先天性巨细胞病毒感染对婴幼儿听力及智力影响的研究

目的　探讨先天性巨细胞病毒 (CMV)感染对婴幼儿生长发育、听力及智力的影响。方法　对 65例先天性CMV感染儿及 82例非感染儿于新生儿期进行生长发育及听力的检测 ,并于生后 6个月至 4岁进行随访。随访内容包括 :体格检查、发育商测试及听力测试。结果　两组生长发育状况无显著性差异。感染组发育商落后8例 ,对照组仅 1例 ,二者有显著性差异。感染组新生儿期、随访时分别有 7例 9耳、9例 11耳未通过TEOAE听力测试 ,对照组均为 1例 1耳未通过 ,未通过率感染组明显高于对照组。新生儿期、随访时双耳反应能量感染组明显低于对照组。 14例进行了ABR检测 (感染组 12例 ,对照组 2例 ) ,其中感染组 9例 17耳听力异常 ,对照组 1例 1耳听力异常。结论　先天性CMV感染对婴幼儿生长发育可能无明显影响 ,但对听力、智力的损害却不容忽视     

Brainstem auditory-evoked responses to different rates of clicks in small-for-gestational age preterm infants at term

AIM: To clarify further the influence of intrauterine growth retardation (IUGR) on early neural development. METHODS: In 30 small-for-gestational age (SGA) preterm infants at term, brainstem auditory-evoked responses (BAERs) were recorded with clicks of different repetition rates. All infants had a birthweight < 3rd centile, without any other major perinatal complications. RESULTS: Compared with the BAER in 36 appropriate-for-gestational age (AGA) term infants, the preterm SGA infants did not show any abnormalities at 21 s(-1) clicks, except for a slight increase in wave III amplitude. At 51 s(-1) clicks, there was an increase in III-V/I-III interval ratio (ANOVA p < 0.05). At 91 s(-1), the I-III interval shortened, whereas the III-V interval and III-V/I-III interval ratio increased (all p < 0.05). Wave V amplitude tended to increase slightly at all repetition rates of clicks used, although this increase did not reach statistical significance. The III-V interval and III-V/I-III interval ratio in the preterm SGA infants at different click rates correlated inversely with occipitofrontal head circumference at the time of testing, i.e. the smaller the head the longer the III-V interval (all p < 0.01). Wave III amplitude at 21 s(-1) also correlated inversely with head circumference (p < 0.01), suggesting that the slight increase in this amplitude in the preterm SGA infants is related to their relatively small head size. CONCLUSION: There were no major abnormalities in the BAER up to 91 s(-1) clicks at term in preterm SGA infants. The slight increase in III-V interval at high-rate stimulation suggests a subtle degree of central neural dysfunction, which is associated with small head size following IUGR.     

听性脑干反应和耳声发射在足月新生儿高胆红素血症听力筛查中的应用

目的探讨听性脑干反应(ABR)和畸变产物耳声发射(DPOAE)应用于高胆红素血症新生儿听力筛查中的差异和意义。方法对197例诊断为高胆红素血症的新生儿同时进行ABR和DPOAE检查,异常者于生后3～4个月进行随访。结果 197例患儿临床上无明显胆红素脑病表现,ABR和DPOAE的总异常率分别为76.65%和14.47%;血清胆红素水平越高,ABR异常率越高(P<0.01),而DPOAE异常率与黄疸程度无明显相关性;DPOAE异常者多并存潜在的围生期其他导致听力损伤的高危因素。重度ABR异常者在生后3～4个月复查时仍有40.7%无改善。结论临床上无明显胆红素脑病表现的高胆红素血症新生儿ABR异常率高,对此类患儿进行听力检查应先ABR后DPOAE或者两者同时进行以避免漏诊。     

脑干听觉诱发电位与畸变产物耳声发射在听觉通路损伤患儿中的应用研究

目的　采用客观听力检测技术 ,分析听觉通路病损患儿的临床听力学特点 ,评价感音神经性聋患儿的蜗性及蜗后病变特征。方法　对感音神经性聋患儿共 310例 (5 0 0耳 ,年龄 1个月至 6岁 ,平均 2 4 2个月 )进行临床分析 ,其中中枢神经系统 (CNS)病变伴听力障碍 10 5例 (2 0 5耳 ) ,将其分为核黄疸 脑瘫组、额叶发育不良组和其他中枢性病变 3组。同年龄段对照组 6 0例 (10 4耳 )。同时检测脑干听觉诱发电位 (BAEP)和畸变产物耳声发射(DPOAE) ,对比不同组别间BAEP波V阈值及DPOAE各自的特点、同一组间不同BAEP波V阈值耳DPOAE的变化特征。结果　 (1)全组感音神经性聋患儿中有CNS病变者比例较高 (10 5例 2 0 5耳 /310例 5 0 0耳 )。 (2 )CNS病变患儿中核黄疸 脑瘫组可见严重的蜗后性听力损失 ,耳蜗功能也轻度受累 ;额叶发育不良组仅出现轻度蜗后听力损失 ;其他中枢性病变一般不累及耳蜗功能。 (3)蜗性听力损失者 ,BAEP波V阈值达 6 0nHLdB时 ,DPOAE幅值明显下降 ;达 70nHLdB以上者 ,DPOAE幅值严重下降或消失。结论　CNS病变伴感音神经性聋患儿听力障碍表现为多样性 ,临床上需联合听力专科采用不同客观听力检测技术进行综合评估 ,才能作出正确诊断。     

Hearing impairment in preterm very low birthweight babies detected at term by brainstem auditory evoked responses

Seventy preterm babies who were born with a birthweight <1500 g were studied with brainstem auditory evoked responses (BAER) at 37-42 wk of postconceptional age. The data were compared with those of normal term neonates to determine the prevalence of hearing impairment in preterm very low birthweight (VLBW) babies when they reached term. The BAER was recorded with click stimuli at 21 s(-1). Wave I and V latencies increased significantly (ANOVA p < 0.01 and 0.001). I-V and III-V intervals also increased significantly (p < 0.05 and 0.001). Wave V amplitude and V/I amplitude ratio did not differ significantly from those in the normal term controls. Ten of the 70 VLBW babies had a significant elevation in BAER threshold (>30 dB normal hearing level). Eleven had an increase in I-V interval (>2.5 SD above the mean in the normal controls) and one had a decrease in V/I amplitude ratio (<0.45). These results suggest that 14% (10/70) of the VLBW babies had a peripheral hearing impairment and 17% (12/70) a central impairment. Three babies had both an increase in I-V interval and an elevation in BAER threshold, suggesting that 4% (3/70) had both peripheral and central impairments. Thus, the total prevalence of hearing impairment was 27% (19/70). Conclusion: About one in four preterm VLBW babies has peripheral and/or central hearing impairment at term. VLBW and its associated unfavourable perinatal factors predispose the babies to hearing impairment.     

听觉脑干反应和耳声发射在高危儿听力筛查中的应用

目的：耳声发射(OAE)和听觉脑干反应(ABR) 是新生儿听力筛查的常用方法。该研究旨在探讨畸变产物耳声发射(DPOAE) 和ABR应用于重症监护病房(NICU)高危新生儿听力筛查的差异和意义。方法：分别应用Smart-EP型听觉脑干诱发电位仪和Smart-OAE畸变产物耳声发射检查仪对600例(1 200耳)不同病因所致的高危儿同时进行DPOAE和ABR检查,将两种方法取得的检测结果进行比较。结果：在600例(1 200耳)高危新生儿中,ABR的异常率(78.6%,943/1 200耳)远高于DPOAE的未通过率(22.3%,268/1 200耳);二种检查的共同阴/阳性率分别为20.8%(241/1 200耳)和21%(252/1 200耳)。1 200耳中有493耳DPOAE和ABR的测试结果一致,占41.1%;707耳的测试结果不一致,占58.9%。DPOAE测试的假阳性率为6.0%(16/268耳),假阴性率为74.1%(691/932耳)。结论： DPOAE仅反映耳蜗功能,单独用于高危新生儿听功能筛查的价值有限。ABR检查果相对可靠,NICU高危新生儿听力筛查应先做ABR检查,ABR异常者再做OAE检查。ABR和OAE二种检测方法相互结合,方能提高高危新生儿听力筛查的准确性。     

The ontogeny of sensory perception in preterm infants

The extra- vs intrauterine development of both visual and auditory cortical evoked response patterns was compared at 33, 37 and 40 weeks conceptional age. The maturation of visual cortical evoked responses is retarded in infants at 37 and 40 weeks conceptional age when born with a gestational age of less than 32 weeks, which thus implies a long extrauterine life span. The maturation of the auditory cortical evoked responses is not influenced by premature exposure to the extrauterine environment.The results are explained on the basis of the particular central nervous system growth spurt periods and a thus defined vulnerable period of different brain structures.     

One-third of term babies after perinatal hypoxia-ischaemia have transient hearing impairment: dynamic change in hearing threshold during the neonatal period

AIM: To examine the process of change in hearing threshold during the neonatal period after perinatal hypoxia-ischaemia. METHODS: The threshold of brainstem auditory evoked responses (BAER) was measured serially during the first month after birth in 92 term babies who suffered hypoxia-ischaemia. RESULTS: The mean BAER threshold in these babies was significantly increased on day 1 (ANOVA p < 0.001). The elevated threshold decreased progressively on days 3 and 5, but was still significantly higher than that in normal controls (p < 0.01). The elevation continuously decreased more slowly on days 10 and 15, and to a near normal level on day 30. Threshold elevation was seen in 31.7% of the babies on day 1, and 34.5% during the first three days. The rate of elevation decreased progressively thereafter. On day 30, 10.6% of the subjects still had increased thresholds. Moderate to severe elevation occurred mainly during the first week and severe elevation occurred predominately on day 1. Threshold elevation starting after days 3-5 is likely to be due to middle-ear disorders. As a whole, during the first month, 44.6% (41/92) of the babies studied had threshold elevation. BAER threshold was correlated weakly with the stage of hypoxic-ischaemic encephalopathy on days 1 and 3. The threshold was significantly higher in babies with severe encephalopathy than in those with mild or moderate encephalopathy during the first 3 d of life. CONCLUSION: Hearing threshold is elevated in about one-third of term babies after hypoxia-ischaemia. The elevated threshold decreases progressively after birth, and returns to normal by one month in most babies. The threshold correlates weakly with the severity of encephalopathy.     

不同低出生体重儿听力损失相关因素分析

目的探讨不同低出生体重儿听力损失及损失程度与出生体重、胎龄的关系。方法应用听性脑干诱发电位对不同低出生体重儿进行听力测试,以单侧耳Ⅴ波反应阈>30dBnHL者作为2～4kHz范围内听力损失指标。结果测试不同低出生体重儿246名,听力损失63名。<1000g超极低出生体重儿3例,听力损失发生率100%;<1500g的极低出生体重儿46例,其听力损失发生18例(39.1%);<2500g的低出生体重儿197人,其听力损失发生42人(21.3%),不同出生体重发生听力损失差异显著(P<0.001)。其中中～重度10例,极重度2例,且出生体重与听力损失程度呈负相关,出生体重越轻,听力损失越重(r=0.378P=0.002)。胎龄<30周的早产儿3例,均有听力损失发生;胎龄30～34周的早产儿47例,听力损失22人(46.8%);胎龄34～37周的早产儿共171人,听力损失发生30人(17.5%);胎龄>37周的足月小样儿25例,听力损失发生8例(32%),不同胎龄患儿发生听力损失差异显著(P<0.001)。结论不同低出生体重儿是听力损失的高发人群,听力损失与不同低出生体重、胎龄有明显的关系,听力损失程度与出生体重呈显著负相关。足月小样儿是独立的高危因素。     

Brainstem auditory evoked responses in infants at risk of sudden infant death

Brainstem auditory evoked responses (BAERs) were recorded from 63 near-miss Sudden Infant Death Syndrome (NMSIDS) infants, 26 siblings of SIDS (SSIBS) infants and 67 control infants between 0 and 30 weeks post-term. The majority of BAERs recorded from the NMSIDS and SSIBS infants had normal form and interpeak intervals (V-I and V-IIn) within normal limits for their age. However, 15% of these infants had interpeak intervals outside the normal range, suggesting abnormal neural function in these cases. The distributions of interpeak intervals for all NMSIDS and SSIBS infants were skewed towards longer times compared to control infants. The distributions of V-IIn intervals for both groups of at risk infants were significantly different to that of control infants. While the observations confirm that the recording of BAERs is not suitable for identifying infants at risk of SIDS, they suggest, however, that maturation of neural processing in the brainstem of these infants may be delayed.     

Brainstem size and function at term age in relation to later neurosensory disability in high-risk, preterm infants

The aim of this study was to measure brainstem size on magnetic resonance imaging (MRI) scans of high-risk, preterm infants, to assess brainstem function by brainstem auditory-evoked potentials (BAEP) and to determine the predictive value of these measures for the neurosensory outcome. A total of 51 preterm infants (gestational age <34 wk, birthweight <1500 g) underwent examinations at term age; neuromotor outcome and hearing were followed up until a corrected age of 18 mo. Fourteen (27%) infants had neurosensory disability. Those with a later neurosensory disability had a significantly smaller brain stem than those with a normal outcome. The preterm infants had significantly longer peak latency (L) V and interpeak latency (IPL) III–V than the full-term control infants. Most of the preterm infants with severe cerebral palsy or hearing loss had abnormal BAEP. Sensitivity of morphometric dimensions for predicting neurosensory disability was only 20–31%, but specificity was 97–100%. Abnormal L I and IPL III–V in BAEP predicted disability with a sensitivity of 93% and a specificity of 57–59%.
Conclusion: We conclude that adverse events during the perinatal period may lead to morpho-functional changes in the brain stem in high-risk, preterm infants, and it seems that functional changes are accurate in predicting neurosensory disability in such patients.     

Non-nutritive sucking in full-term and preterm infants studied at term conceptional age

Non-nutritive sucking (NNS) patterns in full-term newborn and preterm infants were studied at term conceptional age. The preterm group showed a distinct NNS pattern with a higher frequency and lower amplitude. In the preterm group, gender differences were observed, the girls having higher frequency and larger amplitude. The full-term infants' NNS patterns were also related to pacifier use during early childhood. Experience, gender, maturity and level of tension are suggested as explanatory factors for differences in NNS patterns.     

新生儿重症监护病房早产儿听力损失的危险因素分析

目的 探讨不同胎龄早产儿及多种高危因素与听力损失程度的关系,为临床诊断、治疗提供可靠依据.方法 选取2010年1月至2012年6月入住我院NICU的早产儿为观察组,同期按约1∶1的比例选取普通新生儿病房的足月儿为对照组,两组患儿均为双耳瞬态耳声发射(TEOAE)初筛未通过者.应用脑干听觉诱发电位(BAEP)对不同胎龄新生儿进行听力测试,以单耳Ⅴ波反应阈＞ 65 dBpeSPL (30 dBHL)为听力损失的参考指标,对多种高危因素进行逐步回归分析,并对听力损失患儿进行随访.结果 本文共检测123例早产儿和100例足月儿,早产儿听力损失总发生率为66.7％(164/246耳),其中各胎龄组异常率分别为＜30周100％(12/12耳),30～34周75.0％(87/116耳),35～ 36周55.1％(65/118耳),足月儿总异常率为39.5％(79/200耳).早产儿各胎龄组异常率均高于足月儿,差异有统计学意义(P＜0.05).不同胎龄组之间早产儿BAEP差异有统计学意义(P＜0.05),表现为胎龄越小,Ⅰ、Ⅲ、Ⅴ波峰潜伏期越延长,而Ⅲ-Ⅴ、Ⅰ-Ⅴ峰间期差异无统计学意义(P＞0.05).出生胎龄(F =6.254)、高胆红素血症(F =6.925)、宫内感染(F =8.846)、ABO溶血(F=8.000)是早产儿听力损失的独立危险因素(P＜0.05).随访的76例听力损失早产儿中,42例恢复正常(55.3％),随访的34例听力损失足月儿中,28例恢复正常(82.4％).结论 BAEP是一种比较客观评价早产儿听力损失及脑干功能的可行检测技术.造成NICU早产儿听力损失的主要危险因素是胎龄、高胆红素血症、宫内感染和ABO溶血.     

Sex and gestational age effects on auditory brainstem responses in preterm and term infants

Background

Some studies find delayed development of the auditory brainstem in preterm infants, but others do not.

Aim

To compare auditory brainstem responses (ABRs) in healthy preterm and term infants depending on sex and gestational age (GA).

Methods

Participants were 111 preterm (27–36 weeks GA) and 92 term (37–41 weeks GA) infants. ABR tests were conducted at 6 weeks (corrected age if preterm).

Results

There were no overall differences between term and preterm groups in ABRs. However, males showed longer latencies for waves III, V, and I–III, III–V, and I–V intervals and smaller amplitudes for wave III and V than females in both preterm and term groups (all p values ≤ .01). A 3-way interaction between group, sex, and GA (p < .05) showed that preterm males with later GA had longer wave I–V interval, whereas term females with later GA showed shorter wave I-V interval. Growth velocity predicted wave I–V interval in preterm infants, controlling for other factors (male: p = .07, female: p < .05).

Conclusion

ABRs in preterm and term infants were similar at 6 weeks (corrected age if preterm), but males had less advanced ABRs than females. More rapid growth predicted less mature ABR in later GA preterm infants in this setting where they were unlikely to receive extra iron. The roles of GA, growth, and iron balance in ABR development warrant further study.     

The general movement checklist: A guide to the assessment of general movements during preterm and term age

ObjectivesTo develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score.MethodsThree examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31–45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers’ satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction).ResultsThe scorers’ satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p < 0.001). The checklist score also differentiated between poor-repertoire (median = 13) and cramped-synchronized general movements (median = 7; p = 0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa = 0.68–1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa = 0.56–0.93); (iii) the checklist was good to excellent (ICC = 0.77–0.96).ConclusionThe general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.     

Evaluation of an automated auditory brainstem response infant hearing screening method in at risk neonates

An automated auditory brainstem response (ABR) methodthe ALGO-1 Plus-has been developed for hearing screening in healthy neonates. The aim of this study was to test the validity of this automated ABR screening method in at-risk neonates in a neonatal intensive care unit. Two hundred and fifty at-risk neonates were selected for screening according to the criteria of the American Joint Committee on Infant Hearing. All 250 neonates were screened with the ALGO-1 Plus for bilateral hearing loss. When two consecutive screenings pointed to bilateral hearing loss (refer) further audiological investigations were performed and where necessary therapeutic measures were taken. All children who passed the screening unilateral or bilateral enrolled in a nationwide behavioural screening programme at the age of 9 months as well as in a 6-monthly follow up programme documenting speech and language development. A total of 245 (98%) neonates passed the ALGO-1 screening, 230 (92%) at the first attempt and 15 (6%) at the second attempt. Five (2%) were referred with bilateral hearing loss. One of these died of congenital rubella shortly after screening and bilateral congenital hearing loss of >35 dB was confirmed in the other 4. None of the infants who passed the screening were discovered to have moderate to severe bilateral hearing loss (> 40 dB) with behavioural screening (n=183/233) or at follow up (n=233/233). In this study, all at-risk neonates with bilateral congenital hearing loss were detected with ALGO-1 Plus screening. No falsenegatives were discovered.     

早产儿在不同刺激速率下的脑干听觉诱发电位变化

目的：早产儿的脑干功能发育与足月儿是否存在差异,国外的研究报道并不一致,该文通过分析不同刺激速率下的脑干听觉诱发电位,比较早产儿与足月儿的脑干功能发育状态及增加刺激速率在检测脑干功能中的作用。方法：早产儿组30例,无围生期及新生儿期合并症;足月儿组38例,为健康足月儿。两组于胎龄37～42周时进行脑干听觉诱发电位检查,声刺激速率为21.1次/s、51.1次/s和91.1次/s,分析Ⅰ,Ⅲ,Ⅴ波的潜伏期和振幅,ⅠⅢ,ⅢⅤ,ⅠⅤ峰间期以及ⅢⅤ/ⅠⅢ峰间期比值。结果：在60dBnHL刺激强度下,随刺激速率增加,两组中Ⅰ,Ⅲ,Ⅴ各波的潜伏期及峰间期均逐渐延长,振幅逐渐下降,潜伏期及峰间期与刺激速率成正相关(P<0.01),振幅与速率成负相关(P<0.01)。两组比较,各频率ⅠⅤ峰间期均无差异,但随刺激速率增高,早产儿组ⅠⅢ峰间期相对缩短(P<0.05)、ⅢⅤ峰间期相对延长(P<0.01),ⅢⅤ/ⅠⅢ峰间期比值增大(P<0.001)。两组振幅无明显差别。结论：早产儿脑干听觉通路的近外周部分较近中枢部分提前发育;提高刺激速率有助于发现更多的神经生理变化,提高脑干听觉诱发电位的诊断价值。