Factors associated with sensorineural hearing loss among survivors of extracorporeal membrane oxygenation therapy
Factors associated with sensorineural hearing loss among survivors of extracorporeal membrane oxygenation therapy
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DOI：
10.1542/peds.2004-0247
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发表时间：
2005-06-01
期刊：
影响因子：
8
通讯作者：
Jones, DT
中科院分区：
文献类型：
--
作者：
Fligor, BJ;Neault, MW;Jones, DT
目标.奋进解释为什么一些体外膜肺氧合（ECMO）治疗的毕业生会发生感音神经性听力损失（SNHL），而另一些则不会，研究SNHL程度的变异性，试图解释为什么一些SNHL毕业生会经历进行性恶化，而另一些则不会，并根据已确定的风险因素描述SNHL发作的时间过程。采用比例风险回归分析进行回顾性病历审查，以从患者和治疗变量列表中识别SNHL的特定风险因素。波士顿儿童医院，一家儿科三级护理机构和ECMO中心。出生于1986 - 1994年的新生儿ECMO毕业生谁存活出院，并进行了听力学评价（n = 111）和随机样本的ECMO毕业生谁存活出院，并没有进行听力学评价（n = 30）。听力学数据，包括是否存在SNHL、最近评估时SNHL的严重程度、听力的稳定性或进行性恶化（首次评估与最近评估相比）以及迟发型SNHL的发生率。在接受听力学测试的111名ECMO毕业生中，有29名（26%）在上次评估时患有SNHL。在这29例SNHL受试者中，21例（72%）患有进行性SNHL，其中14例（48%）患有迟发型SNHL。发现SNHL的年龄为4个月~ 8岁11个月。比例风险回归分析确定的与SNHL发作时间显著相关的因素包括先天性腹股沟疝的初步诊断（风险比：2.60）、ECMO治疗时间（风险比：7.18）和儿童接受氨基糖苷类抗生素的天数（风险比：5.56）。构建Kaplan-Meier“至事件发生时间”曲线以说明SNHL发生的时间过程，其受被确定为显著风险因素的每个变量的影响。这些发现说明了所有ECMO毕业生在整个童年时期进行早期，常规，听力学评估的必要性。如本文所建议的，对于因先天性腹股沟疝病史、长期ECMO治疗和/或长期氨基糖苷类抗生素治疗而具有更高SNHL风险的儿童，应根据儿童的个体风险指标，在整个儿童期进行更密切的监测。在这些风险指标的基础上，可以努力将ECMO治疗儿童时听力损失的风险降至最低。此外，这些风险指标可以帮助咨询ECMO毕业生的家庭，了解孩子发展SNHL的具体风险以及如何管理。
Objectives. To endeavor to explain why some graduates of extracorporeal membrane oxygenation (ECMO) therapy develop sensorineural hearing loss (SNHL) whereas others do not, to study the variability seen in the degree of SNHL, to attempt to explain why some graduates with SNHL experience progressive worsening whereas others do not, and to describe the time course of the onset of SNHL on the basis of identified risk factors.Design. A retrospective chart review with proportional-hazards regression analysis to identify specific risk factors for SNHL from a list of patient and treatment variables.Setting. Children's Hospital Boston, a pediatric tertiary-care facility and ECMO center.Patients. Neonatal ECMO graduates born in 1986 1994 who survived to discharge and underwent audiologic evaluations (n = 111) and a random sample of ECMO graduates who survived to discharge and did not undergo audiologic evaluations (n = 30).Outcome Measures. Audiologic data, including the presence or absence of SNHL, the severity of SNHL at the most recent evaluation, the stability or progressive worsening of hearing (with the first evaluation compared with the most recent evaluation), and the occurrence of delayed-onset SNHL.Results. Twenty-nine (26%) of 111 ECMO graduates who underwent audiologic testing had SNHL at the last evaluation. Of these 29 subjects with SNHL, 21 (72%) had progressive SNHL, of whom 14 (48%) had delayed-onset SNHL. The age of identification of SNHL ranged from 4 months to 8 years 11 months. Factors identified with proportional-hazards regression analyses as being associated significantly with the time to onset of SNHL were a primary diagnosis of congenital diaphragmatic hernia (hazard ratio: 2.60), length of ECMO therapy (hazard ratio: 7.18), and number of days children received aminoglycoside antibiotics (hazard ratio: 5.56). Kaplan-Meier "time-to-event" curves were constructed to illustrate the time course of onset of SNHL, as affected by each of the variables identified as significant risk factors.Conclusions. These findings illustrate the need for early, routine, audiologic evaluations throughout childhood for all ECMO graduates. Children at even greater risk for developing SNHL because of a history of congenital diaphragmatic hernia, prolonged ECMO therapy, and/or a lengthy course of aminoglycoside antibiotic therapy should be monitored even more closely throughout childhood, depending on the child's individual risk indicators, as suggested here. On the basis of these risk indicators, efforts can be made to minimize the risk of hearing loss while a child is being treated with ECMO. In addition, these risk indicators can assist with counseling families of ECMO graduates regarding the child's specific risk of developing SNHL and how it can be managed should it occur.