Questions/Answers

Early detection and effective intervention are the best practical strategy to develop speech and language competences of the newborn with hearing loss problem. The incidence of newborn with hearing loss is about 1-3 per 1000 newborn worldwide and this incidence is even rising in the newborn with high risk factors such as birth asphyxia, hyperbilirubinemia and perinatal infection. Annually, Rajavithi hospital reports of 3,800-4,000 newborns. The newborn hearing screening project was initiated in 2010 with the coverage rate of 100% of the newborns in Rajavithi Hospital. The project was thereafter continuous and developed continuously. In 2019, double protocol of newborn hearing screening program was introduced in Rajavithi hospital, in which the otoacoustic emission (conventional) and automated auditory brainstem response (AABR) techniques were applied. The accuracy rate and cost-effectiveness were thorough studied. Thereafter, the model of early screening and early intervention of the newborn with hearing loss problem of Rajavithi hospital has been implemented through government hospitals nationwide. Presently, the small project of Rajavithi hospital is turned to be a national service plan, which is conducted the Ministry of public health of Thailand. The objective of the service plan is to include not less than 95% of the newborn in Thailand in hearing loss screening and intervention program.

By improving the process management of newborn hearing screening and intervention. The result impact of more accuracy and more cost-effectiveness. The system of newborn hearing screening operate by in-patient nurse with double protocol hearing screening technique combine with the service of ENT department of Rajavithi hospital. The department is consisted of otolaryngologist, audiologist, ENT-nurse and speech therapist. Intervention and habilitation program includes hearing aid usage and cochlear implantation to provide all sustainable service and quality.

SDG 3: Good health and well-being by early detection and early intervention of newborn with hearing loss problem will improve quality of life of the affected child. They can use auditory–verbal communication instead of sign language. SDG 10: By the program of universal hearing screening and intervention which is conducted by the Ministry of public health and other related foundation and organization, all the newborns will access to the service of early detection equally without any socio-economic boundary.

The policy advocacy from universal hearing screening and intervention project of Rajavithi hospital has been implemented in to the national service plan and gradually extended to the provincial hospitals of Thailand. Every newborn with hearing loss problem will have right to receive the service without asking.

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(Quantity) Hearing loss screening of the newborn: 2016-2018 = 11,237 cases Cochlear transplantation and speech habilitation: 2016-2018 = 29 cases (Quality) About 70 % of the enrolled patient have gained the CAP score of more than 5 within 2 years. (Output) The percentage of hearing loss newborn with habilitation that attend regular school. 2016-2018 = 79% (Impact) Decrease burden of sign language communication people in Thai population and decrease number of children of deafness in sign language special school 2016 = 3,443 cases, 2017 = 3,252 cases, 2018 = 3,061 cases respectively.

A: The implementation is conducted through the ministry of public health mechanism. National service plan is responsible by otolaryngologist in each public health region. National clinical practice guideline for newborn hearing screening program was determined by the collaboration of otolaryngologists. The national service plan committee was established to implement the program to the provincial hospitals in every health region all over the country.

B: In Thailand, about 300,000 out of 600,000 newborns are given birth in non-government hospital. Our next step plan is to initiate a co-creation with private and other non-government hospitals and implement the same program nationwide.

For the sustainable and effective newborn hearing screening program, Rajavithi hospital introduced the model of hearing-loss screening by in-patient nurse. Nurses of obstetrics and newborn ward were trained. Every newborn is screened within 48 hours, the screening process will be performed at ward by the nurse instead of waiting for any specialist. This can improve the coverage and cost-effectiveness when compare with other hospitals.

This newborn hearing screening and intervention program has been delivered to the national service plan which conduct by the ministry of public health. The program is expanding throughout the country as "Universal Newborn Hearing Screening".

All database from the screening program will be collected as the national data platform. These data will be integrated into the digital government.

The model of universal hearing screening was firstly implemented for system test at Inburi general hospital (Singburi province), Chaiyapoom general hospital (Chaiyaphoom province), and Bangsapan hospital (Prajuabkirikan province). The double protocol of newborn hearing screening were adapted and fine-tuned according to limitation of each test site.

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Most expenses are supported by the national health security office. Special nurse training course taken place at Rajavithi hospital with the financial support by the hospital foundation. Sixty nurses are trained annually. Audiologists will be increasingly trained annually by the co-operation with the speech- rehabilitation association and the medical schools.

The Newborn Hearing loss: Screening and habilitation program had been launched as a policy. All the expenses will be able to reimburse from the national health security office.

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The internal process within Rajavithi hospital was accredited by the Healthcare Accreditation Institute (HAI) of Thailand on 5 May 2021. Disease specific certification was granted and valid until May 2024 The Key Performance Indicators are • The coverage of newborn hearing screening >95% • The positive screening rate <4% • The positive cases receive intervention within 6 month >90% The outcome of these indicators are all above standard.

The screening and CAPS score after 2 years of treatment are used as the main indicators.

The results after the Newborn Hearing loss: Screening and habilitation program are evaluated mainly with habilitation success rate. Hearing loss newborn were detected and included into the program in 2018 - 2020: 8, 7 and 6 cases respectively. Cochlear implantation and speech habilitation were fully success in 6, 6 and 5 cases (2018-2020) ; while 2, 1 and 1 cases were rehabilitated with hearing aid equipment.

The Royal college of otolaryngologists Thailand has established the guideline and implemented in the institute for otolaryngology training. Policy and knowledge management in provincial hospital are monitored and supported by the medical school network. Audiologist training program in medical schools for increasing the audiologists who are the key persons in diagnosis and hearing aid fitting is in progression.

The otolaryngologist and healthcare team in each health provincial regions are the main stakeholder of the key success. Process implementation, data collection, problem management and network connection are controlled by the ministry of public health. The national service plan committee are composed of otolaryngologist from health provincial regions are established.

The data collection and analysis about newborn hearing screening is not synchronized in every health provincial region. Each region uses their own tool and method. Single health data system has to be developed. Data collection sheet and platform used by each region have to be studied and concerned.