中华耳科学杂志Issue(2)：174-178,5.
重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查
Hearing screening in the neonatal intensive care unit: focus on auditory neuropathy
摘要
Abstract
Objective Auditory neuropathy (AN) has been a well-accepted clinical entity during the last years. Though we are able to diagnose AN reliably, little is known concerning its epidemiology, etiology and prognosis. This study is aimed to search for a hearing screening model and to explore the prevalence of AN in the neonatal intensive care unit (NICU) infants. Methods A two-stage hearing screening program by automated auditory brainstem response (AABR) was used. The first test was performed before discharge from the NICU. Those who failed the initial screening underwent a second AABR test in an outpatient setting after one month. If failing the second screening, the infant was referred to our audiology center for further diagnostic evaluations including auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE), and immittance test within three months. The pass criteria of ABR were the presence of wave V in response to 35 dB nHL click stimuli. Only infants demonstrating considerably elevated thresholds (≥70 dB nHL), absent or atypical ABR in combination with normal DPOAE and normal tympanogram were considered as suffering from AN. Results The subjects included were 1343 infants who were discharged from NICU between September 2007 and April 2009. One hundred and seventeen newborns (8.7%) failed the pre-discharge AABR test. Of those, 88 (75.2%) received the second AABR screening after one month, and 22 were referred. Ten of the 22 referred infants were eventually identified to have hearing loss with ABR thresholds at greater than 35 dB nHL in at least one ear. Two of these cases (1.5‰) showed elevated threshold (≥70 dB nHL) or absent ABR while DPOAEs were present and tympanogram normal, with absent middle ear acoustic reflexes, and were diagnosed with AN. The total prevalence of hearing impairment and AN in this group of newborns were about 7.4‰ and 1.5‰ respectively. Conclusions The prevalence of total hearing loss (7.4‰) and of AN (1.5‰) in our NICU infants are lower than that reported in the literatures. No risk factor seems to be effective predictor for the AN according to this observation, which is probably due to the small target population selected. Two-stage screening program of AABR is an ideal model for hearing screening in NICU infants.关键词
听力筛查/听神经病/自动听性脑干反应/新生儿重症监护病房Key words
Hearing screening/ Auditory neuropathy/ Automated auditory brainstem response/ Neonatal intensive care unit分类
医药卫生引用本文复制引用
吴金毛,叶炎林,王三南,邢光前..重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查[J].中华耳科学杂志,2011,(2):174-178,5.基金项目
江苏省“科教兴卫工程”医学重点人才基金(RC2007064) （RC2007064）
