Department of Neonatology, Meyer Children’s Hospital, Haifa, Israel.
Pediatrics. 2012 Jul;130(1):e95-100. doi: 10.1542/peds.2011-3179. Epub 2012 Jun 11.
Neonatal hearing screening occasionally fails. We noticed that infants born by cesarean delivery (CD) appeared to fail the first otoacoustic emissions (OAE) test more frequently than infants delivered vaginally (VD). This might increase maternal anxiety. We aimed to evaluate the influence of mode of delivery on failure to pass the first OAE.
Overall, 1653 infants of >35 weeks' gestation were evaluated. OAE was performed before discharge. Perinatal-neonatal variables and results of OAE were recorded retrospectively.
Compared with VD infants, CD infants had lower gestational age and 1-minute Apgar, more small for gestational age (SGA), and earlier age at first OAE. Univariate analysis: CD, male gender, gestational age 35 to 37 weeks, birth weight ≤ 2500 g, SGA, and younger age at first OAE were significantly associated with failed first OAE. In infants weighing 2501 to 4000 g, CD infants had 3-fold higher rates of failed first OAE in comparison with VD infants (20.7% vs 7.1%) before 48 hours of age. In the multivariate analysis, variables independently significantly associated with failed first OAE were male gender (odds ratio [OR] 1.42 [1.02-1.98]), CD (emergency CD: OR 3.18 [2.21-4.57], elective CD: OR 3.32 [2.04-5.42]), age 12 to 23 hours at first OAE (OR 3.1 [2.1-4.58]) and SGA (OR 2.2 [1.15-4.28]).
CD infants had significantly higher failure rates on first OAE. We speculate that CD is accompanied by retained fluid in middle ear which may impair neonatal hearing. The timing of first OAE after CD should preferably be postponed beyond 48 hours of age to improve OAE passage and minimize maternal anxiety and costs.
新生儿听力筛查偶尔会失败。我们注意到，剖宫产（CD）分娩的婴儿似乎比阴道分娩（VD）的婴儿更频繁地未能通过第一次耳声发射（OAE）测试，这可能会增加产妇的焦虑。我们旨在评估分娩方式对首次 OAE 未通过的影响。
共有 1653 名>35 周妊娠的婴儿接受了评估。OAE 在出院前进行。回顾性记录围产期-新生儿变量和 OAE 结果。
与 VD 婴儿相比，CD 婴儿的胎龄和 1 分钟 Apgar 较低，较小的胎龄（SGA）比例较高，首次 OAE 的年龄较早。单因素分析：CD、男性、胎龄 35 至 37 周、出生体重≤2500g、SGA 和首次 OAE 年龄较小与首次 OAE 失败显著相关。在体重为 2501 至 4000g 的婴儿中，与 VD 婴儿相比，CD 婴儿在<48 小时时首次 OAE 失败的发生率高 3 倍（20.7%对 7.1%）。在多因素分析中，与首次 OAE 失败显著相关的变量为男性（比值比[OR]1.42[1.02-1.98]）、CD（紧急 CD：OR 3.18[2.21-4.57]，择期 CD：OR 3.32[2.04-5.42]）、首次 OAE 年龄为 12 至 23 小时（OR 3.1[2.1-4.58]）和 SGA（OR 2.2[1.15-4.28]）。
CD 婴儿首次 OAE 失败率明显较高。我们推测 CD 伴有中耳积液，可能会损害新生儿听力。CD 后首次 OAE 的最佳时间应推迟至>48 小时，以提高 OAE 通过率，并最大程度地减少产妇焦虑和成本。
