Vos Bénédicte, Senterre Christelle, Lagasse Raphaël, Levêque Alain
Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
BMC Pediatr. 2015 Oct 16;15:160. doi: 10.1186/s12887-015-0479-4.
Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.
A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).
Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.
We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.
了解听力损失的风险因素对于设计比利时新生儿听力筛查项目至关重要。因此，需要根据当前科学知识对其进行更新。本研究旨在更新比利时新生儿筛查项目中对有听力损失新生儿风险因素的新生儿的临床管理和随访建议。
进行了文献综述，并使用推荐分级、评估、制定和评价（GRADE）系统评估方法来确定每个风险因素的证据质量水平和推荐强度。随后，通过三轮德尔菲共识过程（两份在线问卷和一次面对面会议）对科学知识状态、证据质量水平和分级推荐进行了评估。
先天性感染（即巨细胞病毒、弓形虫病和梅毒）、听力损失家族史、（外）祖父母近亲结婚、畸形综合征和胎儿酒精综合征作为听力损失的新生儿风险因素呈现出“高”证据质量水平。由于听觉功能对胆红素毒性的敏感性，高胆红素血症的证据质量评估为“中等”水平。相比之下，极低出生体重、低阿氏评分和新生儿重症监护病房住院的证据质量水平从“非常低”到“低”不等，耳毒性药物的证据质量为“非常低”。这些“非常低”和“低”水平的可能解释包括这些健康状况或治疗的管理改善，以及诸如混杂效应等方法学弱点，这使得难以就个体风险因素得出结论。在推荐声明中，专家们强调避免未识别的新生儿听力损失，并选择即使在证据薄弱的情况下也纳入听力损失风险因素。该小组还强调了听力损失风险因素的累积效应。
我们基于上述循证方法和专家临床经验，修订了对有听力损失新生儿风险因素的新生儿的临床管理和随访建议。下一步是在比利时筛查项目中实施这些研究结果。
