Meyer C, Witte J, Hildmann A, Hennecke K H, Schunck K U, Maul K, Franke U, Fahnenstich H, Rabe H, Rossi R, Hartmann S, Gortner L
Children's Hospital, Medical University, Lübeck, Germany.
Pediatrics. 1999 Oct;104(4 Pt 1):900-4. doi: 10.1542/peds.104.4.900.
To determine the incidence and risk factors for hearing disorders in a selected group of neonates and the feasibility of selective hearing screening.
Multicenter prospective trial at five centers in Germany.
Enrollment criteria: in addition to previously defined risk factors by the Joint Committee on Infant Hearing (family history of hearing loss, in utero infections, craniofacial anomalies, birth weight <1500 g, critical hyperbilirubinemia, ototoxic medications, bacterial meningitis, postnatal asphyxia, mechanical ventilation >5 days, stigmata, or syndromes associated with hearing loss), the impact of maternal drug abuse, birth weight <10th percentile, persistent pulmonary hypertension, and intracranial hemorrhage more than or equal to grade III or periventricular leukomalacia on infant hearing were evaluated. The screening procedure was performed by automated auditory brainstem response (A-ABR; ALGO 1-plus; Natus Med Inc, San Carlos, CA).
univariate analyses of risk factors versus A-ABR results and a multivariate regression analysis were used; additionally, the total test time was recorded.
Seven hundred seventy recordings from 777 infants enrolled consecutively constitute the basis of this analysis. Mean gestational age was 33.8 +/- 4.3 weeks, birth weight 2141 +/- 968 g; 431 infants being male and 339 female; 41 (5.3%) infants exhibited pathologic A-ABR results (16 bilateral and 25 unilateral). Meningitis or sepsis, craniofacial malformations, and familial hearing loss were independent significant risk factors. Median total test time was 25 minutes. Follow-up examinations in 31 infants revealed persistent hearing loss in 18 infants (13 infants sensorineural, 5 from mixed disorders), 7 requiring amplification.
Hearing screening in high-risk neonates revealed a total of 5% of infants with pathologic A-ABR (bilateral 2%). Significant risk factors were familial hearing loss, bacterial infections, and craniofacial abnormalities. Other perinatal complications did not significantly influence screening results indicating improved perinatal handling in a neonatal population at risk for hearing disorders.
确定一组特定新生儿听力障碍的发病率和危险因素，以及选择性听力筛查的可行性。
德国五个中心的多中心前瞻性试验。
纳入标准：除了婴儿听力联合委员会先前定义的危险因素（听力损失家族史、宫内感染、颅面畸形、出生体重<1500g、严重高胆红素血症、耳毒性药物、细菌性脑膜炎、产后窒息、机械通气>5天、体征或与听力损失相关的综合征）外，还评估了母亲药物滥用、出生体重<第10百分位数、持续性肺动脉高压以及≥III级颅内出血或脑室周围白质软化对婴儿听力的影响。筛查程序采用自动听性脑干反应（A-ABR；ALGO 1-plus；Natus Med Inc，圣卡洛斯，加利福尼亚州）进行。
采用危险因素与A-ABR结果的单因素分析和多因素回归分析；此外，记录总测试时间。
连续纳入的777例婴儿的770份记录构成了本分析的基础。平均胎龄为33.8±4.3周，出生体重2141±968g；男性婴儿431例，女性婴儿339例；41例（5.3%）婴儿A-ABR结果异常（16例双侧异常，25例单侧异常）。脑膜炎或败血症、颅面畸形和家族性听力损失是独立的显著危险因素。总测试时间中位数为25分钟。对31例婴儿的随访检查发现18例婴儿存在持续性听力损失（13例感音神经性听力损失，5例混合性听力障碍），7例需要佩戴助听器。
高危新生儿听力筛查发现共有5%的婴儿A-ABR结果异常（双侧异常2%）。显著的危险因素是家族性听力损失细菌性感染和颅面畸形。其他围产期并发症对筛查结果无显著影响，表明在有听力障碍风险的新生儿群体中围产期护理有所改善。
