Neonatal Department, Rotunda Hospital, Dublin 1, Ireland.
Data Analysis, Childrens University Hospital, Temple Street, Dublin 1, Ireland.
Eur J Paediatr Neurol. 2019 Jan;23(1):81-86. doi: 10.1016/j.ejpn.2018.10.002. Epub 2018 Oct 10.
To establish the local incidence of hearing loss in newborns with Hypoxic Ischaemic Encephalopathy (HIE) and to identify associated risk factors.
Retrospective Cohort Study. Neonatal Intensive Care Unit (NICU) dual stage hearing screening protocol, including automated otoacoustic emissions (AOAE) and automated auditory brainstem response (AABR) testing.
57 newborns received therapeutic hypothermia for HIE. Twelve babies (21%) died. Audiology data was incomplete in 3 babies. Complete data was available for 42 babies (male n = 24), 4 (9.5%) of whom had hearing impairment. The development of hearing loss was associated with abnormal blood glucose levels (p = 0.006), low Apgar score at 1 min (p = 0.0219) and evidence of multi organ dysfunction [high creatinine (p = 0.0172 and 0.0198) and raised liver transaminases (aspartate aminotransferase (AST) p = 0.0012, alanine aminotransferase (ALT) p = 0.0037)]. An association with gentamicin was not found.
This study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE. Blood glucose should be monitored carefully in these infants and developmental surveillance should include formal audiology. Further larger studies are needed to clarify the role, if any, of hypothermia per se in causation of hearing loss and to fully identify risk factors for hearing impairment in this population.
The current study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE. No association between gentamicin use and the development of hearing impairment was found however initial blood glucose outside the normal range was of significance. Other factors associated with hearing impairment were low Apgar scores, greater need for resuscitation and evidence of multi organ dysfunction (renal and liver failure).
确定患有缺氧缺血性脑病（HIE）的新生儿听力损失的局部发生率，并确定相关的危险因素。
回顾性队列研究。新生儿重症监护病房（NICU）的双重阶段听力筛查方案，包括自动耳声发射（AOAE）和自动听性脑干反应（AABR）测试。
57 名新生儿接受了 HIE 的治疗性低温治疗。12 名婴儿（21%）死亡。3 名婴儿的听力学数据不完整。42 名婴儿（男性 n=24）的完整数据可用，其中 4 名（9.5%）有听力障碍。听力损失的发展与血糖水平异常（p=0.006）、1 分钟时低 Apgar 评分（p=0.0219）和多器官功能障碍的证据有关[高肌酐（p=0.0172 和 0.0198）和升高的肝转氨酶（天冬氨酸氨基转移酶（AST）p=0.0012，丙氨酸氨基转移酶（ALT）p=0.0037）]。未发现与庆大霉素有关。
本研究证实，接受治疗性低温治疗的中度/重度 HIE 的足月婴儿听力障碍很常见。这些婴儿的血糖应密切监测，发育监测应包括正式的听力学检查。需要进一步的更大规模研究来阐明低温本身在听力损失中的作用，如果有的话，并充分确定该人群听力障碍的危险因素。
目前的研究证实，接受治疗性低温治疗的中度/重度 HIE 的足月婴儿听力障碍很常见。然而，没有发现庆大霉素使用与听力障碍发展之间的关联，但是初始血糖超出正常范围具有重要意义。与听力障碍相关的其他因素包括 Apgar 评分较低、复苏需求增加和多器官功能障碍（肾功能衰竭和肝功能衰竭）的证据。
