Desai S, Kollros P R, Graziani L J, Streletz L J, Goodman M, Stanley C, Cullen J, Baumgart S
Department of Pediatrics, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
J Pediatr. 1997 Aug;131(2):233-9. doi: 10.1016/s0022-3476(97)70159-8.
We determined the sensitivity and specificity of neonatal brain-stem auditory evoked potentials (BAEP) as markers for subsequent hearing impairment and for developmental problems found later in infancy and childhood.
BAEP studies were performed before discharge in infants treated with extracorporeal membrane oxygenation (ECMO), and two specific abnormalities were analyzed: elevated threshold and delayed central auditory conduction. Behavioral audiometry was repeated during periodic follow-up until reliable responses were obtained for all frequencies, and standardized developmental testing was also conducted. The sensitivity and specificity of an elevated threshold on the neonatal BAEP for detecting subsequent hearing loss, and the relationship of any neonatal BAEP abnormality to language or developmental disorders in infancy, were calculated.
Test results for 46 ECMO-treated infants (57.5%) were normal, and those for 34 infants (42.5%) were abnormal, with either elevated wave V threshold, prolonged wave I-V interval, or both on neonatal BAEP recordings. Most significantly, 7 (58%) of the 12 children with subsequent sensorineural hearing loss had left the hospital after showing normal results on threshold tests. There was no significant difference in the frequency of hearing loss between subjects with abnormal (5/21, or 24%) and those with normal BAEP thresholds (7/59, or 12%; Fisher Exact Test, p = 0.28). Therefore the sensitivity of neonatal BAEP testing for predicting subsequent hearing loss was only 42%. Neonatal BAEP specificity for excluding subsequent hearing loss was 76%. In contrast, on language development testing, 19 children demonstrated receptive language delay. Of these children, 12 (63%) had abnormal neonatal BAEP recordings and 7 (37%) had a normal BAEP threshold, normal central auditory conduction test results, or both (p = 0.04).
Neonatal BAEP threshold recordings were of limited value for predicting subsequent hearing loss common in ECMO-treated survivors. However, an abnormal neonatal BAEP significantly increased the probability of finding a receptive language delay during early childhood, even in those with subsequently normal audiometry findings. Because neonatal ECMO is associated with a high risk of hearing and receptive language disorders, parents should be counseled that audiologic and developmental follow-up evaluations in surviving children are essential regardless of the results of neonatal BAEP testing.
我们确定了新生儿脑干听觉诱发电位（BAEP）作为后续听力障碍以及婴儿期和儿童期后期发现的发育问题标志物的敏感性和特异性。
对接受体外膜肺氧合（ECMO）治疗的婴儿在出院前进行BAEP研究，并分析两种特定异常情况：阈值升高和中枢听觉传导延迟。在定期随访期间重复进行行为听力测定，直到获得所有频率的可靠反应，并进行标准化发育测试。计算新生儿BAEP阈值升高对检测后续听力损失的敏感性和特异性，以及任何新生儿BAEP异常与婴儿期语言或发育障碍的关系。
46例接受ECMO治疗的婴儿（57.5%）测试结果正常，34例婴儿（42.5%）测试结果异常，新生儿BAEP记录显示V波阈值升高、I-V波间期延长或两者皆有。最显著的是，12例后续发生感音神经性听力损失的儿童中有7例（58%）在阈值测试结果正常后出院。BAEP异常的受试者（5/21，或24%）和BAEP阈值正常的受试者（7/59，或12%）之间听力损失频率无显著差异（Fisher精确检验，p = 0.28）。因此，新生儿BAEP测试预测后续听力损失的敏感性仅为42%。新生儿BAEP排除后续听力损失的特异性为76%。相比之下，在语言发育测试中，19名儿童表现出接受性语言延迟。在这些儿童中，12例（63%）新生儿BAEP记录异常，7例（37%）BAEP阈值正常、中枢听觉传导测试结果正常或两者皆正常（p = 0.04）。
新生儿BAEP阈值记录对于预测ECMO治疗幸存者中常见的后续听力损失价值有限。然而，即使在随后听力测定结果正常的儿童中，新生儿BAEP异常也显著增加了幼儿期发现接受性语言延迟的可能性。由于新生儿ECMO与听力和接受性语言障碍高风险相关，应向家长咨询，无论新生儿BAEP测试结果如何，对存活儿童进行听力和发育随访评估至关重要。
