ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy.
Department of Paediatrics, Cambridge University Hospitals, Hills Road, Cambridge, UK.
Eur Arch Otorhinolaryngol. 2024 Jul;281(7):3397-3421. doi: 10.1007/s00405-024-08527-x. Epub 2024 Feb 27.
PURPOSE: To review possible risk factors for permanent delayed-onset, progressive sensorineural hearing loss (SNHL) in the paediatric population to recommend follow-up protocols for early detection. METHODS: PRISMA-compliant systematic review was performed, including observational studies on the paediatric population up to 16 years old who have passed the newborn hearing screening programme (NHSP), investigating the development of late-onset, progressive SNHL. Electronic searches were performed through Medline, Embase, Cochrane, and Emcare. RESULTS: 37 studies were included. 21 showed an association between late-onset SNHL and congenital cytomegalovirus (cCMV) infection (age at hearing loss diagnosis 0.75 to 204 months, mean 45.6 ± 43.9), while 16 between late-onset SNHL and other congenital or perinatal factors, namely Neonatal Intensive Care Unit (NICU) stay, prematurity, neonatal respiratory failure, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, hypocapnia, hypoxia, alkalosis, seizure activity, congenital diaphragmatic hernia (CDH), inner ear malformation, and gene mutations (age at hearing loss diagnosis 2.5 to 156 months, mean 38.7 ± 40.7). CONCLUSIONS: cCMV infection may cause late-onset SNHL, which can be missed on standard NHSP. There is, therefore, evidence to support universal screening programmes to enable detection in even asymptomatic neonates. Ongoing audiological follow-up for all children with cCMV is advisable, to enable timely treatment. In the paediatric population presenting conditions such as NICU stay > 5 days, prematurity ≤ 34 weeks gestation, severe neonatal respiratory failure, mechanical ventilation, ECMO support, and CDH surgery, an audiological follow-up from 3 months of age up to at least 3-4 years of age, and at least annually, should be recommended.
目的:回顾小儿人群中永久性迟发性、进行性感觉神经性听力损失(SNHL)的可能危险因素,以推荐早期检测的随访方案。
方法:进行了符合 PRISMA 标准的系统评价,纳入了已通过新生儿听力筛查计划(NHSP)的 16 岁以下小儿人群的观察性研究,调查迟发性、进行性 SNHL 的发生情况。通过 Medline、Embase、Cochrane 和 Emcare 进行电子检索。
结果:共纳入 37 项研究。21 项研究表明迟发性 SNHL 与先天性巨细胞病毒(cCMV)感染相关(听力损失诊断年龄为 0.75 至 204 个月,平均 45.6±43.9),16 项研究表明迟发性 SNHL 与其他先天性或围产期因素相关,即新生儿重症监护病房(NICU)住院、早产、新生儿呼吸衰竭、机械通气、体外膜肺氧合(ECMO)支持、低碳酸血症、缺氧、碱中毒、癫痫发作活动、先天性膈疝(CDH)、内耳畸形和基因突变(听力损失诊断年龄为 2.5 至 156 个月,平均 38.7±40.7)。
结论:cCMV 感染可引起迟发性 SNHL,在标准的 NHSP 中可能被漏诊。因此,有证据支持进行普遍筛查计划,以便即使是无症状的新生儿也能得到检测。建议对所有 cCMV 患儿进行持续的听力随访,以便及时进行治疗。对于在 NICU 住院时间超过 5 天、早产≤34 周妊娠、严重新生儿呼吸衰竭、机械通气、ECMO 支持和 CDH 手术的小儿人群,应从 3 个月龄开始进行听力随访,至少持续到 3-4 岁,且至少每年进行一次。
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