything from the people who perform the front-line screening?
”We get really good feedback from them – and from the parents who come up to us. The biomedical analysts are very good at informing the parents about what’s happening. We also talk to them about cases where there’s not been a response, and where they’ve been referred up to us.”
How would you describe the cooperation with the biomedical analysts?
”It’s working out very well – although they’d probably say that it’s a bit difficult to get through on the phone sometimes! Otherwise, it’s really good, and uncomplicated.”
Do you, or any of your colleagues, have any suggestions for improvements?
”If anything, it would be nice if the measurements could be quicker. On occasion, it can take up to a minute and then it can be hard to keep them still.”
What’s the quickest test you’ve performed?
”Once I’d just put in the probe and almost immediately I heard the jingle indicating it was finished. It only took about two seconds!”
Have you had any contact with the suppliers of AccuScreen, for example, in connection with any problems?
”Yes, they have been out here, but we haven’t really needed any support because there haven’t really been any problems. If I have any difficulties, I just ask one of my colleagues and that usually solves the problem. For example, on one occasion, the instrument started blinking – we simply changed the battery right away so that it wouldn’t cut out in the middle of a test.”
At the end of 2005, the new screening program could boast of having screened a total of 3448 babies representing 99% of those born in Frederiksborg county. Of the 3260 well babies screened, only 94 (2.8%) had been referred for re-screening (so far 6 babies with bilateral, and two with unilateral hearing loss have been identified).
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