Martínez-Cruz Carlos F, García Alonso-Themann Patricia, Poblano Adrián, Cedillo-Rodríguez Ileana A
Department of Pediatric Follow-Up, National Institute of Perinatology, 11000 Mexico City, Mexico.
Cognitive Neurophysiology Laboratory, National Institute of Rehabilitation, 14389 Mexico City, Mexico.
Int J Pediatr. 2014;2014:605828. doi: 10.1155/2014/605828. Epub 2014 Feb 9.
The objective was to determine frequency of sensorineural hearing loss (SNHL), identified by abnormal threshold in evoked potentials, absence of otoacoustic emissions and behavioral responses, auditory neuropathy (AN) (absence of evoked potentials, with preservation of otoacoustic emissions), and neurological comorbidity in infants with hyperbilirubinemia (HB) treated with exchange-transfusion (ET). From a total of 7,219 infants, ET was performed on 336 (4.6%). Inclusion criteria were fulfilled in 102; 234 children did not meet criteria (182 outside of the study period, 34 did not have complete audiological evaluation, and 18 rejected the followup). Thirty-five children (34%) were born at-term and 67 (66%) were preterm. Children had a mean age of 5.5 ± 3.9 years. Main causes of ET were Rh isoimmunization in 48 (47%), ABO incompatibility in 28 (27.5%), and multifactorial causes in 26 (25.5%). Fifteen (15%) children presented with SNHL. Preterm newborns presented more often with SNHL. Indirect bilirubin level was higher in children with SNHL (22.2 versus 18.7 mg/dL, P = 0.02). No cases of AN were documented. An increased risk of neurologic sequelae was observed in children with SNHL. In conclusion, we disclosed a high frequency of SNHL in children with neonatal HB and ET and neurological alterations. No cases of AN were observed.
目的是确定接受换血治疗（ET）的高胆红素血症（HB）婴儿中感音神经性听力损失（SNHL）的发生率，其通过诱发电位阈值异常、耳声发射和行为反应缺失来确定，以及听觉神经病（AN）（诱发电位缺失，但耳声发射保留）和神经合并症的发生率。在总共7219名婴儿中，336名（4.6%）接受了ET治疗。102名符合纳入标准；234名儿童不符合标准（182名在研究期之外，34名没有完整的听力评估，18名拒绝随访）。35名儿童（34%）为足月儿，67名（66%）为早产儿。儿童的平均年龄为5.5±3.9岁。ET的主要原因是48名（47%）的Rh血型不合，28名（27.5%）的ABO血型不相容，以及26名（25.5%）的多因素原因。15名（15%）儿童出现SNHL。早产儿更常出现SNHL。SNHL儿童的间接胆红素水平更高（22.2对18.7mg/dL，P = 0.02）。未记录到AN病例。观察到SNHL儿童发生神经后遗症的风险增加。总之，我们发现新生儿HB和ET儿童中SNHL的发生率很高，且存在神经改变。未观察到AN病例。
