极低出生体重儿听力障碍的患病率及独立危险因素

Prevalence and independent risk factors for hearing impairment among very low birth weight infants.

作者信息

Wang Chien-Ho, Yang Chang-Yo, Lien Reyin, Chu Shih-Ming, Hsu Jen-Fu, Fu Ren-Huei, Chiang Ming-Chou

机构信息

Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305, Taiwan.

Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, 33305, Taiwan; Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Department of Pediatrics, The LAC/USC Medical Center, Keck School of Medicine, University of Southern California, 2051 Marengo Street, Los Angeles, CA 90033, USA.

出版信息

Int J Pediatr Otorhinolaryngol. 2017 Feb;93:123-127. doi: 10.1016/j.ijporl.2016.12.029. Epub 2016 Dec 27.

DOI:10.1016/j.ijporl.2016.12.029

PMID:28109482

Abstract

BACKGROUND

Although we've made big strides in perinatal and neonatal care, auditory handicap remains a serious complication in those who were born very premature.

OBJECTIVES

The aim was to determine the prevalence and analyze possible risk factors of hearing impairment in very-low-birth-weight (VLBW) infants.

MATERIALS AND METHODS

This was a retrospective study by reviewing medical records of all VLBW infants (BW ≤ 1500 g) admitted to NICU of Chang Gung Children's Hospital over 2 years period from Jan. 2010 to 2011. Brainstem auditory evoked potentials (BAEP) hearing screening was performed at 3 months postnatal corrective age and repeated if failed the 1st time, then refer to ENT doctor if BAEP confirmed abnormal. All VLBW infants examined for hearing impairment were included and data were retrieved retrospectively and analyzed for neonatal risk factors using logistic regression.

RESULTS

Over the period, 309 VLBW infants were screened. Prevalence of uni- or bilateral hearing impairment was 3.9% (12/309; 95% CI 2.6-4.1). The mean corrective age on diagnosed of hearing impairment was 2.9 ± 1.1 (range 1-5) months. Mean gestational age was 27.9 weeks (SD 1.4) and mean birth weight was 1028 g (SD 180). By univariant analysis for hearing impairment, severe birth asphyxia, craniofacial anomalies, ventilator dependence, patent ductus arteriosus ligation, and use of postnatal ototoxins yielded good prediction of hearing impairment in this population. However, using multivariate analysis revealed that the only independent risk factors for hearing impairment were ototoxins (OR: 3.62; CI: 1.67-7.82), PDA ligation (OR: 4.96; CI: 2.34-10.52), craniofacial anomalies (OR: 3.42; CI: 1.70-6.88)and assisted prolonged use of oxygen at gestational age of >36 weeks (OR: 5.94; CI: 2.61-13.54).

CONCLUSION

The incidence of hearing impairment among VLBW infants was 3.9%. Prolonged supplemental oxygen use is a marker for predicting hearing impairment; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of hearing impairment.

摘要

背景

尽管我们在围产期和新生儿护理方面取得了长足进步，但听力障碍仍是极早产儿的严重并发症。

目的

旨在确定极低出生体重（VLBW）婴儿听力障碍的患病率并分析可能的危险因素。

材料与方法

这是一项回顾性研究，回顾了2010年1月至2011年期间入住长庚儿童医院新生儿重症监护病房（NICU）的所有VLBW婴儿（出生体重≤1500g）的病历。在出生后矫正年龄3个月时进行脑干听觉诱发电位（BAEP）听力筛查，首次筛查未通过则重复进行，若BAEP确诊异常则转诊至耳鼻喉科医生。纳入所有接受听力障碍检查的VLBW婴儿，回顾性收集数据并使用逻辑回归分析新生儿危险因素。

结果

在此期间，共筛查了309例VLBW婴儿。单侧或双侧听力障碍的患病率为3.9%（12/309；95%CI 2.6 - 4.1）。诊断为听力障碍时的平均矫正年龄为2.9±1.1（范围1 - 5）个月。平均胎龄为27.9周（标准差1.4），平均出生体重为1028g（标准差180）。通过对听力障碍的单因素分析，严重出生窒息、颅面畸形、呼吸机依赖、动脉导管未闭结扎和出生后使用耳毒性药物对该人群的听力障碍有较好的预测作用。然而，多因素分析显示，听力障碍的唯一独立危险因素是耳毒性药物（OR：3.62；CI：1.67 - 7.82）、动脉导管未闭结扎（OR：4.96；CI：2.34 - 10.52）、颅面畸形（OR：3.42；CI：1.70 - 6.88）以及孕龄>36周时长期辅助吸氧（OR：5.94；CI：2.61 - 13.54）。