Percurso assistencial das crianças avaliadas pelo serviço de referênciade triagem auditiva neonatal do Hospital Sofia Feldman no período de2010 a 2011

Abstract

Introduction: Newborn Hearing Screening Programs (NHS) are being implemented worldwide, aiming the early detection of hearing deficit in the newborn. The evaluation of these programs becomes an important tool for the quality control of the care offered and for corrective actions by public health policymakers. Objective: Describe the healthcare historyof the children screened in a Newborn Hearing Screening Reference Service (NHSRS) in Belo Horizonte and analyze the intra-urban differentials related to the outcome of the Newborn Hearing Screening tested at a NHSRS and living in Belo Horizonte in the period from January 2010 to February 2011, having as reference the Health Vulnerability Index(HVI). Method: A database with information regarding the children screened by the NHSRS in the period from January 2010 to February 2011 was analyzed. The study was therefore divided in two phases. In the first, the results were evaluated having as parameters the qualityindicators proposed by the American Academy of Pediatrics (1999) and the Joint Committee on Infant Hearing (2007). Chi-Squared and Kruskal-Wallis tests were used for the study of the relationship between the variables. In the second phase the children screened by the NHSRC and living in Belo Horizonte were analyzed. The Health Vulnerability Index (HVI) of the census sector of each child was obtained by the geo-referencing of their respective addresses. A multivariate analysis was undertaken using the decision tree technique, considering a statistical model for each answer. A thematic map of points representing the geographic distribution of the children evaluated by the NHS Program was also elaborated. Results: In the period studies, 6.987 newborn were screened. The rate of routing for retesting, compliance to the retesting and routing for diagnostic were respectively 8.0, 71.9 and 2.1%. The absenteeism in the retest phase corresponded to 28.1% and there was no statistic relevant relationship with the age and origin of the children in the moment of the hearing screening. In the reevaluation phase, the absenteeism corresponded to 73.6% of the children routed. The age median of the children at the moment of the Newborn Hearing Screening was of 23 days, and 65% of them were evaluated in the 30 first days of life. The proportion of children with risk indicator for hearing loss (RIHL) that failed the NHS was greater than that of children that passed (p<0.0001). The risk that a child with RIHL fails the NHS was 2,4 times greater than that of a child without RIHL (IC 95% = 2,0 3,0). It was also noticed that children in the group that failed the NHS were older than those in the group that passed (p<0.0001). Considering the sample of the second phase, the probability of failure in NHS by children with a very high HVI or without HVI data was 1.5. higher than for children living in other neighborhoods. For the children living in areas of low, medium and high HVI and that undertook the RIHL after 30 days of life, the probability of failure in the RIHL was 2.1 times higher in children that had RIHL (17.2%) than those that do not have it (8.1%). It was also noticed an unequal distribution of children tested and of failures in the HNS and between the region of the municipality. Conclusion: The social determinants of health influenced the result of the children in the HNS Program. Inter-setoral actions in the areas of greatest healthvulnerability are needed to contribute to the reduction of the inequality, with positive impactson the pediatric hearing health in the municipality. The NHSRS studied met three of the four indicators evaluated. The results highlight a need for strategic actions to increase the numberof children screened in the first 30 day of life. The absence of integrated information systems between the screening and diagnostic services rendered impossible the identification of the number of children with the hearing disorder detected and treated at an early stage.