Sininger Y S, Cone-Wesson B, Folsom R C, Gorga M P, Vohr B R, Widen J E, Ekelid M, Norton S J
Multicenter Consortium on Identification of Neonatal Hearing Impairment, Seattle, Washington, USA.
Ear Hear. 2000 Oct;21(5):383-99. doi: 10.1097/00003446-200010000-00006.
Seven thousand one hundred seventy-nine infants, 4478 from the neonatal intensive care unit (NICU) and the remaining from the well-baby nursery, were evaluated with an automated ABR protocol in each ear. Two channel recordings were obtained (vertex to mastoid or channel A and vertex to nape of neck or channel B) in response to click stimuli of 30 and 69 dB nHL in all infants as well as 50 dB nHL in infants who did not meet criteria for response at 30 dB. Criteria for response included F(SP) > or =3.1 and a tester-judgment of response. Criteria could be met in the first or repeat test with a maximum of 6144 accepted sweeps per test.
More than 99% of infants could complete the ABR protocol. More than 90% of NICU and well-baby nursery infants "passed" given the strict criteria for response, whereas 86% of those with high risk factors met criterion for ABR response detection. The number of infants who did not meet ABR response criteria in one or both ears was systematically related to stimulus level with the largest group not meeting criteria at 30 dB followed by 50 and 69 dB nHL. Meeting criteria on the ABR was positively correlated with the amplitude of wave V, with low noise and low electrode impedance. Factors that predicted how many sweeps would be needed to reach criterion F(SP) included noise level of the test site, state of the baby (for example, quiet sleep versus crying), recording noise, electrode impedance and response latency. Channel A (vertex to mastoid) reached criterion more often than channel B (vertex to nape of neck) due to higher noise in channel B. Average total test time for 30 dB nHL screening in both ears was under 8 minutes. Well babies with risk factors took slightly longer to evaluate than other groups with this automated ABR procedure and have higher noise levels.
ABR implemented with an automated detection algorithm using a 30 dB nHL click stimulus is reliable technique for rapid assessment of auditory status in newborns. Factors other than hearing loss that influenced the test result include infant state, electrode location and impedance, testing site, and infant risk status. Even so, ABRs were reliably recorded in the vast majority of babies under circumstances in which most babies are found in the perinatal period.
1）描述用于新生儿听力筛查研究的听觉脑干反应（ABR）测量系统及优化方法。2）使用明确、特定的ABR结果指标，确定与筛查相关的记录因素和婴儿因素。
对7179名婴儿进行评估，其中4478名来自新生儿重症监护病房（NICU），其余来自健康婴儿护理室，对每只耳朵采用自动ABR方案进行检测。所有婴儿均接受30和69 dB nHL的短声刺激，对未在30 dB达到反应标准的婴儿还接受50 dB nHL的短声刺激，同时记录两个通道（从头顶到乳突或通道A，从头顶到颈后部或通道B）的反应。反应标准包括F(SP)≥3.1以及测试者判断为有反应。在首次或重复测试中可达到该标准，每次测试最多接受6144次扫描。
超过99%的婴儿能够完成ABR检测流程。鉴于严格的反应标准，超过90%的NICU婴儿和健康婴儿护理室婴儿“通过”检测，而86%有高危因素的婴儿达到ABR反应检测标准。一只或两只耳朵未达到ABR反应标准的婴儿数量与刺激强度存在系统性关联，未达到标准的最大群体出现在30 dB，其次是50和69 dB nHL。ABR达到标准与V波振幅、低噪声和低电极阻抗呈正相关。预测达到标准F(SP)所需扫描次数的因素包括测试地点的噪声水平、婴儿状态（如安静睡眠与哭闹）、记录噪声、电极阻抗和反应潜伏期。由于通道B噪声较高，通道A（从头顶到乳突）比通道B（从头顶到颈后部）更常达到标准。双耳30 dB nHL筛查的平均总测试时间不到8分钟。采用这种自动ABR程序，有危险因素的健康婴儿比其他组评估时间略长，且噪声水平更高。
采用30 dB nHL短声刺激的自动检测算法实施ABR，是快速评估新生儿听觉状态的可靠技术。除听力损失外，影响测试结果的因素包括婴儿状态、电极位置和阻抗、测试地点以及婴儿风险状态。即便如此，在围产期大多数婴儿所处的环境中，绝大多数婴儿的ABR仍能可靠记录。
