Study on factors associated with hearing screening results among 1 300 newborns in neonatal intensive care unit
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摘要: 目的 分析新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿听力筛查结果,探讨NICU新生儿听力筛查阳性率的影响因素。方法 选取2019年5月—2020年4月在北京市朝阳区设有NICU的机构收治的1 300例新生儿为筛查对象,出生48 h后病情稳定时至出院前时采用瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)及自动听性脑干反应(automated auditory brainstem response,AABR)进行筛查,未通过者3月龄行听力学诊断。通过问卷调查收集母亲孕周、分娩方式以及新生儿出生体重、高胆红素血症、颅面部畸形、窒息史、胎粪吸入史等临床资料,分析筛选出NICU新生儿未通过听力筛查的影响因素,并对确诊听力损伤的患儿进行追踪随访至6月龄。结果 1 300例NICU新生儿中,筛查通过1 228例,通过率为94.46%。经TEOAE、AABR筛查及TEOAE与AABR联合筛查的未通过率分别为2.69%、4.48%和6.24%,联合筛查的未通过率高于单独TEOAE筛查,差异具有统计学意义(χ2=4.350,P=0.037)。筛查未通过的72例患儿经听力学诊断,确诊有听力障碍38例,听力障碍人数占比2.92%。单因素分析显示,胎数、出生体重、新生儿评分(Apgar评分)、NICU住院天数、高胆红素血症和新生儿呼吸窘迫综合征与未通过听力筛查有关(P<0.05)。多因素logistic回归分析显示,高胆红素血症、多胎、Apgar评分<10分、NICU住院天数>5 d为NICU新生儿听力筛查异常的主要相关危险因素(P<0.05)。结论 NICU新生儿是听力障碍的高发人群,TEOAE与AABR联合筛查可对单一方法筛查模式进行有效补充,做好NICU新生儿听力的早期筛查和定期的听力学评估十分必要。Abstract: Objective To analyze the hearing screening results among newborns in the neonatal intensive care unit (NICU),and to explore factors associated with it.Methods 1 300 newborns admitted to NICU in Chaoyang District,Beijing were recruited as the screening subjects from May 2019 to April 2020.Transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) were applied to newborns in stable condition 48 hours after delivery for preliminary screening.Those who failed initial screening would undergo definitive hearing assessment at the third postnatal month.Clinical information were collected through questionnaire survey in terms of gestational age,delivery mode,neonatal birth weight,hyperbilirubinemia,craniofacial malformation,history of asphyxia,history of meconium aspiration,and etc.Factors associated with the results of neonatal hearing screening were analyzed.Neonates diagnosed with hearing impairment were followed up till 6 month age.Results Out of 1 300 cases,there were1 228 cases passed hearing screening test,and the passing rate was 94.46%.The rates of failing TEOAE,AABR or combined TEOAE/AABR screening was 2.69%,4.48%and 6.24%,respectively.The failing rate of combined screening was higher than that of TEOAE screening (χ2=4.350,P=0.037).72 infants accepted hearing diagnosis test and 38 were diagnosed as hearing impairment,accounting 2.92%.Univariate analysis indicated that multiple births,birth weight,Apgar score,length of stay in NICU,hyperbilirubinemia and neonatal respiratory distress syndrome were associated with failed hearing screening (P<0.05).Further logistic regression showed that hyperbilirubinemia,multiple births,Apgar score < 10 and NICU hospital stay > 5 days were main risk factors of hearing loss (P<0.05).Conclusion NICU newborn is a high risk group of hearing impairment.TEOAE combined with AABR is an effective supplement to single way hearing screening.Therefore,it is necessary for NICU newborns to undergo early screening and regular audiological assessment.
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Keywords:
- neonatal intensive care unit /
- high-risk newborns /
- hearing screening /
- risk factors
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