新生儿高胆红素血症的听觉脑干诱发反应及诱发性耳声发射的临床意义

本文对3O例（60耳）新生儿高胆红素血症及22例（44耳）正常新生儿为对照进行听觉脑干诱发反应（ABR）及诱发性耳声发射（EOAES）检测。30例（60耳）高胆病人异常耳数分别为41．67％，33.33％；正常对照组检测结果异常耳数分别为0，6．82％。同时发现随着血清总胆红素浓度升高，异常耳数增加，并证实约有1／3病人有耳蜗外毛细胞受损。提示新生儿高胆病人听觉系统损害发病率较高。以上两种方法检测是一种无创伤性，并能客观地反映听力及脑子功能、耳蜗外毛细胞受损。可通过以上检测更准确地确定受损部住，以便及时治疗减少后遗症发生。     

新生儿高胆红素血症的听觉脑干诱发反应及诱发性耳声发射的临…

本文对３０例新生儿高胆红素血症及２２例正常新生儿为对照进行听觉脑干诱发反应及诱发性耳声发射检测。３０例高胆病人异常耳数分别为４１．６７％，３３．３３％，正常对照组检测结果异常耳数分别为０，６．８２％，同时发现随着血清总胆红浓度升高，异常耳数增加，并证实约有１／３病仍耳蜗外毛细胞受损，提示新生儿高胆病人听觉系统损害发病率较高，以上两种方法检测是一种无创伤性，并能客观地反映听力及脑干功能，耳蜗外毛细胞     

高胆红素血症新生儿听力损伤的研究

目的 通过对高胆红素血症新生儿进行畸变产物耳声发射(DPOAE)及听性脑干反应(ABR)检测,了解其听力损伤的特点,为早期干预提供依据.方法 对105例足月高胆红素血症新生儿进行DPOAE检查,其中有17例急性胆红素脑病患儿同时进行ABR检测.105例新生儿根据胆红素水平分为轻、中、重度3组,中、重度黄疸新生儿再分为溶血组与非溶血组,对其检测结果进行统计学分析.结果 高胆红素血症患儿DPOAE总异常率为33.7%.DPOAE异常率随着胆红素浓度增高逐渐增高,42 d后逐渐恢复;溶血组DPOAE异常率(48%)较非溶血组异常率(35.23%)高;胆红素脑病组ABR的异常率(61.76%)与DPOAE异常率比较(47.06%)无统计学意义.结论 高胆红素血症可引起新生儿耳蜗功能异常,但可逐渐恢复.新生儿溶血是引起胆红素听力损伤的高危因素之一.ABR与DPOAE联合应用对早期评估高胆红素血症新生儿听力损伤比单独应用更准确.     

高危新生儿听性脑干反应和瞬态声诱发耳声发射两种听力损伤监测结果比较

目的探讨将听性脑干反应(ABR)和瞬态声诱发耳声发射(TEOAE)应用于高危新生儿听力损伤监测中的特点、差异和意义。方法分别应用MADSENCapella+型全功能耳声发射分析仪和MADSENERA2260型听性脑干反应仪对171例(342耳)不同病因导致的高危新生儿同时进行TEOAE和ABR测试,将2种测试方法进行比较。结果在171例(342耳)患儿中,TEOAE初筛通过率为66.96%(229/342耳),ABR通过率92.99%(318/342耳),两者共同阴性率为70.47%(241/342耳),TEOAE初筛的假阳性率为84.07%(95/113耳),假阴性率为2.62%(9/229耳)。结论ABR测试是可靠的新生儿听力筛查方法,TEOAE具有方便、客观、快速、无创等特点,为较好的新生儿听力筛查方法,但假阳性率高。二者需相互结合,相互补充。     

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。     

行为测定和脑干听诱发电位在新生儿高胆红素血症中的应用

目的：通过对新生儿高胆红素血症患儿进行行为测定(neonatal behavioral neurological assessment, NBNA)及脑干听诱发电位(brainstem aditory evoked potentials, BAEP)的测定,评估高胆红素血症在未发生核黄疸时对脑损伤的情况。方法：对新生儿高胆红素血症患儿同时进行行为测定、脑干诱发电位的测定。结果：高胆红素血症影响新生儿行为能力,当胆红素≥205.2 μmol/L时,胆红素水平与行为测定评分呈负相关。高胆主要影响到非生物听、视定向反应及主动肌张力的改变。BAEP测定结果显示听阈值随胆红素浓度增高而增高。高胆红素血症患儿各波IPL和Ⅴ波PL延长,经治疗后黄疸消退,行为测定评分先恢复正常,脑干诱发电位逐渐恢复正常。结论：这2种测定可早期发现高胆所致轻微脑损伤,有利于指导早期治疗、早期干预。     

新生儿高胆红素血症199例听损伤特征分析

目的　探讨高胆红素血症新生儿及其与缺氧缺血性脑病 (HIE)、极低出生体重 (VLBW)分别或同时存在时的听力损伤特点,为早期治疗干预提供依据。方法　1998年 1月至 2004年 2月,选择广西医科大学第一附属医院新生儿科住院的 199例高胆红素血症新生儿为研究对象,将 199例 (398耳 )新生儿分为单纯高胆红素血症组、高胆红素血症 +HIE组、高胆红素血症 +VLBW组、高胆红素血症 +VLBW+HIE4组,对每组患儿予听性脑干诱发电位(ABR)检测。结果　高胆红素血症新生儿ABR总的反应阈为(57 12±21 53)dBnHL,总的异常率为 46 73%。当高胆红素血症与HIE、VLBW三种高危因素同时并存时,其异常发生率、重度异常发生率、平均反应阈均显著提高。结论　高胆红素血症与HIE、VLBW等高危因素分别或同时并存时,听损伤的机率相应增加,听损伤的程度也随之加重。此类患儿更应及早干预,重点随访。     

听性脑干诱发电位Ⅴ波潜伏期耳间差值与新生儿高胆红素血症的相关性研究

目的 研究用短声(强度60?dBnHL)刺激患儿产生听性脑干诱发电位,探讨不同血清总胆红素(total serum bilirubin,TSB)水平患儿Ⅴ波潜伏期耳间差值(inter-aural latency difference,ILD)是否有差异性.方法 前瞻性选取2019年5月至2020年10月在浙江省玉环市人...     

自动脑干诱发电位技术在高胆红素血症新生儿听力筛查中的应用

目的探讨自动脑干诱发电位技术(AABR)在高胆红素血症新生儿听力筛查中的可行性和效果。方法选择2007年1月至2011年1月本院就诊并接受新生儿听力初筛和复筛的高胆红素血症足月新生儿(血清总胆红素值>220μmol/L)为观察组,同时在我院产科正常分娩的足月新生儿为对照组。听力初筛与复筛均使用AABR的两阶段模式,初筛时间为生后2～3天,无论通过与否均于出生后42～60天来我院进行复筛;复筛未通过的患儿,于生后3个月时回院行听性脑干反应(ABR)及听性稳态反应(ASSR)检测,并同时行第3次AABR检查。结果观察组1258例(2516耳),初筛通过1540耳,初筛通过率61.2%;对照组1514例(3028耳),初筛通过2913耳,初筛通过率96.2%,两组差异有统计学意义(χ2=1053.42,P<0.001)。观察组复筛通过2003耳,复筛通过率79.6%;对照组复筛通过2970耳,复筛通过率98.1%,两组差异有统计学意义(χ2=507.64,P<0.001)。轻度、中度、重度高胆红素血症患儿复筛通过率分别为87.9%、82.9%、69.4%,差异有统计学意义(χ2=81.49,P<0.001)。经ABR及ASSR检测,对照组2例患儿(2耳)、观察组29例患儿(38耳)确诊为听力障碍。结论高胆红素血症新生儿听力障碍发生率明显高于对照组;血清胆红素水平越高,听力筛查通过率越低。高胆红素血症患儿应进行听力筛查。     

新生儿高胆红素血症脑干听觉诱发电位检测的临床意义

目的观察高胆红素血症对新生儿脑干听功能的影响。方法应用脑干听觉诱发电位（BAEP）检查90例足月新生儿高胆红素血症（高胆组）及30例正常对照组。结果与对照组比较高胆组血清胆红素水平与PL（各波峰潜伏期）或IPL（各波峰间期）时间异常率密切相关，胆红素水平越高，PL或IPL异常率越高。血清总胆红素浓度超过256．5μmol／L，可出现PL及IPL异常改变。高胆组BAEP各波的PL和IPL延长，与对照组比较差异有显著性。结论足月儿血清总胆红素浓度超过256．5μmol／L，中枢神经系统即可受到损害，应给予积极治疗。BAEP对了解新生儿听觉和脑干功能障碍有意义。     

Auditory brainstem response and otoacoustic emissions in hearing screening of full term infants with hyperbilirubinemia

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.     

Infant hearing screening with an automated auditory brainstem response screener and the auditory brainstem response

From 1653 babies hospitalized in the Veterans General Hospital—Taipei from 1993 to 1995, 260 infants at risk of hearing impairment were selected. The risk criteria of hearing impairment for neonates were based on the recommendation of the US Joint Committee on Infant Hearing, 1990 Position Statement. All these infants were screened with the Algo-1 Plus, an automated auditory brainstem response (ABR) screener at a mean postconceptional age of 40.7 ± 4.5 weeks. Thirty-nine cases (39/260, 15%) involving 57 ears (57/520, 11%), failed the screening. Except for one infant who died, the babies had an ABR test for both air- and bone-conducted stimuli and an otological examination. The case-specific incidence of conductive hearing deficit at the initial ABR test was 5.4%. The prevalence of sensorineural hearing deficits was between 2.3% confirmed and 3.1% including infants who did not have follow-up tests. The n-value that indicated agreement between the Algo-1 and ABR results was 0.64, and the overall efficiency of using Algo-1 to correctly identify pass or failure of the ABR was 83%.     

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。     

Auditory brainstem evoked response as a hearing test in infants and children: A follow up study

Abstract In recent years the auditory brainstem evoked response (BSER) has become an established aid in assessing hearing in unco-operative subjects. We have reviewed our experience with this technique in 293 infants and children aged less than 11 years. We have found that the threshold for click BSER correlates well with the average audiometric threshold in the 2–4 kHz range. We have had encouraging preliminary experience to support the claim by other workers that 500 Hz stimuli may be used to assess low tone auditory function. In interpreting results it is important to appreciate that hearing levels may fluctuate with disorders such as otitis media and occasionally in cases of meningitis. Caution is also advised in interpreting results in cases where central nervous system pathology capable of affecting auditory pathways is known to exist.     

Feasibility of neonatal hearing screening program with two-stage transient otoacoustic emissions in Turkey

BACKGROUND: The objective of this study was to investigate the incidence of hearing loss in neonates and evaluate the feasibility of a two-stage Transient Evoked Otoacoustic Emission (TEOAE) screening test. Maternal concerns about hearing screening were also studied. METHODS: Neonatal intensive care patients and well babies were screened using a two-stage TEOAE test, which was followed by an Auditory Brainstem Response (ABR) test for those babies who failed the first test twice. RESULTS: In total, 711 neonates were screened. At the end of the two TEOAE tests, the cumulative pass rate was 99.3% and false-positive rate was 0.3%. Five neonates (0.7%) were referred for the ABR test. Sensorineural hearing loss was found in three of them (0.4%). Of these three neonates, one was from the well baby nursery and two were from the NICU population. Families generally welcomed the screening program, with no refusals. Positive test results have not caused important maternal concerns. CONCLUSIONS: Congenital hearing impairment is a prevalent disease in Turkey. The two-stage TEOAE program is suitable for the neonatal hearing screening program. In general, hearing screening tests do not cause notable maternal concerns.     

高胆红素血症新生儿总胆红素/白蛋白比值与脑干听觉诱发电位的关系

目的 探讨总胆红素/白蛋白比值与脑干听觉诱发电位(BAEP)的相关性及其预测高胆红素血症新生儿听力损害的临床价值.方法 检测113例新生儿的总胆红素(TSB)、白蛋白水平,计算总胆红素/白蛋白比值(B/A),将B/A值≥ 3.0 × 10-3的83例新生儿作为观察组,并根据B/A值分4个亚组;另30例B/A ﹤ 3.0 × 10-3的新生儿作为对照组.检测所有新生儿的BAEP,分析TSB水平、B/A值与BAEP异常的相关性.结果 观察组各亚组间新生儿的BAEP异常率差异有统计学意义(P ＜ 0.01),随B/A值增大,BAEP异常率增高;观察组各亚组间新生儿BAEP的Ⅴ波潜伏期及Ⅰ-Ⅴ、Ⅲ-Ⅴ波间期的差异有统计学意义(P均＜ 0.05);TSB水平、B/A值的工作特征曲线(ROC)下面积(AUC)差异也有统计学意义(P ＜ 0.05);BAEP异常与B/A值密切相关(χ2 ＝ 13.489,P ＜ 0.05).结论 B/A值与BAEP异常相关性高,具有预测高胆红素血症新生儿听力损害的临床价值.     

Automated auditory brainstem response in neonatal hearing screening

Severe congenital hearing impairment is an important handicap affecting 0.1% of apparently healthy liveborn infants and 1-2% of graduates of neonatal intensive care units. The prognosis for intellectual, emotional, language and speech development in the hearing-impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 mo. Universal screening is preferable, since about 50% of infants with hearing loss are not discovered if neonatal hearing screening is restricted to high-risk groups. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer/middle ear and cochlea but also about the auditory pathway up to the brainstem. AABR has an agreement with conventional auditory brainstem response up to 98%. It uses a 35 dB near hearing level click. No operator interpretation is needed and it can be used on the ward and during oxygen therapy without disturbance from ambient noise. Reported referral rates in a hospital-based screening programme at the time of discharge vary, with an average of 4%. AABR has also been used in a home-based setting, with the same results. The time necessary for screening varies with the setting, but ranges from 4 to 15min. Initial costs range from $15 to $25 per test, which is similar to neonatal screening for metabolic diseases. In addition to individual healthcare savings, early diagnosis may lead to savings on costs of intensive speech-language intervention and educational facilities.