Olusanya Bolajoko O
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria.
Ann Afr Med. 2013 Apr-Jun;12(2):98-104. doi: 10.4103/1596-3519.112399.
The purpose was to determine the risk of sensorineural hearing loss (SNHL) in young infants with abnormal head sizes in a developing country.
A matched case-control study of two (hospital-based and community-based) cohorts of term infants who failed a two-stage hearing screening test with transient-evoked otoacoustic emissions and automated auditory brainstem response in Lagos, Nigeria. Abnormal head size (microcephaly or macrocephaly) was determined with World Health Organisation's growth standards for head circumference. The adjusted odds ratios for the risk of SNHL in microcephalic and macrocephalic infants were established through unconditional and conditional logistic regression analyses.
Some 194 cases and 970 matched controls drawn from 8,872 term singletons 3 months or younger were studied. The median age of enrolment was 1 day in the hospital-based cohort and 17 days in the community-based cohort. Microcephalic infants in both cohorts were significantly at risk of SNHL while no significant risk was found among macrocephalic infants regardless of birth setting.
Microcephalic infants should be routinely screened for potential hearing loss particularly where universal newborn hearing screening is not immediately practicable. Etiological investigation of abnormal head size in this and similar population is warranted. Routine screening and maternal immunization for congenital infections should also be considered.
本研究旨在确定在一个发展中国家，头围异常的幼儿发生感音神经性听力损失（SNHL）的风险。
在尼日利亚拉各斯，对两组（基于医院和基于社区）足月儿队列进行配对病例对照研究，这些足月儿在两阶段听力筛查测试中，瞬态诱发耳声发射和自动听性脑干反应测试未通过。根据世界卫生组织头围生长标准确定头围异常（小头畸形或大头畸形）。通过无条件和条件逻辑回归分析，确定小头畸形和大头畸形婴儿发生SNHL风险的调整比值比。
从8872名单胎足月儿（3个月及以下）中选取了约194例病例和970例匹配对照进行研究。基于医院的队列中，入组时的中位年龄为1天；基于社区的队列中，入组时的中位年龄为17天。两个队列中的小头畸形婴儿发生SNHL的风险均显著增加，而无论出生环境如何，大头畸形婴儿中均未发现显著风险。
小头畸形婴儿应常规筛查潜在听力损失，尤其是在无法立即开展普遍新生儿听力筛查的情况下。对该人群及类似人群头围异常进行病因学调查很有必要。还应考虑对先天性感染进行常规筛查和产妇免疫接种。
