Effect of sepsis and systemic inflammatory response syndrome on neonatal hearing screening outcomes following gentamicin exposure
Effect of sepsis and systemic inflammatory response syndrome on neonatal hearing screening outcomes following gentamicin exposure
复制标题
DOI：
10.1016/j.ijporl.2015.09.004
复制
发表时间：
2015-11-01
影响因子：
1.5
通讯作者：
Steyger, Peter S.
中科院分区：
文献类型：
--
作者：
Cross, Campbell P.;Liao, Selena;Steyger, Peter S.
目的：新生儿重症监护病房（NICU）毕业生的听力损失范围为2%至15%，而足月分娩的听力损失为0.3%，这种差异的病因尚不清楚。大多数新生儿重症监护室入院接受潜在耳毒性氨基糖苷治疗，如庆大霉素，用于推定败血症。内毒素血症和炎症与小鼠耳蜗氨基糖苷摄取增加和耳毒性增强有关。我们检验了败血症或全身性炎症反应综合征（SIRS）和静脉注射庆大霉素暴露会增加新生儿重症监护病房入院患者听力损失风险的假设。方法：俄勒冈健康与科学大学（OHSU）机构审查委员会批准了本研究设计。288名婴儿符合最初的标准，103名最终加入这项研究的受试者的父母或监护人都有书面的知情同意书。对OHSU Doernbecher儿童医院新生儿护理中心91名入组受试者的前瞻性数据进行了处理。在放电前获得畸变产物耳声发射（dpoae； f2频率范围：2063- 10031 Hz）以评估听觉表现。为了通过DPOAE筛选，需要双耳在10个频率中的bbbb6正常响应；否则，受试者出院后将被视为“转诊”进行听力诊断评估。从OHSU的电子健康记录系统中获取累积剂量数据和新生儿败血症或SIRS的诊断，并对数据进行处理以获得风险比。结果：采用DPOAE筛选标准，共纳入36例（39.5%）受试者。74名（81%）受试者静脉注射庆大霉素。20例（22%）使用庆大霉素= 4 d， 71例（78%）使用庆大霉素= 4 d(1.92)，差异有统计学意义（p = 0.01）。18例患者有脓毒症或符合新生儿SIRS标准，其中9例患者使用庆大霉素5天，与所有其他受试者相比，DPOAE转诊风险比为2.12 （p = 0.02）。与其他队列相比，万古霉素或呋塞米与庆大霉素重叠治疗的受试者的风险比几乎显著（RR = 1.77, p = 0.05）。结论：我们报告了接受静脉注射庆大霉素4天的患者转诊DPOAE筛查的风险增加，这可能导致NICU毕业生中听力损失的患病率更高。我们建议进行一项扩大的前瞻性研究，以收集更大的受试者队列，确定脓毒症或新生儿SIRS，以增加该研究设计的统计能力。后续研究还需要获得随访的诊断听力学数据，以验证DPOAE筛查的结果，除了标准的AABR筛查外，是否是NICU庆大霉素暴露后永久性听力损失的可靠预测指标。2015爱思唯尔爱尔兰有限公司版权所有。
Objectives: Hearing loss in neonatal intensive care unit (NICU) graduates range from 2% to 15% compared to 0.3% in full-term births, and the etiology of this discrepancy remains unknown. The majority of NICU admissions receive potentially ototoxic aminoglycoside therapy, such as gentamicin, for presumed sepsis. Endotoxemia and inflammation are associated with increased cochlear uptake of aminoglycosides and potentiated ototoxicity in mice. We tested the hypothesis that sepsis or systemic inflammatory response syndrome (SIRS) and intravenous gentamicin exposure increases the risk of hearing loss in NICU admissions.Methods: The Institutional Review Board at Oregon Health & Science University (OHSU) approved this study design. Two hundred and eight infants met initial criteria, and written, informed consent were obtained from parents or guardians of 103 subjects ultimately enrolled in this study. Prospective data from 91 of the enrolled subjects at OHSU Doernbecher Children's Hospital Neonatal Care Center were processed. Distortion product otoacoustic emissions (DPOAEs; f2 frequency range: 2063-10,031 Hz) were obtained prior to discharge to assess auditory performance. To pass the DPOAE screen, normal responses in >6 of 10 frequencies in both ears were required; otherwise the subject was considered a "referral" for a diagnostic hearing evaluation after discharge. Cumulative dosing data and diagnosis of neonatal sepsis or SIRS were obtained from OHSU's electronic health record system, and the data processed to obtain risk ratios.Results: Using these DPOAE screening criteria, 36(39.5%) subjects would be referred. Seventy-four (81%) subjects had intravenous gentamicin exposure. Twenty (22%) had >= 4 days of gentamicin, and 71(78%) had = 4 days of gentamicin was 1.92 (p = 0.01). Eighteen subjects had sepsis or met neonatal SIRS criteria, 9 of whom had >= 5 days of gentamicin and a DPOAE referral risk ratio of 2.12 (p = 0.02) compared to all other subjects. Combining subjects with either vancomycin or furosemide overlap with gentamicin treatment yielded an almost significant risk ratio (RR = 1.77, p = 0.05) compared to the rest of the cohort.Conclusions: We report an increased risk of referral with DPOAE screening for those receiving >= 4 days of intravenous gentamicin administration that may contribute to the greater prevalence of hearing loss in NICU graduates. We propose an expanded prospective study to gather a larger cohort of subjects, identifying those with sepsis or neonatal SIRS, to increase the statistical power of this study design. Subsequent studies also need to obtain follow-up diagnostic audiological data to verify whether the outcomes of DPOAE screening, in addition to the standard AABR screen, is a reliable predictor of permanent hearing loss following gentamicin exposure in the NICU. (C) 2015 Elsevier Ireland Ltd. All rights reserved.