Rastogi Shantanu, Mikhael Michel, Filipov Panayot, Rastogi Deepa
Division of Neonatology, Maimonides Infants and Children Hospital, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Int J Pediatr Otorhinolaryngol. 2013 Mar;77(3):402-6. doi: 10.1016/j.ijporl.2012.11.040. Epub 2012 Dec 27.
There is increased risk of hearing loss in preterm neonates. This risk is further increased by environmental noise exposure especially from life support equipment such as ventilation. Nasal continuous positive airway pressure (NCPAP) used for respiratory support of preterm neonates is known to be associated with prolonged exposure to high levels of noise. However, there is paucity of information on the effect of NCPAP as compared to mechanical ventilation on hearing loss among preterm neonates.
A retrospective chart review was performed on neonates with birth weight (BW) <1500g. Association of clinical factors including the use of NCPAP and mechanical ventilation with failure of hearing screen were studied. Those who failed hearing screen were followed for 2 years to observe long term effects of NCPAP on the hearing loss.
Of 344 neonates included in the study, 61 failed hearing screen. Gestational age (p=0.008), BW (p=0.03), ventilation (p=0.02), intrauterine growth retardation (p=0.02), necrotizing enterocolitis (NEC) (p=0.02), apnea (p<0.001), use of vancomycin (p=0.01) and furosemide (p=0.01) were associated with failure of hearing screen. On multivariate analysis, ventilation (OR 4.56, p=0.02), apnea (OR 2.2, p<0.001) and NEC (OR 2.4, p=0.02) were predictors of failed hearing screen. As compared to those not ventilated, the odds of failing hearing screen was 4.53 (p<0.01) and 4.59 (p<0.01) for those treated with NCPAP and mechanical ventilation respectively, with there being no difference between these two ventilatory modalities. Of the 61 neonates, 42 were followed for 2 years, of which 19 had confirmed hearing loss. Among these 19 neonates, there was no difference (p=0.12) between those who were treated with NCPAP or with mechanical ventilation.
There is no increase in the hearing loss in preterm neonates treated with NCPAP as compared to mechanical ventilation despite being exposed to higher environmental noise generated by the NCPAP.
早产新生儿听力丧失的风险增加。环境噪声暴露，尤其是来自诸如通风等生命支持设备的噪声，会进一步增加这种风险。用于早产新生儿呼吸支持的鼻持续气道正压通气（NCPAP）已知与长时间暴露于高水平噪声有关。然而，与机械通气相比，关于NCPAP对早产新生儿听力丧失影响的信息较少。
对出生体重（BW）<1500g的新生儿进行回顾性病历审查。研究包括使用NCPAP和机械通气在内的临床因素与听力筛查未通过之间的关联。对听力筛查未通过的患儿随访2年，以观察NCPAP对听力丧失的长期影响。
在纳入研究的344例新生儿中，61例听力筛查未通过。胎龄（p = 0.008）、出生体重（p = 0.03）、通气（p = 0.02）、宫内生长迟缓（p = 0.02）、坏死性小肠结肠炎（NEC）（p = 0.02）、呼吸暂停（p < 0.001）、使用万古霉素（p = 0.01）和呋塞米（p = 0.01）与听力筛查未通过有关。多因素分析显示，通气（比值比[OR] 4.56，p = 0.02）、呼吸暂停（OR 2.2，p < 0.001）和NEC（OR 2.4，p = 0.02）是听力筛查未通过的预测因素。与未接受通气的新生儿相比，接受NCPAP和机械通气治疗的新生儿听力筛查未通过的几率分别为4.53（p < 0.01）和4.59（p < 0.01），这两种通气方式之间无差异。在这61例新生儿中，42例随访了2年，其中19例确诊听力丧失。在这19例新生儿中，接受NCPAP或机械通气治疗的患儿之间无差异（p = 0.12）。
与机械通气相比，接受NCPAP治疗的早产新生儿尽管暴露于NCPAP产生的更高环境噪声中，但听力丧失并未增加。
