Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
Ann Thorac Surg. 2012 Apr;93(4):1248-53. doi: 10.1016/j.athoracsur.2011.08.042. Epub 2011 Nov 20.
Bilateral sensory permanent hearing loss (PHL) has been reported after neonatal respiratory failure but has rarely been noted in survivors after cardiac operations. We report the prevalence and severity of PHL after Norwood right ventricular-pulmonary artery shunt for hypoplastic left heart syndrome (HLHS), document progressive loss, and explore markers of acute illness and ototoxic medications for PHL.
This interprovincial longitudinal outcome study after neonatal complex cardiac operations at Stollery Children's Hospital, Edmonton, Alberta, Canada, 2002 to 2007, completed repeated diagnostic audiologic assessments for all survivors by registered pediatric-experienced audiologists. Demographic, surgical, and perisurgical variables, including ototoxic medications, were collected. The association of potentially predictive variables with PHL and its severity were determined by univariate analysis and multiple logistic and linear regression analysis.
At an age older than 3.5 years, progressive PHL was present in 12 of 42 survivors (28.6%, 95% confidence interval, 16.2% to 44.8%; mortality, 20.9%). Overall lowest partial pressure of arterial oxygen (odds ratio, 1.315; 95% confidence interval, 1.051 to 1.506), and cumulative dose of furosemide given as bolus (odds ratio, 1.062; 95% confidence interval, 1.018 to 1.109) combined to predict PHL and gave 39% of the variance of PHL severity. Antibiotics and neuromuscular blockers were not associated with PHL.
Monitoring outcomes of neonates after HLHS surgery revealed unexpected PHL associated with hypoxia and bolus administration of furosemide. As survival improves, close follow-up is necessary to identify outcomes and seek modifiable predictive variables. Changes in the mode of furosemide administration may prevent this complication.
新生儿呼吸衰竭后曾有双侧感觉性永久性听力损失（PHL）的报道，但在心脏手术后的幸存者中很少见。我们报告了在因左心发育不全综合征（HLHS）行 Norwood 右心室-肺动脉分流术后 PHL 的流行率和严重程度，记录了进行性听力损失，并探讨了急性疾病和耳毒性药物与 PHL 的关系。
这是一项在加拿大阿尔伯塔省埃德蒙顿市斯特罗利儿童医院进行的新生儿复杂心脏手术后的跨省纵向结局研究，在 2002 年至 2007 年期间，由有经验的注册儿科听力学家对所有幸存者进行了重复的诊断性听力评估。收集了人口统计学、手术和围手术期变量，包括耳毒性药物。通过单变量分析和多元逻辑回归和线性回归分析确定潜在预测变量与 PHL 及其严重程度的相关性。
在年龄超过 3.5 岁时，42 名幸存者中有 12 名（28.6%，95%置信区间，16.2%至 44.8%；死亡率，20.9%）存在进行性 PHL。总的最低动脉血氧分压（比值比，1.315；95%置信区间，1.051 至 1.506）和作为推注给予的呋塞米累积剂量（比值比，1.062；95%置信区间，1.018 至 1.109）共同预测 PHL，占 PHL 严重程度方差的 39%。抗生素和神经肌肉阻滞剂与 PHL 无关。
监测 HLHS 手术后新生儿的结局显示，与缺氧和呋塞米推注相关的意外 PHL。随着存活率的提高，必须密切随访以确定结局并寻找可改变的预测变量。改变呋塞米给药方式可能预防这种并发症。
