Division of Pediatric General Surgery, The Montreal Children's Hospital, Montreal, QC, Canada H3H 1P3.
J Pediatr Surg. 2013 May;48(5):942-5. doi: 10.1016/j.jpedsurg.2013.02.007.
The incidence of sensorineural hearing loss (SNHL;>20 dB loss) in CDH survivors is debated. We evaluated long-term audiological outcomes at a single tertiary care center with ECMO capability and an established neonatal follow-up program.
With REB approval, records of CDH survivors from 2000 to 2010 were retrospectively analyzed. Demographic, postnatal, and audiometric information was gathered. All underwent auditory brainstem response (ABR) or otoacoustic emissions screening before discharge and complete audiological surveillance. Thirty-three patients were evaluated to age 4+ years with others continuing follow-up.
Forty-three patient records were reviewed with 1 excluded (transferred to another institution). Median GA and BW were 39 weeks (35-41) and 3.1 kg (2-4), respectively. Median ventilation days were 10 (2-189) with 34 infants ventilated 5+ days. Sixteen (36%) received HFOV, 21 (49%) iNO, and 5 (12%) ECMO. The median time to CDH repair was 3 days (1-23), and 11 (26%) required patch repair. Nine infants (21%) received diuretics and oxygen after discharge. Audiological surveillance identified only one patient with SNHL (received HFO, iNO, and patch repair).
Neonatal screening identifies CDH survivors at risk for hearing difficulties but must be followed with comprehensive testing until school age. The incidence of SNHL may be less than previously reported in this population.
先天性膈疝（CDH）幸存者中感觉神经性听力损失（SNHL；>20dB 损失）的发生率存在争议。我们评估了一家具有体外膜肺氧合（ECMO）能力和成熟新生儿随访计划的三级保健中心的长期听力结果。
在获得伦理委员会批准的情况下，回顾性分析了 2000 年至 2010 年 CDH 幸存者的记录。收集了人口统计学、产后和听力信息。所有患者在出院前均接受了听觉脑干反应（ABR）或耳声发射筛查，并进行了全面的听力监测。33 名患者接受了 4 岁以上的评估，其余患者仍在继续随访。
共对 43 名患者的记录进行了审查，其中 1 名患者（转至另一机构）被排除在外。中位胎龄和出生体重分别为 39 周（35-41 周）和 3.1kg（2-4kg）。中位通气时间为 10 天（2-189 天），有 34 名婴儿通气 5 天以上。16 名（36%）患者接受高频振荡通气（HFOV），21 名（49%）患者接受一氧化氮吸入（iNO），5 名（12%）患者接受 ECMO。CDH 修复的中位时间为 3 天（1-23 天），11 名（26%）患者需要修补。9 名婴儿（21%）在出院后接受利尿剂和吸氧治疗。听力监测仅发现 1 名 SNHL 患者（接受 HFOV、iNO 和修补术）。
新生儿筛查可识别出有听力困难风险的 CDH 幸存者，但必须进行全面的测试，直至学龄期。在该人群中，SNHL 的发生率可能低于之前的报道。
