新生儿重症监护病房接受治疗的婴儿是否需要进行多阶段、全面的听力筛查测试？

[Do infants treated in the neonatal intensive care unit need multi-stage, universal hearing screening testing?].

作者信息

Tomasik Tomasz, Godek Janusz, Kwinta Przemko, Kusak Beata, Pietrzyk Jacek J

机构信息

Klinika Chorób Dzieci, Uniwersytecki Szpital Dzieciecy w Krakowie.

出版信息

Przegl Lek. 2011;68(1):47-53.

PMID:21563445

Abstract

INTRODUCTION

The universal hearing screening program has special value for neonatal intensive care unit (NICU) patients because of the multiple risk factors of hearing loss they are subjected to.

AIM

To summarize the results of hearing tests on consecutive stages of the screening program and to evaluate the value of hearing loss factors.

MATERIALS AND METHODS

The group included 851 infants born between 1.10.2006 - 31.12.2009 and treated in the NICU of the University Children's Hospital in Cracow, Poland. Infants with abnormal screening test results (TEOAE) and/or with hearing loss risk factors, or absent from the first stage of the test were qualified for the next stage hearing diagnostics (TEOAE+ABR). Multivariate logistic regression was used in order to evaluate hearing loss risk factors.

RESULTS

679 (80%) newborns were screened by the first stage hearing test. 579 (68%) were tested on the second level diagnostics. 60 patients are still under control. 11/519 (2.1%) had hearing impairment (sensorineual or mixed). 10 had bilateral and 1 had unilateral hearing impairment. The family history was negative for congenital hypoacusis. 1st minute Apgar score < 4 points, congenital TORCH infections and craniofacial anomalies were independent risk factors of hearing loss, however it was not possible to predict more than 2/11 patients with hearing loss based on these factors. Patients with abnormal result of the first stage test had lower birth weight and gestation age than that with normal result. The sensitivity of the first TEOAE test was 82%, specificity 70%, PPV 6.2%, NPV 99%.

CONCLUSION

Hearing impairment was rarely a complication of treatment in the NICU, although it was 10 times more frequent in comparison to the whole newborn population. Because the sensitivity, specificity and PPV of first hearing test is not satisfactory, next stage diagnostics in the audiology department are strongly recommended.

摘要

引言

由于新生儿重症监护病房（NICU）的患者面临多种听力损失风险因素，通用听力筛查计划对他们具有特殊价值。

目的

总结筛查计划连续阶段的听力测试结果，并评估听力损失因素的价值。

材料与方法

该组包括2006年10月1日至2009年12月31日期间在波兰克拉科夫大学儿童医院NICU接受治疗的851名婴儿。筛查测试结果异常（TEOAE）和/或有听力损失风险因素，或未参加第一阶段测试的婴儿有资格进入下一阶段听力诊断（TEOAE+ABR）。采用多因素逻辑回归评估听力损失风险因素。

结果

679名（80%）新生儿接受了第一阶段听力测试。579名（68%）接受了第二级诊断测试。60名患者仍在接受监测。11/519名（2.1%）有听力障碍（感音神经性或混合性）。10名双侧听力障碍，1名单侧听力障碍。家族史中先天性听力减退为阴性。出生后第1分钟阿氏评分<4分、先天性TORCH感染和颅面畸形是听力损失的独立风险因素，然而，基于这些因素无法预测超过2/11的听力损失患者。第一阶段测试结果异常的患者出生体重和胎龄低于结果正常的患者。第一次TEOAE测试的敏感性为82%，特异性为70%，阳性预测值为6.2%，阴性预测值为99%。