Yoshikawa Satoko, Ikeda Katsuhisa, Kudo Takayuki, Kobayashi Toshimitsu
Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai 980-8575, Japan.
Auris Nasus Larynx. 2004 Dec;31(4):361-8. doi: 10.1016/j.anl.2004.07.007.
To investigate the incidence of neonatal hearing loss in well-baby populations and in a neonatal intensive care unit and to identify potential risk factors for hearing loss in a neonatal intensive care unit which the Joint Committee on Infant Hearing (JCIH) had not recommended.
Auditory screening was conducted in 226 infants (452 ears) born in Tohoku University from 2000 to 2001. The cases included 124 healthy newborn infants (248 ears), and 102 newborn infants (204 ears) treated in the neonatal intensive care unit (NICU). Hearing impairment was confirmed through a primary screening of the automated auditory brainstem response (AABR) and a secondary test of the auditory brainstem response (ABR) with otolaryngologic evaluation. Based on these examinations, we divided infants into two groups, 'Pass' and 'Refer'.
Nine patients (15 ears) in Refer group were identified through our protocol. The incidence of the Refer group was 0.8% (1 out of 124) in the well-baby nursery, 7.8% (8 out of 102) in the NICU populations. The infants in Refer group were shown to have a higher incidence of congenital infection (P < 0.01), high C-reactive protein (CRP) (> or =10 mg/dl), chromosomal aberration, and central nervous system abnormality (P < 0.05). On the other hand, there were no statistical differences between the Pass and Refer groups in NICU, birth weight (<2200 g), gestational age, the values of total serum bilirubin, the values of arterial blood gases (pH, PaCO2 , PaO2 ), percutaneous oxygen saturation (SpO2), hemodynamics (blood pressure and heart rate) (P > 0.1). Respiratory status such as the Apgar score (the abbreviation for appearance, pulse, grimace, activity, respiration) (1 min; < or =4), (5 min; < or =6), Silverman retraction score, ototoxic drug use, respiratory distress syndrome (RDS), Meconium aspiration syndrome (MAS), and persistent pulmonary hypertension of newborn (PPHN) were also not statistically related to hearing loss (>0.999).
Even in a small number of infants, there are positive relationships between hearing loss and congenital infection, high CRP (> or =10 mg/dl), chromosomal aberration and central nervous system abnormality. The CRP (> or =10 mg/dl) variable are not listed in the high-risk register published by the JCIH, but we can say that the variable may predict hearing impairment in our patient population. The possibility of autosomal recessive inheritance of genes for deafness is supposed when newborns have no other risk factors for hearing loss. This leads us to conclude that hearing screening is an effective way to find out hearing loss population.
调查健康婴儿群体及新生儿重症监护病房中新生儿听力损失的发生率，并确定婴儿听力联合委员会（JCIH）未推荐的新生儿重症监护病房中听力损失的潜在风险因素。
对2000年至2001年在东北大学出生的226例婴儿（452耳）进行听觉筛查。病例包括124例健康新生儿（248耳）和102例在新生儿重症监护病房（NICU）接受治疗的新生儿（204耳）。通过自动听性脑干反应（AABR）的初步筛查以及听性脑干反应（ABR）的二次测试和耳鼻喉科评估来确诊听力障碍。基于这些检查，我们将婴儿分为两组，“通过”组和“转诊”组。
通过我们的方案，在“转诊”组中确定了9例患者（15耳）。在健康婴儿护理室中，“转诊”组的发生率为0.8%（124例中的1例），在NICU群体中为7.8%（102例中的8例）。“转诊”组的婴儿先天性感染发生率较高（P<0.01）、C反应蛋白（CRP）水平高（≥10mg/dl）、染色体畸变和中枢神经系统异常发生率较高（P<0.05）。另一方面，在NICU中，“通过”组和“转诊”组在出生体重（<2200g）、胎龄、总血清胆红素值、动脉血气值（pH、PaCO2、PaO2）、经皮血氧饱和度（SpO2）、血流动力学（血压和心率）方面无统计学差异（P>0.1）。呼吸状况，如阿氏评分（外观、脉搏、 grimace、活动、呼吸的缩写）（1分钟；≤4）、（5分钟；≤6）、西尔弗曼呼吸凹陷评分、耳毒性药物使用、呼吸窘迫综合征（RDS）、胎粪吸入综合征（MAS）和新生儿持续性肺动脉高压（PPHN）与听力损失也无统计学相关性（P>0.999）。
即使在少数婴儿中，听力损失与先天性感染、高CRP（≥10mg/dl）、染色体畸变和中枢神经系统异常之间也存在正相关。CRP（≥≥10mg/dl）变量未列在JCIH公布的高危登记册中，但我们可以说该变量可能预测我们患者群体中的听力障碍。当新生儿没有其他听力损失风险因素时，推测存在耳聋基因的常染色体隐性遗传。这使我们得出结论，听力筛查是发现听力损失人群的有效方法。
