Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, N-9038, Tromsø, Norway.
Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Eur J Pediatr. 2024 Mar;183(3):1163-1172. doi: 10.1007/s00431-023-05321-5. Epub 2023 Nov 22.
The purpose of this study is to evaluate the association between perinatal asphyxia, neonatal encephalopathy, and childhood hearing impairment. This is a population-based study including all Norwegian infants born ≥ 36 weeks gestation between 1999 and 2014 and alive at 2 years (n = 866,232). Data was linked from five national health registries with follow-up through 2019. Perinatal asphyxia was defined as need for neonatal intensive care unit (NICU) admission and an Apgar 5-min score of 4-6 (moderate) or 0-3 (severe). We coined infants with seizures and an Apgar 5-min score < 7 as neonatal encephalopathy with seizures. Infants who received therapeutic hypothermia were considered to have moderate-severe hypoxic-ischemic encephalopathy (HIE). The reference group for comparisons were non-admitted infants with Apgar 5-min score ≥ 7. We used logistic regression models and present data as adjusted odds ratios (aORs) with 95% confidence intervals (CI). The aOR for hearing impairment was increased in all infants admitted to NICU: moderate asphyxia aOR 2.2 (95% CI 1.7-2.9), severe asphyxia aOR 5.2 (95% CI 3.6-7.5), neonatal encephalopathy with seizures aOR 7.0 (95% CI 2.6-19.0), and moderate-severe HIE aOR 10.7 (95% CI 5.3-22.0). However, non-admitted infants with Apgar 5-min scores < 7 did not have increased OR of hearing impairment. The aOR for hearing impairment for individual Apgar 5-min scores in NICU infants increased with decreasing Apgar scores and was 13.6 (95% CI 5.9-31.3) when the score was 0. Conclusions: An Apgar 5-min score < 7 in combination with NICU admission is an independent risk factor for hearing impairment. Children with moderate-severe HIE had the highest risk for hearing impairment. What is Known: • Perinatal asphyxia and neonatal encephalopathy are associated with an increased risk of hearing impairment. • The strength of the association, and how other co-morbidities affect the risk of hearing impairment, is poorly defined. What is New: • Among neonates admitted to a neonatal intensive care unit (NICU), decreased Apgar 5-min scores, and increased severity of neonatal encephalopathy, were associated with a gradual rise in risk of hearing impairment. • Neonates with an Apgar 5-min score 7, but without NICU admission, did not have an increased risk of hearing impairment.
本研究旨在评估围产期窒息、新生儿脑病与儿童听力障碍之间的关联。这是一项基于人群的研究，纳入了 1999 年至 2014 年间所有≥36 孕周且出生时存活、2 岁时（n=866232）在挪威的婴儿。数据来自五个国家健康登记处，随访至 2019 年。围产期窒息定义为需要新生儿重症监护病房（NICU）入住，且 Apgar 5 分钟评分为 4-6（中度）或 0-3（重度）。我们将有癫痫发作且 Apgar 5 分钟评分<7 的婴儿定义为伴有癫痫发作的新生儿脑病。接受治疗性低温的婴儿被认为患有中重度缺氧缺血性脑病（HIE）。与比较的参考组是 Apgar 5 分钟评分≥7 且未入院的婴儿。我们使用逻辑回归模型，以 95%置信区间（CI）的调整比值比（aOR）表示数据。所有入住 NICU 的婴儿听力障碍的 aOR 均增加：中度窒息 aOR 2.2（95%CI 1.7-2.9），重度窒息 aOR 5.2（95%CI 3.6-7.5），伴有癫痫发作的新生儿脑病 aOR 7.0（95%CI 2.6-19.0），以及中重度 HIE aOR 10.7（95%CI 5.3-22.0）。然而，Apgar 5 分钟评分<7 且未入院的婴儿听力障碍的 OR 无增加。NICU 婴儿的 Apgar 5 分钟评分每降低 1 分，听力障碍的 aOR 就会增加，当评分降至 0 时，aOR 为 13.6（95%CI 5.9-31.3）。结论：Apgar 5 分钟评分<7 并伴有 NICU 入院是听力障碍的独立危险因素。患有中重度 HIE 的儿童听力障碍的风险最高。已知：•围产期窒息和新生儿脑病与听力障碍风险增加相关。•这种关联的强度以及其他合并症如何影响听力障碍的风险，定义尚不明确。新发现：•在入住新生儿重症监护病房（NICU）的新生儿中，Apgar 5 分钟评分下降和新生儿脑病严重程度增加与听力障碍风险逐渐升高相关。•Apgar 5 分钟评分 7 分但未入住 NICU 的新生儿听力障碍风险无增加。
