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Guidelines For High Risk Neonatal Hearing Screening

These guidelines was developed by the Surgical and Emergency Medical ServicesUnit, Medical Services Development Section of Medical Development Divisionand the Drafting Committee.

Published in August 2009

A catalogue record of this document is available from the Library and ResourceUnit, Institute for Medical Research, Ministry of Health;

MOH/P/PAK/182.09 (GU)

All copyrights reserved


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ACKNOWLEDGEMENT

Surgical and Emergency Services Unit, Medical Development would like toacknowledge the contributions of the Drafting Committee headed by WanShuhailah bt Wan Husain, Audiologist, Hospital Sultanah Nur Zahirah, KualaTerengganu and other audiologists for their commitment and dedication towardsthe development of this document.

Special gratitude to Mr Abd Majid Mohd Nasir as the National Advisor of ORLSurgery for his leadership, guidance and continuing support in developing thisdocument.


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TABLE OF CONTENTS PAGE

FOREWORD

Deputy Director General of Health (Medical) 5

ARTICLES

List of Abbreviations 6

1.0 Introduction 7

2.0 Definition 8

3.0 Objective 8

4.0 Roles and responsibilities 9

5.0 Methodology 15

6.0 Training for screening personnel 17

7.0 Management 18

8.0 Program evaluation and monitoring 19

APPENDIX 1

High Risk Register 21

APPENDIX 2

Flowchart for High Risk Neonatal Hearing Screening 23

APPENDIX 3

Work Process of High Risk Neonatal Hearing Screening 24

APPENDIX 4

High Risk Neonatal Hearing Screening 26

REFERENCES 27

DRAFTING COMMITTEE 28


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FOREWORD BYDEPUTY DIRECTOR GENERAL MINISTRY OF HEALTH MALAYSIA

(MEDICAL)

Good hearing is essential for a child’s overall development. Hearing loss is one of

the most common birth defect. Approximately 3 out of 1,000 babies are born with

significant hearing loss. If a child’s hearing loss goes undetected at birth, it can

result in delays in language and social development. Early intervention greatly

improves the child’s prognosis of achieving normal social, emotional and language

development.

These guidelines will guide health care professionals working towards attaining the

highest professional standards in the field of newborn hearing screening. In

addition they address the issues of the resources, trained and credentialed

personnel and organizational structure needed to run the screening as a national

program.

I believe that with the adoption of these guidelines, the High Risk Neonatal Hearing

Screening Program will develop into a Universal Screening for all the newborns in

our country. This will contribute significantly towards a healthy nation.

The Ministry recognizes the commitment and support given by the members of

the committee for the development of GUIDELINES FOR HIGH RISK NEONATAL

HEARING SCREENING. Special gratitude to all other parties who have directly

or indirectly contributed to the successful publication of this document.

Datuk Dr. Noor Hisham B AbdullahDeputy Director General of Health (Medical)Ministry Of Health MalaysiaAugust 2009


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LIST OF ABBREVIATIONS

AABR Automated Auditory Brainstem Response

ABR Auditory Brainstem Response

B/O Baby of

CMV Cytomegalovirus

dBnHL Decibel (norms) Hearing Level

DOB Date of birth

HRNHS High Risk Newborn Hearing Screening

KPI Key Performance Indicator

MOH Ministry of Health

NICU Neonatal Intensive Care Unit

OAE Otoacoustic Emission

ORL Otorhinolaryngology

SCN Special Care Nursery


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INTRODUCTION

Hearing loss is one of the most common major abnormalities present

at birth and, if undetected, will impair speech, language and cognitive

development. The prevalence of high risk babies with hearing loss is

estimated at 2 to 4 per 100 infant in the intensive care unit.

The critical period for language and speech development is generally

regarded as the first 3 years of life. Children who are identified with hearing

loss between birth and 6 months of age and have received immediate

intervention (amplification, medical referral, family-centered programs, etc)

have significantly higher developmental functions as compared to those with

late detection and intervention. There is a general agreement that a neonatal

hearing screening program should be implemented so hearing impaired baby

could be detected as early in life as possible and the rehabilitation process

can take full advantage of the auditory plasticity of the developing sensory

system.

Universal neonatal hearing screening program is the current standard

practice in developed countries to detect hearing impairment among children

at early age. The American Academy of Pediatrics supports the statement of

the Joint Committee on Infant Hearing (1994), which endorses the goal of

universal detection of hearing loss in neonates before 3 months of age, with

appropriate intervention no later than 6 months of age.

In Malaysia, the high risk neonatal hearing screening program

(HRNHS) has been introduced to the state government hospitals since 2001.

To date, 30 hospitals have started this program and more will follow suit in the

near future. To standardize the implementation activities, this guideline was

established as a guide to all the healthcare professionals involved in the

screening program at every level.

1.0


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DEFINITIONS

2.1 Screening

The use of tests that are quick and easy to administer to a large group

of people for the purpose of identifying individuals who require further

diagnostic testing.

2.2 Neonate

A baby from birth to four weeks of age.

2.3 High Risk Register

A list of factors that place a neonate or an infant at risk for hearing

loss. Also known as a high-risk hearing register (HRHR)(Appendix 1).

2.4 High Risk Neonatal Hearing Screening (HRNHS)

A hearing screening done to neonates who are born with high risk

factors associated with congenital or acquired hearing loss.

OBJECTIVES

3.1 General Objective

To minimize or prevent the effects of hearing impairment among high

risk neonates.

3.2 Specific Objectives

• To detect hearing impairment ideally by 3 months of age.

• To implement intervention ideally by 6 months of age.

2.0

3.0


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ROLES AND RESPONSIBILITIES

The HRNHS program involves a multi-disciplinary team of

professionals. All team members must work together to ensure the success

of the program. The roles and responsibilities of each team member should

be well defined. The team members are:

➢ Hospital Director;

➢ Otolaryngologists;

➢ Pediatricians;

➢ Obstetricians;

➢ Family Medicine Specialist;

➢ Audiologists;

➢ Speech language therapist;

➢ Screening personnel;

➢ Medical social worker

4.1 Hospital Director

4.1.1 Advisor to the screening program

4.1.2 Provides support in terms of resources:

o Manpower

• Screening Personnel (Staff Nurse, Assistant Medical

Officer, Technician, certified health personnel)

• Audiologists

• Speech Language Therapist

• Health Care Assistant (Pembantu Perawatan Kesihatan)

o Materials

• Health education (e.g. brochures, pamphlets, posters,

electronic Information about hearing screening and

hearing development)

4.0


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o Equipment & consumables

o Space for hearing screening

4.2 Otorhinolaryngologist

4.2.1 Collaborates with other clinical disciplines in terms of

comprehensive patient management.

4.2.2 The clinician whose specialty includes determining the aetiology

of hearing loss, identifying related risk indicators for hearing

loss, including syndromes that involve the head and neck, and

evaluating and treating ear diseases.

4.2.3 An otorhinolaryngologist will determine the appropriate choice

of medical and/or surgical intervention.

4.2.4 When medical and/or surgical intervention is provided, the

otorhinolaringologist is involved in the long-term monitoring

and follow-up.

4.2.5 Provides information and participates in the assessment of

candidacy for amplification, assistive devices, and surgical

intervention, including reconstruction, bone-anchored hearing

aids, and cochlear implantation.

4.3 Paediatrician

4.3.1 To identify the babies who are at high risk of hearing loss and

initiate appropriate screening and referrals.

4.3.2 To monitor the hearing and speech development of the baby at

risk.


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4.3.3 To ensure and support the continuum of audiological

assessment and care.

4.3.4 To initiate referrals for medical specialty evaluations necessary

to determine the presence and etiology of the hearing loss.

4.3.5 To determine any other associated medical conditions.

4.4 Family Medicine Specialist / Primary Healthcare Personnel

4.4.1 To monitor the general health, development, and well-being of

the infant.

4.4.2 To review medical and family history during antenatal visits for

the presence of risk indicators that may require earlier referral.

4.4.3 To ensure and support the continuity of audiological

assessment and care.

4.4.4 To initiate referrals for medical specialty evaluations necessary

to determine the presence and aetiology of the hearing loss.

4.4.5 To monitor hearing development at 6, 12, & 18 months of age.

4.4.6 To monitor speech development at 18 months of age.

4.4.7 To counsel patients or parents.

4.4.8 To include hearing loss awareness in the maternal child health

program.


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4.5 Obstetrician

4.5.1 Prenatal counseling and antenatal identification of patients with

risk factors.

4.5.2 To ensure that all high risk newborns are included in the high

risk neonatal hearing screening program.

4.5.3 To ensure all newborns are included in the universal neonatal

hearing screening program when available.

4.5.4 To include hearing loss awareness in the maternal child health

program.

4.5.5 To counsel patients or parents.

4.6 Audiologist

4.6.1 To coordinate hearing screening programme development,

management, quality assessment and service coordination.

4.6.2 To provide audiological diagnosis, treatment and management

including appropriate referral and documentation.

4.6.3 To provide comprehensive audiologic diagnosis assessment

to confirm the existence of the hearing loss.

4.6.4 To inform the parents regarding the hearing screening result,

impact of the hearing loss and rehabilitation.

4.6.5 To evaluate the infant before selecting him/her as a candidate

for amplification, other sensory devices and assistive

technology and ensure prompt referral for early intervention

programs.


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4.6.6 To provide timely fitting and monitoring of amplification.

4.6.7 To ensure that hearing-screening information is transmitted

promptly to the primary healthcare facility and appropriate data

are submitted to the screening committee.

4.7 Speech language therapist

4.7.1 To provide information to parents on normal language

development.

4.7.2 To administer ongoing formal and informal diagnostic

assessment, to develop individualized therapy plans, to

monitor progress and to evaluate the effectiveness of the plan

for the child and family.

4.7.3 To guide and coach parents to become the primary facilitators

of their child’s listening and spoken language through active

consistent participation in individualized therapy sessions.

4.7.4 To guide and coach parents to help the child integrate listening

and spoken language into all aspects of the child’s life, by

creating environments that support listening for the acquisition

of spoken language through the child’s daily activities to

ensure comprehensive speech & language therapy.

4.7.5 To coordinate and facilitate parents’ support group activities.

4.8 Screening personnel

4.8.1 Any paramedic, who has undergone proper training in

neonatal hearing screening program, knowledgeable about

neonatal hearing screening program, hearing screening

technology and techniques of hearing screening.


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4.8.2 To conduct hearing screening procedure according to the

hearing screening protocols (Appendix 2 and Appendix 3) and

Infection Control Protocol.

4.8.3 To ensure that parents and primary health care professionals

receive and understand the hearing-screening results and

provide documentation.

4.8.4 To key in patient’s information in Hearing Screening Database

for patient’s tracking and program’s monitoring.

4.8.5 To provide parents with appropriate follow-up and resource

information, and that each infant is linked to a Primary

Healthcare Facility.

4.8.6 To consult with coordinator in ordering supplies and brochures

for screening.

4.8.7 To schedule the follow-up appointment prior to discharge

(neonates who are referred for hearing screening).

4.9 Medical social worker

4.9.1 To provide social, emotional and financial support to parents

whose baby have been confirmed with hearing impairment

including purchasing, fund application or rental of hearing aids.

4.9.2 To serve as a liaison with Welfare Department when more

financial support is required.


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METHODOLOGY

5.1 To implement the HRNHS program, the hospital should take into

consideration:

• The availability of Auditory Brainstem Response / ABR machine;

• Screening protocols, including the timing of screening in relative

to nursery discharge;

• Availability of qualified screening personnel;

• Room availability with good acoustical and electrical

environments;

• Follow-up referral criteria and referral pathways for follow-up;

• Availability of a computer system for information management;

• Appropriate data collection and reporting;

• Continuous Quality Improvement

5.2 Test criteria:

5.2.1 Subjects

• All neonates born with high risk factors preferably prior to

hospital discharge.

5.2.2 Technology used:

• ABR machine - Automated or operator-controlled machine.

5.2.3 One Stage screening is used

• Hearing screening done by using ABR only at first stage.

5.2.4 Test time :

• Testing time takes about 15-20 minutes, (the time maybe

longer if a baby is restless and does not include time for

discussion and preparation before test).

5.2.5 Pass/Refer criteria

5.0


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• Pass:

- Reliable evoked response is present at ≤35 dBnHL for both

ears.

• Refer:

- Reliable evoked response is absent at ≤35 dBnHL from

either ear.

5.2.6 No excessive earwax occluding the ear canals

5.2.7 Baby’s condition

• Baby should be stable with no life support, no nasal cannula

and no isolette (preferably open crib).

• For critically ill babies, they may require long term

hospitalization. If the hospitalization is more than 3 months,

the baby should be referred directly to the audiologist for

screening.

• Screening should be done while baby is quiet (or sleeping),

well fed and comfortable.

5.2.8 Place for screening

• Screening should be done in a quiet room with less electrical

appliances.

5.2.9 Equipment calibration

• Screening equipment must be calibrated daily and annually.


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TRAINING FOR SCREENING PERSONNEL

6.1 The trainer

• Audiologist in each hospital

6.2 The trainee can be

• Staff nurse,

• Assistant Medical Officer ,

• technicians,

• health care assistants and

• volunteers.

6.3 The components of training program include:

6.3.1 Introduction of neonatal hearing screening

6.3.2 Basics of OAE and ABR testing

6.3.3 Training on how to use OAE and ABR machine

6.3.4 Trouble shooting

6.3.5 Handling of the baby during the test

6.3.6 Appropriate environment, place and time to run the screening

program

6.3.7 Teaching on result interpretation

6.3.8 Practical sessions

6.3.9 Documentation

6.4 The training program will be done in 2 approaches:

i. Theory – 2 days

ii. Practical under supervision for minimum 50 babies for each

trainee

6.5 Close monitoring by audiologist for 1 month after completing the

training

6.0


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MANAGEMENT

7.1 When there is a PASS RESULT:

• The baby’s hearing is adequate for normal speech and language

development.

• Ongoing monitoring and evaluation is needed when baby is born

with high risk factors (Appendix 1). This ongoing monitoring

should be done by Family Health Physician or Medical Officer in

hospitals and Health Clinics.

7.2 When there is a REFER RESULT:

• The baby needs further audiological evaluation to determine

whether the baby’s hearing status is adequate for normal speech

and language development.

• The abnormal result of the screening is shared with the family

before discharge, and appointment for further evaluation is

scheduled by the Screening Personnel and/or Audiologist.

7.3 When there is a MISSED SCREEN:

• The babies will undergo re-screening with an audiologist within 7

days after discharge.

7.4 Surveillance and screening in the primary healthcare facility

7.4.1 For all babies, regular surveillance of developmental

milestones, auditory skill, parental concerns and speech and

language development should be performed in the primary

healthcare facility.

7.0


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8.0

7.4.2 Babies who do not follow normal development milestone or for

whom there is a concern on hearing or language development

should be referred for speech-language evaluation and/or

audiology assessment.

PROGRAM EVALUATION AND MONITORING

8.1 All post screening data should be entered into ORL registry; Hearing

Screening Database.

8.2 Program coordinator (audiologist) from each hospital should evaluate

the program 3 monthly based on the quality indicators and the

benchmarks as below.

8.3 The Quality Indicators for high risk neonatal hearing screening

8.3.1 Percentage of neonates screened before three months of age.

8.3.2 Percentage of neonates who do not pass the birth admission

screening.

8.3.3 Percentage of neonates who do not pass the screening and

referred for audiological and medical evaluation.

8.3.4 Percentage of neonates who return for follow up services

(either audiological or medical evaluation).

8.3.5 Percentage of babies who fail hearing screening and confirm

with hearing loss before 6 months of age.

8.3.6 Percentage of families who refuse hearing screening on birth

admission.

8.3.7 Age of the babies when intervention is undertaken (e.g.

hearing aid fitting and speech therapy).


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8.4 Benchmarks for High Risk Neonatal Hearing Screening programme

(based on KPI: High Risk Neonate Hearing Screening for early

detection and intervention 2007 by Jawatankuasa Kecil Teknikal

Pegawai Pemulihan Perubatan Pendengaran).

8.4.1 Percentage of neonates underwent hearing screening should

be ≥ 95%.

8.4.2 Referral rate for follow-up following failure in hearing screening

should ≤ 4%.

8.4.3 Percentage of neonates who return for follow up services

(either audiological and medical evaluation) should be ≥ 70%.


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HIGH RISK REGISTER

A. For use with NEONATE

1. Family history of hereditary childhood sensorineural hearing loss

2. In-utero infection, such as cytomegalovirus, rubella, syphilis, herpes and

toxoplasmosis

3. Craniofacial anomalies including those with morphological abnormalities

of the pinna and ear canal

4. Birth weight less than 1,500 grams (1.5 kg)

5. Hyperbilirubinemia at a serum level requiring exchange transfusion

6. Ototoxic medications, including but not limited to the amino glycosides,

used in multiple courses or in combination with loop diuretics

7. Bacterial meningitis

8. APGAR scores of 0 – 4 at 1 minute or 0 – 6 at 5 minutes

9. Mechanical ventilation lasting 5 days or longer

10. Stigmata or other findings associated with a syndrome known to include a

sensorineural and/or conductive hearing loss

B. For use with BABIES (age 29 days through 2 years) when certain

health conditions which require re-screening

1. Parents or caregiver concerns regarding hearing, speech, language, or

developmental delay

2. Bacterial meningitis and other infections associated with sensorineural

hearing loss

3. Head trauma associated with loss of consciousness or skull fracture

4. Stigmata or other findings associated with a syndrome known to include a

sensorineural and/or conductive hearing loss

APPENDIX 1


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5. Ototoxic medications, including but not limited to chemotherapeutic agent

or amino-glycosides, used in multiple courses or in combination with loop

diuretics

6. Recurrent or persistent otitis media with effusion for at least 3 months

C. For use with BABIES (age 29 days through 3 years) who require

periodic monitoring of hearing.

Some newborns and infants may pass initial hearing screening but require

periodic monitoring of hearing to detect delayed-onset sensorineural and/or

conductive hearing loss. Babies with these indicators require hearing

evaluation at least every 6 months until 3 years, and at appropriate intervals

thereafter.

Indicators associated with delayed onset sensorineural hearing loss

include:

1. Family history of hereditary childhood hearing loss.

2. In utero infection, such as cytomegalovirus, rubella, syphilis, herpes

and toxoplasmosis.

3. Neurofibromatosis Type II and neurodegenerative disorders.

Indicators associated with conductive hearing loss include:

1. Recurrent or persistent otitis media with effusion.

2. Anatomic deformities and other disorders that affect Eustachian

tube function.

3. Neurodegenerative disorders.


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FLOWCHART FOR HIGH RISK NEONATAL HEARING SCREENING

APPENDIX 2

Follow-up at primary health

care

High RiskBaby

ScreeningABR

PASS REFER

DiagnosticOAE & ABR

Normalhearing

ConfirmHearing

loss

Intervention


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WORK PROCESS OF HIGH RISK NEONATAL HEARING SCREENING

1. Specialist/ Medical Officer of NICU, SCN, Pediatric Department or postnatal

ward identify high risk baby (based on Appendix 1) for hearing screening.

2. Specialist/ Medical Officers fill-up the hearing screening form (see Appendix

4) and refer to hearing screening personnel.

3. Screening personnel enter baby’s information in Hearing Screening

Database.

4. Inform the parents/caregivers about hearing screening process.

5. Screening personnel prepares the hearing screening equipment.

6. Prepare baby for the hearing screening procedure. Mothers are

encouraged to be with their baby during the procedure.

7. Screening process is done according to Appendix 2 and Appendix 3.

8. Screening personnel informs the result to parents/caregivers and records

all results obtained in the Hearing Screening Database.

9. For babies with pass result but have high risk factors associated with late-

onset, progressive, or fluctuating hearing loss; ongoing medical, hearing

and communication development monitoring should be done in primary

health care during immunization follow-up.

10. For babies with refer result, appointment date for audiological diagnostic

assessment will be given to the parents. Appointment date should be within

6 to 8 weeks, or no later than 3 months of age.

11. Audiological diagnostic assessment will be done in audiology clinic by

appointment.

12. For babies with normal hearing; hearing and communication development

monitoring should be done in primary health care facilities during

immunization follow-ups.

APPENDIX 3


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13. For babies with confirm hearing loss; further audiological, speech and

medical intervention will be given immediately.

14. Audiological interventions includes hearing aids fitting, auditory training and

periodic follow-ups.

15. Speech interventions should include speech and language therapy.

16. Medical interventions should include medical diagnosis and direction for

medical and/or surgical treatment options for hearing loss and/or related

medical disorder(s) associated with hearing loss.

17. For transferred cases, screening personnel shall take note and refer them

to the preferred hospital for further medical evaluation and/or audiological

diagnostic assessment.


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APPENDIX 4

HIGH RISK NEONATAL HEARING SCREENING FORM

B/O : IC/passport (M):

Phone No.:DOB :

Risk factors Risk factors

Family history* Parental concern*

Ventilation > 5 days Ototoxic medication

Hyperbilirubinemia * In-utero infection (CMV*)

Craniofacial anomalies Associated syndrome*

Neurodegenerative disorders Meningitis*

Head trauma APGAR scores of 0 – 4 at 1 minute or 0 – 6 at 5 minutes

Very low birth weight (< 1.5 kg)

* Risk indicators that are marked with an asterisk are of greater concern for delayed-onset hearing loss. Please refer to audiologist after screening

Signature

Name of Medical Officer (NICU ward/ pediatric clinic)

To be filled by screener Parents consent: YES / NO

Auditory Brainstem Response (ABR) testing:

PASS REFER

Right ear

Left ear

Name and signature:

Date:

• carbonized and standardized (2 copies)


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REFERENCES

1. National Institute of Health (NIH) Concensus Statement, 1993.

2. Joint Committee of Infant Hearing, Position Statement 1994

3. Health Technology Assessment Report; Screening For Hearing Loss

in Infants, ,2004

4. Pediatrics, 120(4), pp. 898–921.Joint Committee of Infant Hearing,

Position Statement 2007

5. ASHA guideline 1996; Guidelines for Audiologic Screening

6. Mehl AL, Thomson V. Newborn hearing screening: great omission.

Pediatrics 1998;101:E4

7. Meh AL, Thomson V. The Colorado newborn hearing screening

project, 1992-1999: On the threshold of effective population-based

universal newborn hearing screening. Pedaitrics 2002;109:E7

8. Thompson DC, McPhillips H, Davis RL, Lieu TL, Homer CJ, Helfand

M, Universal Newborn hearing screening : summary of evidence.

JAMA 2001; 286:2000-10

9. Davis A, Bamford J, Wilson I, Ramkalwan T, Forshaw M. Wright S.A

critical review of the role of neonatal hearing screening in detection of

congenital hearing impairment. Health Technology Assessment

1997;1. http://hta.nhsweb.nhs.uk (cited 2002 Sept 19)

10. Harvey Coates, Kim Gifkins. Diagnostic Test: Newborn hearing

screening. Australian Prescriber Vol. 26 No.4 2003

11. Colorado Infant Hearing Advisory Committee Guidelines for Infant

Hearing Screening, Audiological Assessment, and Intervention;

December 14, 2000

12. AAP, Task Force on Newborn and Infant Hearing; Newborn and

Infant Hearing Loss: Detection and Intervention. Pediatrics.

1999;103:527-530

13. Bio-logic, Impementation of Early Hearing Detection and Intervention-

EHDI.2001

9.0


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DRAFTING COMMITTEE

ADVISORS

Datuk Dr. Noor Hisham B Abdullah

Deputy Director General of Health (Medical)

Ministry of Health Malaysia

Dato’ Dr Hj Azmi B. Shapie

Director

Medical Development Division


Dr. Teng Seng Chong

Senior Deputy Director



COORDINATOR

Mr. Abd Majid B. Md Nasir

Head of Department

Otorhinolaringology Department

Hospital Kuala Lumpur


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SECRETARIAT

Dr Patimah Bt. Amin

Senior Principal Director

Surgical And Emergency Medicine Services Unit



Dr Thatcheiany Kumariah

Assisstant Director

Surgical And Emergency Medicine Services Unit



Dr. Muhammed Anis B. Abd Wahab

Assisstant Director

Transplant Unit




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MEMBERS

Wan Suhailah Bt Wan Husain

Audiologist

Hospital Sultanah Nur Zahirah, Kuala Terengganu

Pn Yusmeera Bt Yusoff

Audiologist


Dr Irene Cheah

Paediatrician

Institute Paediatric


Dr Chee Seok Chiong

Neonatologist


Prof Siti Zamratol-Mai Sarah Bt Mukari

Deputy Dean

Faculty of Allied Health Sciences

Universiti Kebangsaan Malaysia

Dr Hussain Imam B. Hj Mohammad Ismail

Head of Department & Consultant

Institute Pediatric



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Dr. K. Mukudan

O&G National Advisor

O&G Department

Hospital Raja Permaisuri Bainun, Ipoh

Puan Bibi Florina Abdullah

Director of Nursing

Nursing Division

Ainul Naquiah Bt Mad Nordin

Audiologist

Hospital Serdang

Nurul Ain Bt. Abdullah

Audiologist


Norasuzi Bt Abd Halim

Audiologist

Hospital Sultanah Bahiyah, Alor Setar

Hanita Bt Hashim

Audiologist

Hospital Ampang

Zaidi B. Ya’acob

Speech and Language Therapist



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Dr Salimah Othman

Principal Assistant Director

Family Health Development

Ministry of Health

Dr Rafidah Mazlan

Audiologist/Lecturer

Faculty of Allied Health Sciences

Universiti Kebangsaan Malaysia

Suzana Bt Mansor

Audiologist

Hospital Universiti Sains Malaysia

Siti Hufaidah Bt Konting

Audiologist

Pusat Perubatan Universiti Malaya

Marina Lamri Alisaputri

Audiologist

Universiti Islam Antarabangsa


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