Robertson Charlene M T, Tyebkhan Juzer M, Peliowski Abraham, Etches Philip C, Cheung Po-Yin
Neonatal and Infant Follow-up Clinic, Glenrose Rehabilitation Hospital, Capital Health, Edmonton, Alberta T5G 0B7, Canada.
Acta Paediatr. 2006 Feb;95(2):214-23. doi: 10.1080/08035250500294098.
To determine relationships between ototoxic drugs and 4-y sensorineural hearing loss (SNHL) in near-term and term survivors of severe neonatal respiratory failure.
All 81 survivors of the Canadian arm of the Neonatal Inhaled Nitric Oxide Study (mortality 32, loss to follow-up 9) received loop diuretics, aminoglycosides, and neuromuscular blockers (NMB), and 50 received vancomycin as neonates. Prospective, longitudinal secondary outcome using audiological tests diagnosed late-onset, progressive SNHL in 43 (53%); not flat (sloping) in 29, flat (severe to profound) in 14. Risk for SNHL was determined.
A combination of duration of diuretic use of >14 d and average NMB dose of >0.96 mg/kg/d contributed to SNHL among survivors (odds ratio 5.2; 95% CI 1.6, 16.7). Markers of illness severity did not contribute. Dosage or duration of aminoglycosides use did not relate to SNHL. Cumulative dosages and duration of use of diuretics; NMB; use of vancomycin; and overlap of diuretics with NMB, aminoglycosides, and vancomycin individually linked to SNHL (p<0.001).
Overuse of loop diuretics and/or NMB contributes to SNHL after neonatal respiratory failure; markers of illness severity or the appropriate administration of aminoglycosides do not.
确定严重新生儿呼吸衰竭近期和足月幸存者中，耳毒性药物与4年感音神经性听力损失（SNHL）之间的关系。
新生儿吸入一氧化氮研究加拿大分部的所有81名幸存者（死亡32例，失访9例）在新生儿期均接受了袢利尿剂、氨基糖苷类药物和神经肌肉阻滞剂（NMB）治疗，50名接受了万古霉素治疗。采用听力测试进行前瞻性纵向次要结局评估，诊断出43例（53%）迟发性、进行性SNHL；其中29例为非平坦型（斜坡型），14例为平坦型（重度至极重度）。确定了SNHL的风险。
袢利尿剂使用时间>14天和平均NMB剂量>0.96mg/kg/d的联合使用导致幸存者出现SNHL（比值比5.2；95%置信区间1.6,16.7）。疾病严重程度指标无影响。氨基糖苷类药物的使用剂量或时间与SNHL无关。袢利尿剂、NMB、万古霉素的累积剂量和使用时间；以及袢利尿剂与NMB、氨基糖苷类药物和万古霉素的联合使用均与SNHL相关（p<0.001）。
新生儿呼吸衰竭后，袢利尿剂和/或NMB的过度使用会导致SNHL；疾病严重程度指标或氨基糖苷类药物的合理使用则不会。
