Dey S K, Islam S, Jahan I, Shabuj K H, Begum S, Chisti M J, Mannan M A, Shahidullah M, Chowdhury S
Professor Dr Sanjoy Kumer Dey, Professor, Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2020 Apr;29(2):405-413.
Hearing impairment is one of the deleterious ramifications of neonatal hyperbilirubinemia, but its impact during the newborn period has not been well studied in Bangladesh. This prospective observational study was conducted during January 2016 to December 2017 in the Department of Neonatology and Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to identify the relationship between hyperbilirubinemia requiring phototherapy or exchange transfusion with hearing impairment in term and late preterm neonates. Admitted term and late preterm neonates with hyperbilirubinemia requiring either phototherapy or exchange transfusion were taken as hyperbilirubinemia group. Neonates without hyperbilirubinemia from postnatal ward were taken as control. All newborn were screened with Distortion Product Otoacoustic Emissions (DPOAE) prior to discharge from hospital. A second screen was done in referred newborn after one month of first screen. A diagnostic Auditory Brainstem Response (ABR) was performed in both the ears prior to 3 months of postnatal age if referred in both 1st and 2nd screen. Total 264 neonates included in this study; 132 in the hyperbilirubinemia and 132 in the control group. In the hyperbilirubinemia group 74(56.06%) were male and 58(43.94) were female. Mean gestational ages in the hyperbilirubinemia group and control group were 36.95±1.60 weeks and 37.01±1.67 weeks respectively. Newborn in the hyperbilirubinemia group, 4(3.03%) had hearing impairment and none had hearing impairment in the control group. Peak Total Serum Bilirubin (TSB) 23mg/dl was found as best cut off value with a sensitivity of 100% and specificity of 93% for the development hearing impairment. Hearing impairment was significantly more frequent among newborn with TSB level >23mg/dl when compared to those having TSB level ≤23mg/dl (20% vs. 0.9%, p=0.009; OR=29, 95% CI 2.79, 301). Hearing impairment was associated with newborns with hyperbilirubinemia requiring phototherapy or exchange transfusion. Peak TSB level >23mg/dl can be predictive for the development of hearing impairment.
听力障碍是新生儿高胆红素血症的有害后果之一，但在孟加拉国，其在新生儿期的影响尚未得到充分研究。这项前瞻性观察性研究于2016年1月至2017年12月在孟加拉国达卡的班加班杜·谢赫·穆吉布医科大学（BSMMU）的新生儿科和耳鼻咽喉头颈外科进行，以确定足月儿和晚期早产儿中需要光疗或换血治疗的高胆红素血症与听力障碍之间的关系。将因高胆红素血症需要光疗或换血治疗而入院的足月儿和晚期早产儿作为高胆红素血症组。将产后病房中无高胆红素血症的新生儿作为对照组。所有新生儿在出院前均采用畸变产物耳声发射（DPOAE）进行筛查。在首次筛查后一个月，对转诊的新生儿进行第二次筛查。如果在第一次和第二次筛查中均被转诊，则在出生后3个月内对双耳进行诊断性听性脑干反应（ABR）检查。本研究共纳入264例新生儿；高胆红素血症组132例，对照组132例。高胆红素血症组中，男性74例（56.06%），女性58例（43.94%）。高胆红素血症组和对照组的平均胎龄分别为36.95±1.60周和37.01±1.67周。高胆红素血症组中有4例（3.03%）新生儿有听力障碍，对照组中无新生儿有听力障碍。发现血清总胆红素（TSB）峰值23mg/dl是发生听力障碍的最佳临界值，敏感性为100%，特异性为93%。与TSB水平≤23mg/dl的新生儿相比，TSB水平>23mg/dl的新生儿听力障碍明显更常见（20%对0.9%，p=0.009；OR=29，95%CI 2.79，301）。听力障碍与需要光疗或换血治疗的高胆红素血症新生儿有关。TSB峰值>23mg/dl可预测听力障碍的发生。
