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National Yang Ming Chiao Tung University

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  • President's Letter

  • Publish Date:2024-06-24
Letters from the President: 03.Identify and Solve Problems
Using Automated Auditory Brainstem Response (aABR) for Newborn Hearing Screening
Using Automated Auditory Brainstem Response (aABR) for Newborn Hearing Screening
(Image credit: Kuan-Yun Chen)
 
Narrated by NYCU President Chi-Hung Lin
Interviewed by Yen-Shen Chen, Written by Yen-Chien Lai
Proofread by Yu-An Lu
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In 1994, after earning my Ph.D. in the United States, I returned to teach at Yang Ming University, where I have been teaching for 30 years. During this time, I was seconded to serve as the Director of Health for Taipei City and New Taipei City for eight years. During my tenure as Director, I was often asked, “What do you think are the differences between being a professor and a director?” Generally, professors are immersed in academic research, while directors need to plan and implement public health policies and interact with the media and the public. The roles are quite different, with one being more inward-focused and the other outward-focused. However, my response then was that, although these roles seem entirely different, they share a common core: “to identify meaningful problems and then try to solve them.
 
Let me illustrate this idea with a story.

When I first became the director, my teacher, Professor Kwang-Jen Hsiao, visited and wanted to understand my administrative plans. Professor Hsiao eagerly shared a public health issue with me: Newborn Hearing Screening. Since 2000, he had done extensive preparatory work on this topic. As I reviewed the materials he provided, I realized that newborn hearing screening is a crucial and essential task. Why do I say this? Let me explain.

Identify the Key Points of the Problem

At that time, medical literature indicated that the incidence of congenital hearing loss in newborns was as high as 1.5 per 1,000, significantly higher than that of congenital metabolic disorders such as G6PD deficiency, hypothyroidism, congenital adrenal hyperplasia, and phenylketonuria. Fortunately, domestic and international research also showed that if newborns undergo hearing screening and are diagnosed within three months and fitted with appropriate hearing aids or other interventions within six months, even children with congenital bilateral hearing loss can achieve nearly normal brain development and language skills. In simple terms, what may seem like a simple, small hearing screening is crucial for newborns with hearing loss. If not treated within this golden period, the child may develop further issues such as speech difficulties, learning delays, and intellectual development disorders. Hence, in Taiwanese, “tshàu-hīnn-lâng (deaf)” often associates hearing impairment with intellectual disability.

As the new director, I thought to myself: since we have identified a meaningful problem, the next step is to figure out how to solve it. During our policy research, we discovered three key points that must be addressed to resolve newborn hearing issues. The first is determining “when” to conduct the hearing screening for newborns. The second is “how” to perform it. The third is how to ensure proper follow-up and treatment. Finally, a crucial point, of course, is how to “convince” my boss, the mayor, to allow us to proceed with this initiative.

The first key point is timing. We have an inherent advantage in Taiwan because most babies are born in hospitals where birth certificates are issued, with almost 100% registration. Basic examinations are conducted in the hospital. We envisioned that if hearing screening could be integrated with these newborn examinations, every newborn could undergo screening. This timing is crucial; once the mother and baby leave the hospital, following up with the examination becomes much more challenging. Therefore, we need to act quickly and complete the screening within a few days after birth (three days for natural births and seven days for cesarean sections).

The second key point is the method. Since babies cannot use tuning forks for hearing tests like children or adults and cannot express whether they hear a sound, we chose the most appropriate solution at the time: using brainwaves (Automated Auditory Brainstem Response, aABR) for testing. When the ear receives sound information, the brainwave pattern changes, making the results obtained this way more accurate.

The third and most important point is how to ensure proper follow-up treatment; only then do the extensive screening efforts make sense. Fortunately, Taiwan has a well-established public health and community nursing system and universal health insurance. If appropriately utilized, solving this problem wouldn’t be difficult. Additionally, effective communication is crucial, especially with superiors. I needed to persuade my direct superior, Mayor Lung-Bin Hau, to allow the Taipei public health team to implement this policy. At that time, Taipei was hosting the Deaflympics. I was inspired and quickly suggested to Deputy Mayor Wen-Hsiang Chiu, “After hosting the Deaflympics, what legacy we could leave for our citizens?” We believed hearing screening was a significant public health issue that deserved attention. Fortunately, the Deputy Mayor helped present the proposal to Mayor Hau, and eventually, we implemented Taiwan’s first newborn hearing screening policy in Taipei.
 






Identify and Solve It, Make the Problem No Longer a Problem

Of course, things were not simple; these key points were just the beginning of solving the problem. Many details needed to be coordinated and communicated across various fronts. For example, using brainwave testing (aABR) was advanced but was not widespread then. Except for significant hospitals, most gynecological clinics or small hospitals did not have this equipment, which could hinder the widespread adoption of brainwave hearing screening. To address this issue, the Department of Health team personally visited hospitals individually to discuss the matter and put in considerable effort. If there was a workforce shortage, we helped find personnel by collaborating with hearing and speech associations.

If there was a lack of equipment, we asked hospitals or clinics to report the number of newborns, and the Taipei Department of Health would send service teams with the necessary equipment. As a result, in the first year of implementing the new policy, the coverage rate of newborn hearing screening reached an impressive 99%, likely the highest globally. We were delighted but continued to review why we couldn’t achieve 100%.
 
Because of this question, we uncovered another problem. Upon reviewing the data, we discovered that this 1% were children born in Taipei City, but their mothers were registered in New Taipei City. As the policy adhered strictly to territorial principles, these newborns could not benefit from Taipei City’s policies. While this scenario was realistic, it was difficult to accept.

Our team pondered how to ensure that these 1% of newborns also received screening. Initially, we considered raising funds. Professor Kwang-Jen Hsiao’s foundation was willing to provide financial support at that time. However, sustainable public policy cannot depend on private donations alone. Therefore, we explored the idea of persuading the Health Promotion Administration (HPA) of the Ministry of Health and Welfare to expand this policy nationwide. This approach would ensure that every child in Taiwan could receive hearing screening, leaving no one overlooked.

We compiled the first year's results of Taipei's hearing screening program into a report and presented it to the HPA. Not only did we showcase the outcomes of Taipei’s policy, but we also outlined a comprehensive plan for nationwide implementation,  including budgetary considerations, specific screening schedules for newborns, and follow-up procedures. We put forth our best effort, and eventually, our proposal for universal newborn hearing screening policy gained support. It expanded from Taipei City to the entire country, achieving over 90% coverage for newborns across Taiwan.

The success of this initiative stemmed from our continuous identification and resolution of challenges encountered along the way.

Finding the Right Problem Is More Important Than Finding the Right Answer

Whether in academic research or policy-making, the true challenge lies not just in discovering the correct solution to a problem, but in identifying “meaningful and worthy problems to solve.” This demands deep reflection, breaking away from conventional thought patterns, and exploring issues often overlooked or considered unimportant. Simply addressing surface-level problems cannot resolve fundamental issues; only by grasping the essence of a problem can we uncover appropriate solutions.

The newborn hearing screening policy initiated and led by Professor Kwang-Jen Hsiao has been in place since 2010. The children who were identified with hearing loss back then are now teenagers. Every year, a related foundation organizes gatherings for children with hearing loss. Whenever I see these children, who were fortunate to receive timely treatment, growing up healthy and leading lives nearly identical to those of other peers, I feel a profound sense of happiness and gratitude.

Einstein once said, “The formulation of a problem is often more essential than its solution.” I wholeheartedly agree with this perspective and wanted to share it with you.



 
President of National Yang Ming Chiao Tung University,
President of National Yang Ming Chiao Tung University,
 
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