Universal newborn hearing screening and postnatal hearing loss
Universal newborn hearing screening and postnatal hearing loss
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DOI：
10.1542/peds.2005-1455
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发表时间：
2006-04-01
期刊：
影响因子：
8
通讯作者：
Welzl-Mueller, K
中科院分区：
文献类型：
--
作者：
Weichbold, V;Nekahm-Heis, D;Welzl-Mueller, K
OBJECTIVE.本研究的目的是确定有出生后永久性儿童听力障碍（PCHI）的儿童的百分比，以及有出生后听力损失风险指标的儿童的百分比。数据来自于1995年至2000年期间在奥地利各医院接受过新生儿听力筛查（UNHS）的双侧PCHI（听力水平>40 dB，较好的耳朵，无辅助）儿童的临床图表。听力损失被认为是出生后，当一个孩子通过UNHS，但后来被发现有听力障碍。根据美国婴儿听力联合委员会（JCIH）2000年声明的建议，通过审查儿童的临床图表来评估风险指标的存在。在105例双侧PCHI患儿中，23例（22%）表现出产后损害。在对这一数字进行不确定性校正后，估计出生后损害占9岁时所有双侧PCHI的25%。在17名儿童中发现了风险指标，但并不完全符合JCIH提出的风险指标。发现的危险因素是听力损失的家族史（3例儿童）、脑膜炎（2例）、颅面畸形（2例）、持续性肺动脉高压（1例）、先天性巨细胞感染（1例）、体外膜肺氧合（1例）、复发性渗出性中耳炎（1例），以及除JCIH列表外的耳毒性治疗（5例），妊娠33周前出生（2例）（1例合并了最后2例）。6名儿童未显示出生后听力损失的风险指标。我们的研究结果表明，大约25%的儿童双侧听力损失是出生后的，这支持了UNHS在检测PCHI中的主导作用。然而，关于同时查明产后病例的规定是有道理的。因为在这些儿童中，有些没有检测到风险指标，而另一些儿童的听力在3岁后开始下降，所以对这个年龄段的高危儿童进行听力监测可能是不够的。建议采取其他方法，如在幼儿园或学校进行听力筛查。
OBJECTIVE. The goal of this study was to determine the percentage of children who have a postnatal permanent childhood hearing impairment (PCHI) and the percentage thereof who have risk indicators for a postnatal hearing loss.METHODS. Data were drawn retrospectively from the clinical charts of children who had bilateral PCHI (>40 dB hearing level, better ear, unaided) and had undergone universal newborn hearing screening (UNHS) between 1995 and 2000 in various Austrian hospitals. A hearing loss was recognized as postnatal when a child passed UNHS but was later found to have a hearing impairment. The presence of risk indicators, as suggested by the Year 2000 Statement of the American Joint Committee on Infant Hearing (JCIH), was assessed by reviewing the children's clinical charts.RESULTS. Of a total of 105 children with bilateral PCHI, 23 (22%) showed postnatal impairment. After correction of this number for underascertainment, postnatal impairment was estimated to account for 25% of all bilateral PCHI at age 9 years. Risk indicators were found in 17 children but did not fully correspond to those proposed by the JCIH. The risk factors found were a family history of hearing loss (3 children), meningitis (2), craniofacial malformation (2), persistent pulmonary hypertension (1), congenital cytomegaly infection (1), extracorporeal membrane oxygenation (1), recurrent otitis media with effusion (1), and, in addition to the JCIH list, ototoxic therapy (5), and birth before 33rd gestational week (2) (1 child had a combination of the last 2). Six children showed no risk indicators for the postnatal hearing loss.CONCLUSIONS. Our findings suggest that similar to 25% of bilateral childhood hearing loss is postnatal, which supports the leading role of UNHS in detecting PCHI. Provisions for also identifying postnatal cases nevertheless are justified. Because in some of these children no risk indicators are detectable and in others the hearing deterioration starts after age 3 years, audiologic monitoring of at-risk children up to this age may not be sufficient. Additional methods, such as hearing screening at nursery schools or schools, are recommended.