the concern with the hearing grows to each day , a time that the infantile deafness is considered a problem of public health . the illness attacks of one the three healthful neonates in each 1,000 births and approximately two the four in 1.000 babies of risk . the deafness is disease more prevalent ( 30 : 10.000 ) related to the birth , when compared with other diseases as , for example , those detected with the heel prick , phenylketonuria ( 1 : 10.000 ) ; falciform anemia ( 2 : 10.000 ) ; hypothyroidism ( 2,5 : 10.000)1 
 2 
 3 
 4 
 5 . in defense of the precocious detention of the auditory alterations , the american academy of pediatrics ( 1999 ) and the joint committee on infant hearing ( 2000 ) suggest that the programs of hearing screening neonatal ( ptan ) carry through objective evaluation for electrophysiological measure , using the eoa and/or evoked potential auditory of brainstem ( peate)4 
 6 
 7 . however , the examination of the peate presents high cost and demand much time for its application . moreover , by needing personal specialized , it is not recommended as method of first line in the universal selection , although to be used in the evaluation of situations identified for other methods3 . the examination of transient evoked otoacoustic emission ( eoat ) comes being widely used in everybody . the application most promising of the evoked emissions mentions its use to it as device of selection for the identification of auditory deficiency , especially in just - been born and suckling existing in the whole world . the examination of the eoat is of easy use , objective , not invasive , fast , of low cost , makes possible the selection of a great number of children and is observed in almost all the normal ears1 
 2 
 8 . the evoked otoacoustic emissions are caught sonorous energies of low intensity in the external acoustic meatus in reply to a sonorous stimulation . the procedure does not offer damages , risks , discomfort ; it is fast , painless , with high sensitivity and specificities to detect auditory alterations1 
 2 . from this perspective , this study has for objective esteems the prevalence of auditory alterations in just - born in a hospital school . after approval in a committee of ethics of a university hospital , initiated the present study . one is about a study of carried through prospective transversal delineation in the maternity of the hospital in the center - west of brazil , the period of may of 2008 to may of 2009 . the population of reference for the present study , enclosed the just - been born ones that they had appeared for selection between may of 2008 to may of 2009 . the collection of data occurred in the service of audiology of the hospital , where the responsible mother or answered to one anamneses , that she approached given relative to the health in the gestational and neonatal period , beyond spoon information on the presence or not of the pointers of risk for the deafness . it had been enclosed , in the sampling , children born in the maternity , of both the gender , whose responsible they had agreed to participating of the study , signing the term of free assent and clarified ( tcle ) . it was adopted as exclusion criteria the born just - been born ones in other units of health and/or it are of the period of comprehensiveness of the study , as well as those whose responsible they had not agreed to participating of the research . the study it considered as changeable , the sex , gestational age and the presence of pointers of risk for deafness , that as joint committee on infant hearing ( 2000 ) encompass : neonates that are more than 48 hours in the neonatal uti ; malformation of head and neck ; syndromes associates the auditory alterations ; familiar history of congenital auditory deficiency ; neonates infections such as toxoplasmosis , syphilis , cytomegalovirus congenital , herpes and rubella ( storch)6 . at the high moment of the hospital one of the mother and the just - been born one , the mother was lead to the sector of phonoaudiology set appointments one day for the auditory selection of its son . the examinations had been set appointments for ambulatory evaluation during the first month of life of the child . the selections had been offered a time per week , in the fridays . for the evaluation of the cochlear function was used a device of transient otoacoustic emissions ( eoat ) capella ( madsen ) hardwired to a portable microcomputer . during natural sleep or after breast - feeding , the sounding lead for capitation of the emissions was connected in the external auditory conduit of the just - been born one . in agreement , with the anatomical distribution of the frequencies in the cochlea it was considered , as criteria of normality , presence of reply in three of the five bands of frequency , relation level signal / the 6 equal or superior noise dbnps ( decibel sound pressure level ) in the frequencies of 2 , 3 and 4khz and equal or superior reproducibility 50% , as well as relation signal / the 3 equal or superior noise dbnps and equal or superior reproducibility 50% in the frequencies of 1 and 1,5 khz . in case that the examination presented modified in the first selection , one second selection was carried through 15 days after the first eoat . in the second selection , as well as in the first one , a new evaluation of the eoat was carried through . in the cases where as the examination he remained modified , the children , in which the otoscopy met normal , had been lead the phase of the inquiry , and directed to the accomplishment of the peate examination9 
 10 . the children with alterations otoscopic had been treated and later submitted to the third examination of eoat . the size of the sample was esteem on the basis of the main objective of this work . for the calculation of the sample size considering the error of 5% , through this test , a sample of 220,6 was gotten just - been born and had been enclosed in this study 226 children . the collected data had been organized in electronic spread sheet of the excel for posterior analysis in statistical package for social science spss version 17.0 . in the analysis statistics test of fisher in substitution to the qui - square in tables was used where if they related the gender ( masculine and feminine ) with the reply absence . for conclusion how much to the test , the reliable level of 95% was fixed , that is , significant p  <  0,05 . in the chance where the study it was developed , the hospital unit not had device for the accomplishment of the eoat examination . of this form , the device used during the research belonged to a particular clinic , being available only one time per week . in the period of the computed study 764 soon , the responsible ones for the just - been born ones had been invited to participating of the research in question . the 226 just - been born that they had appeared the selection had been tested by means of the test of eoat , being 113 ( 50% ) of masculine sex and 113 ( 50% ) of the feminine one . the age varied to 1 day to 8 months , 60 ( 26.5% ) had been born daily pay - term , 165 ( 73.0% ) the term and 1 ( 0.5% ) after - term . in the first evaluation of the just - been born ones that had presented presence of emissions , 86 ( 48% ) in the cases of reply absence , 13 ( 27.7% ) of the masculine sex had presented unilateral absence and 16 ( 34.0% ) bilateral . in relation to the feminine sex , 8 ( 17.0% ) it is observed that it did not have significant difference in relation to the sex and the imperfection ( p  =  0,237 ) , as evidenced in table 1 . fisher test : p  =  0,237 of the 226 just - been born taken care of , 46 ( 20.4% ) had presented absence of emissions and had been directed for the second evaluation . a child , due to more advanced age ( 8 months ) was directed directly to the otolaryngologist doctor . of those , 26 ( 56.5% ) had appeared and 20 ( 43.5% ) had not appeared to the retest . of the total of children evaluated in as the examination , 18 ( 69.2% ) had presented presence of emissions , and 8 ( 30.8% ) had remained with absence . of the 8 children , 7 ( 27.0% ) had presented bilateral absence and 1 ( 3.8% ) unilateral one ( right ear ) , 6 ( 75.0% ) children were of masculine sex and 2 ( 25.0% ) of the feminine one . one notices that it did not have difference in relation to the sex and the imperfection in second evaluation eoa ( p  =  0,750 ) as it demonstrates table 2 . fisher test : p  =  0,750 of the 9 children directed for medical evaluation , 5 ( 55.5% ) had appeared and had been examined by the otolaryngologist . of these , 3 ( 75.0% ) had presented normal otoscopy and had been directed for peate examination and 2 ( 66.7% ) had alterations to the otoscopy ( cork of earwax and serous otitis ) . two had appeared to the examination , and had presented abnormality in the results , confirming the deafness presence . the responsible for the children had been guided and directed ( with reports ) for acquisition of personal hearing amplification device ( aasi ) and rehabilitation . in the studied sample ( 226 ) , 61 ( 27.0% ) just - been born had presented pointers of risk for deafness . the found pointers more during anamneses had been : 47 ( 20.8% ) , neonates with bigger permanence that 48 hours in the neonatal uti , familiar history of congenital auditory deficiency in 8 children ( 3.5% ) , 4 ( 1.8% ) with some congenital infection ( syphilis , toxoplasmosis , rubella , cytomegalovirus , herpes ) and 2 ( 0.9% ) with syndromes not necessarily associates the auditory alterations , what it can be observed in chart 1 . although to be the ideal , the accomplishment of the examination before the hospital high one nor always is possible . in the maternity in study , the children receive high hospital between 36 and 48 hours of life . data demonstrate that , in countries as the ivory coast the mothers and just - been born healthful the birth in public hospital or two days in particular net remains only one day after , what it becomes impracticable the selection during the internment11 . the same it does not occur in greece , where the neonates after receive high 4 or 5 days after the birth12 . in the present study , just - born 29.6% of the 764 had been submitted to the selection . literature describes high values of comprehensiveness . however , one is about programs of tan implanted has years in the searched units . in the first evaluation , the index of children with normal hearing evaluated as deficient auditory , that is , the results false - positive in the first eoat , was of 7,9% . as much in saudi arabia how much in sicily the false - positive indices had presented inferior 2.3% and 0.74% respectively14 
 15 . in malaysia , the raised tax of failure ( false - positive in about 15% in the first test ) is attributed to the fact of the test to have been carried through before 24-hour . in this age , the just - been born ones are more inclined to have residues in external auditory canal ( cae ) , that it intervenes with the capitation of the otoacoustic emissions16 . authors consider that the increased one of the age can promote an improvement in the index of presence of reply in the first eoat and , consequently , a reduction in the false - positive tax8 
 17 . of the 26 ( 56.5% ) children who had appeared for as the examination , 8 ( 30.8% ) had remained with negative test and had been directed for specialized medical evaluation . similar index was evidenced in saudi arabia . in that country , of 1.043 just - been born examined in the second stage , 29% had not had reply15 . lesser failure rates had been observed in a study in the city of ferrara where 2.05% had been disapproved in the second phase and had been evaluated in third18 . superior failure rates had been observed in a research in greece with 541 neonates that had repeated the test . of these , 238 ( 44% ) had remained with absence of eoat in the retest12 . in the third stage of procedure established in this study , 9 children had been directed for otolaryngologic evaluation for presenting absence in the examination of emissions . of the children who had appeared and had been examined by the specialist , 3 had presented normal otoscopy and had been directed for peate , 2 had presented otoscopic alterations , one with cork of earwax and another one with serous average otitis that , after treated , had been directed for the third examination of emissions . the child with average otitis , after to be treated , got presence of emissions in both the ears . to another child of this form , the high index of imperfection can be attributed to the number of children with otologic alterations observed by the otolaryngologic during the otoscopy . the secretion presence in the ear , in the first hours of life , can compromise the conduction of the sound causing absence in the emissions19 . in the state of the espirito santo 3 ( 0.08% ) children had presented alterations of average ear8 . in greece , of the 238 ( 44% ) disapproved in second eoat , 18 they had average otitis with effusion12 . in the studied population ( 226 just - been born ) , the prevalence of auditory alterations was of 0,9% with estimate of 9:1.000 . these data go to the meeting of the evidenced ones in a study carried through in bauru . in that city , the authors had verified that of the 11,466 just - been born submitted to the auditory selection , 11 children had presented sensorineural auditory loss , a prevalence of 0,96%9 . in the cantabria , the incidence of congenital deafness was of 8,5 for each 100010 . in the cte d'ivoire , such prevalence are raised when compared with other finding in milan and ferrara , where the prevalence of congenital deafness in the population was esteem in 0,32% and 0,45% respectively18 
 20 . in the south african continent 3 in each 1,000 children present deafness to the rising13 . the literature describes the bilateral deafness as the most frequent . in milan , for example , in the studied population , 63 children ( 0.32% ) had presented auditory loss , between which 33 had bilateral deafness20 . in arabia , of the 22 children with deafness , 20 children had had bilateral sensorineural auditory loss15 . in this study , of three children who had been directed for inquiry for the peate examination , two ( 0.9% ) they had carried through the examination , whose resulted they had presented compatible electrophysiological with severe sensorineural auditory loss in an ear and deep degree in the ear counter - lateral . of the total of just - been born evaluated , 61 presented factors of risk for deafness , representing 27.0% of the sample . a child with deafness diagnosis presented familiar history of auditory deficiency as indicating of risk for deafness , while to another one did not present factor of associated risk . the studies carried through in two brazilian maternities , 12.61% of the children were carrying of pointers of risk for deafness8 . in the population of two university hospitals , 29.92% and 12.5% of the respective samples presented at least a pointer of risk for auditory deficiency5 
 21 . of the 11,466 just - been born sorted in bauru - sp , 11.20% had presented one or more factors of risk for auditory alterations9 . in the present study , even so the two children with confirmed deafness were of the masculine sex , an association between the sex and the affected ear was not evidenced . such fact occurred , as much in the first one how much in the second tests . these findings little differ from the observed ones in the research carried through in saudi arabia , where it did not have significant difference between girls and boys15 . for the jcih , the ideal it is that the diagnosis occurs before the three months of age and that the intervention is initiated by return of the six months6 . corroborating with the goal established for the committee , in the present study , the child appeared  it  for the first examination with 15 days of life , being prostetized before the 4 months of age . in the case of child b  , the confirmation of the deafness occurred in skillful time ( only 20 days after the first examination ) . however , the first emission occurred to the 8 months of age . in case that , the same one had carried through the eoat in the first month of life , certainly , would have been prostetized in the time praised for the jcih6 . differently , in the espirito santo the age of diagnosis was of four months and way and the system of amplification acquired to the 11 months the age8 . in the nigerian , the average of age of diagnosis of the loss of the hearing was of , approximately , 8 months22 . currently , the two children with deafness confirmed meet prostetized and inserted in whitewashing programs . in the studied population , 11.5% ( 26/226 ) of the children had inconclusive diagnosis ; therefore they had not appeared to the pursuing . difficulties similar were faced in research carried through in the nigerian , where 10% of the children had not concluded the diagnosis22 . high values had been described in malaysia and ivory coast , where 35% and 81.25% of the children had not returned for diagnosis11 
 16 . the lack of sensitization of the country how much to the importance of the precocious identification of the auditory loss it intervenes with the pursuing , a time who are they them responsible right - handers for the child13 . the precocious diagnosis has been each emphasized time more , a time that the detention of the deafness before the three months of age and the intervention before the six favor a development in the deaf child next to the one to the children listeners3 . the auditory privation , in general way , affects the quality of life of the child , therefore it compromises the acquisition of the language , cognitive , educational , psychological and social the aspects . thus , the first step to minimize the upheavals caused for the deafness is , without a doubt , the precocious identification and intervention of the illness , being necessary the involvement and awareness of all the professionals of health and the family . the limitations of the study , it is cited difficulty in collecting the data and , some factors is involved in this process , between them the lack of adhesion to the test , that can be attributed to the fact of the researchers to available the examination only in the fridays . for this reasons , the selection could not be carried through daily , or before , of high the hospital one . another observed important factor was not the involvement of the parents in the evaluations that can have been influenced for the disinterest produced for the unfamiliarity on the deafness , for the unreliability and distrust in relation to the result , or for diverse reasons , which are not part of the objectives of the present study . measures as to available the accomplishment of the examination every day of the week could reduce the possibility of abandonment to the test . however , during the research it had facility in the access to the medical specialist , as well as the o examination of peate , necessary for diagnosis of the auditory deficiency . the presented data can contribute in the direction to supply to subsidies the future analyses on the thematic one in the region . of the 226 just - been born evaluated , 2 ( 0.9% ) had had the diagnosis of confirmed deafness . thus , the prevalence of auditory alterations in the studied population was of 0,9% with estimate of 9:1000 born alive . in a city without real information on the just - born prevalence of auditory loss , the current study it offers given excellent epidemiologists for public health e , presents the first report on the subject , supplying resulted preliminary future implantation and development of a program of neonatal auditory selection in the institution .
summary 
 introduction :  the precocious diagnosis and the intervention in the deafness are of basic importance in the infantile development . the loss auditory and more prevalent than other joined riots to the birth . 
 objective :  esteem the prevalence of auditory alterations in just - born in a hospital school . 
 method :  prospective transversal study that evaluated 226 just - been born , been born in a public hospital , between may of 2008 the may of 2009 . 
 results :  of the 226 screened , 46 ( 20.4% ) had presented absence of emissions , having been directed for the second emission . of the 26 ( 56.5% ) children who had appeared in the retest , 8 ( 30.8% ) had remained with absence and had been directed to the otolaryngologist . 
 five ( 55.5% ) had appeared and had been examined by the doctor . 
 of these , 3 ( 75.0% ) had presented normal otoscopy , being directed for evaluation of the evoked potential auditory of brainstem ( peate ) . of the total of studied children , 198 ( 87.6% ) 
 had had presence of emissions in one of the tests and , 2 ( 0.9% ) with deafness diagnosis . 
 conclusion :  the prevalence of auditory alterations in the studied population was of 0,9% . the study it offers given excellent epidemiologists and it presents the first report on the subject 
 , supplying resulted preliminary future implantation and development of a program of neonatal auditory selection .