新生儿高胆红素血症血清前白蛋白及总胆红素/白蛋白比值与脑干听觉诱发电位的关系

目的 研究新生儿高胆红素血症患儿血清前白蛋白水平、总胆红素/白蛋白(B/A)比值以及脑干听觉诱发电位(BAEP)的变化及其相关性,为早期预测高胆红素血症的神经毒性提供新方法.方法 根据胎龄、体质量及是否符合黄疸干预标准将出生7d内的94例新生儿高胆红素血症患儿分为BAEP正常组47例和BAEP异常组47例.检测两组患儿...     

新生儿高胆红素血症脑干听觉诱发电位的临床意义

通过脑干听觉诱发电位(BAEP)的检测,研究血清胆红素水平对新生儿听力的影响.对240例(4800耳)高胆红素血症患儿进行了BAEP检测,并以240例正常新生儿作为对照组,随访监测异常患儿.高胆患儿中BAEP异常161例(253耳),总异常耳数率52.7%.同时发现高胆红素血症程度越重,BAEP异常改变越严重.随访114例BAEP异常患儿,14例仍有中、重度异常,其中脑瘫2例.研究提示,BAEP是简便易行、无创性、客观性好的检测方法,能及早发现听力异常并进行干预.     

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。     

重度高胆红素血症新生儿总胆红素/白蛋白比值及酸中毒与脑干听觉诱发电位异常的关系

目的：探讨重度高胆红素血症新生儿总胆红素/白蛋白比值（B/A比值）、酸中毒与脑干听觉诱发电位（BAEP）异常的关系及其临床意义。方法：纳入2008年11月至2009年10月间重度高胆红素血症患儿967例。按照BAEP的结果,分为BAEP正常组（799例）和BAEP异常组（168例）。对B/A比值、酸中毒与BAEP的关系分别进行单因素分析,再根据日龄因素分别进行分层χ2检验。结果：单因素分析结果显示,BAEP异常组较BAEP正常组具有更低的pH值和BE值以及更高的B/A比值,差异有统计学意义。分层χ2检验分析结果显示,对于重度高胆红素血症任何日龄组的患儿,当存在酸中毒或当B/A比值>1时,其BAEP异常的发生率均较对照组增高,差异均有统计学意义。结论：高B/A比值、酸中毒是重度高胆红素血症患儿发生BAEP异常的危险因素,且对于任何日龄段的患儿均是如此。故对于任何日龄组的重度高胆红素血症患儿,当存在上述危险因素时,应尽快纠正其酸中毒,降低B/A比值,以降低胆红素听力损伤的发生。     

新生儿高胆红素血症脑干听觉诱发电位的临床意义

通过脑干听觉诱发电位(BAEP)的检测，研究血清胆红素水平对新生儿听力的影响。对240例(480耳)高胆红素血症患儿进行了BAEP检测，并以240例正常新生儿作为对照组，随访监测异常患儿。高胆患儿中BAEP异常16l例(253耳)，总异常耳数率52．7％。同时发现高胆红素血症程度越重，BAEP异常改变越严重。随访114例BAEP异常患儿，14例仍有中、重度异常，其中脑瘫2例。研究提示，BAEP是简便易行、无创性、客观性好的检测方法，能及早发现听力异常并进行干预。     

重度高胆红素血症新生儿脑干听觉诱发电位的改变

目的 观察新生儿重度高胆红素血症脑干听觉传导系统的改变.方法 根据血清总胆红素水平把77例新生儿分成3组:A组31例(胆红素342.0～427.5 μmol/L),B组29例(胆红素427.5～513.0 μmol/L),C组17例(>513.0 μmol/L),3组新生儿进行脑干听觉诱发电位检测.结果 3组患儿Ⅰ波及Ⅰ-Ⅲ峰间期异常率随胆红素水平升高而升高,差异有显著性(P<0.01),Ⅲ波、Ⅴ波及Ⅲ-Ⅴ峰间期异常率3组间差异无显著性(P>0.05).3组患儿Ⅴ波反应阈均以轻中度升高为主,A、B两组主要表现为轻度升高,C组主要表现为中度升高,1例患儿重度升高.结论 重度高胆红素血症可导致新生儿听神经损害,血清胆红素水平与脑干听觉诱发电位异常程度有直接关系,主要表现为外周听神经损害,客观听域轻中度升高,应合理干预高胆红素血症以减少神经系统损害.     

总胆红素与白蛋白比值对预测胆红素神经毒性价值的探讨

目的　探讨总胆红素 /白蛋白比值 (B/A)与脑干听觉诱发电位 (ABR)的关系及在预测胆红素神经毒性中的价值。方法　将 43例足月非溶血性高胆红素血症患儿 ,根据ABR表现分成A、B、C三组 ,比较三组患儿血清总胆红素 (TBC)、B/A的变化 ,分析B/A与ABR的相关性。结果　与A、B两组比较 ,C组TBC及B/A比值均明显升高 (P <0 0 5 ,P <0 0 1) ,B/A比值与ABR异常密切相关 (χ2 =7 76 ,P <0 0 5 )。结论　B/A比值是预测胆红素脑病的良好指标 ,对于足月高胆患儿B/A比值 >5 0× 10 -3 者应采取积极的治疗措施。     

新生儿高胆红素血症听觉诱发电位检测的临床意义

目的 通过对新生儿高胆红素血症患儿进行胞干听觉诱发电位(BAEP)检测，评估高胆红素血症在未发生核黄疸时对脑损害及听力的影响。方法 对新生儿高胆红素血症患儿入院后进行脑干听觉诱发电位的测定。结果 49例高胆红素血症患儿中异常BAEP发生率为37％(18／49例)，表现为各波潜伏期(PL)及波间潜伏期(IPL)的延长和听阈值的增高，听阈值随胆红素浓度的增高而增高，经治疗后黄疸消退，脑干听觉诱发电位大部分恢复正常。结论 高胆红素血症对新生儿可造成听力损害，BAEP是检测高胆红素血症患儿听力筛查的重要手段之一。     

新生儿高胆红素血症听觉诱发电位检测的临床意义

目的　 通过对新生儿高胆红素血症患儿进行脑干听觉诱发电位 (BAEP)检测 ,评估高胆红素血症在未发生核黄疸时对脑损害及听力的影响。 方法 　对新生儿高胆红素血症患儿入院后进行脑干听觉诱发电位的测定。 结果 　 49例高胆红素血症患儿中异常BAEP发生率为 3 7%( 18/ 49例 ) ,表现为各波潜伏期 (PL)及波间潜伏期 (IPL)的延长和听阈值的增高 ,听阈值随胆红素浓度的增高而增高 ,经治疗后黄疸消退 ,脑干听觉诱发电位大部分恢复正常。 结论 　高胆红素血症对新生儿可造成听力损害 ,BAEP是检测高胆红素血症患儿听力筛查的重要手段之一     

胆红素/清蛋白比值及脑干听觉诱发电位与胆红素神经毒性的相关性

目的 探讨高胆红素血症患儿血清总胆红素(TBIL)、总胆红素/清蛋白比值(B/A比值)与胆红素神经毒性的相关性,分析高胆红素血症患儿脑干听觉诱发电位(ABRs)中脑干功能损伤及听神经功能损伤敏感程度.方法 将91例足月高胆红素血症患儿根据ABRs结果分为A组(未见明显异常)、B组(仅脑干功能受损)、C组(仅听神经受损)、D组(脑干功能及听神经均受损),比较各组间TBIL、B/A比值的差异并分析二者与ABRs的关系.结果 A组与B组比较,TBIL差异无统计学意义(t=1.566,P＞0.05),B/A比值差异有统计学意义(t=1.898,P＜0.05);B组与C组TBIL、B/A比值比较差异均有统计学意义(tTBIL=2.372,PTBIL＜0.05;tB/A=2.794,PB/A＜0.01);A组与C组比较、A组与D组比较、B组与D组比较,TBIL比值差异均有统计学意义(t =2.452、3.328、2.256,P均＜0.05);A组与C组比较、A组与D组比较、B组与D组比较,B/A比值差异均有统计学意义(=2.571、4.680、2.657,P均＜0.05、0.01);C组与D组比较,TBIL、B/A比值差异均无统计学意义(tTBIL=0.705,PTBIL ＞0.05;tB/A=0.636,PB/A ＞0.05).TBIL、B/A比值的受试者工作特征曲线(ROC)下面积分别为0.919、0.829.TBIL、B/A比值与ABRs有显著相关性(r=0.495、0.564,P均＜0.05).结论 B/A比值是预测足月儿胆红素神经毒性的良好指标,ABRs异常中脑干功能较听神经易受损.     

Follow-up study of auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy

BACKGROUND: Several authors reported that there was a close relationship between unbound bilirubin concentrations and abnormal results of auditory brainstem responses. Full-term infants with high-unbound bilirubin concentrations who were treated with human albumin were followed to evaluate their hearing abilities by using auditory brainstem responses. METHODS: Fifty-eight infants (gestational age, 39.4 +/- 1.4 weeks; birthweight, 3,245 +/- 435 g) with high unbound bilirubin concentrations (> or = 0.9 micro g/dL) were treated with intensive phototherapy. Twenty infants (control group) received only phototherapy, while 38 others (albumin-treated group) were also given i.v. human albumin administration (1 g/kg bodyweight) during the first 2 h of phototherapy. The follow-up study of auditory brainstem responses was carried out at 6 and 12 months of age. Development quotient tests were carried out at 18 months of age. RESULTS: Abnormalities of auditory brainstem response were detected in three infants in the albumin-treated group and six infants in the control group at 6 months. Two infants in the albumin-treated group and four infants in the control group had improved at 12 months. The results of the follow-up study at 18 months of age in the both groups were normal with development quotient >85. No patients with hearing disability and cerebral palsy were clinically detected at the age of 2 years. CONCLUSION: The results suggest that albumin priming might be effective for decreasing the rate of auditory brainstem response abnormalities at 6 months.     

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...     

Vestibular evoked myogenic potentials in term newborn infants with severe hyperbilirubinemia

Background: The aim of this study was to determine the effects of severe hyperbilirubinemia on vestibular evoked myogenic potentials (VEMP). Methods: A prospective study was designed. Seventeen term infants who suffered from severe hyperbilirubinemia in the first 5 postnatal days of age were included in the study group. The control group consisted of 17 healthy term infants. Audiological evaluation was performed, including tympanometry and transient evoked otoacoustic emissions, and VEMP tests. Results: All newborns passed audiological evaluation. Biphasic waveforms of VEMP were obtained in all of the 34 infants who had been tested. Both latencies of p13 and n23 were significantly delayed in the severe hyperbilirubinemia group (P < 0.05). Conclusion: This pilot is the first study to show that severe hyperbilirubinemia causes delay in VEMP latencies. We suggest that severe hyperbilirubinemia might affect the vestibular nuclei or the integrity of the inferior vestibular nerve and vestibulospinal tract. Further studies need to explain the relation between hyperbilirubinemia and the vestibular system.     

体感诱发电位和脑干听觉诱发电位预测恢复期严重意识障碍患儿意识恢复的价值

目的探讨恢复期严重意识障碍患儿体感诱发电位(SEP)、脑干听觉诱发电位(BAEP)动态变化特点,及其对患儿意识恢复的预测价值。方法 2013年7月-2014年6月住院治疗的脑损伤恢复期严重意识障碍患儿52例,入住康复科48h内完成临床评估和SEP、BAEP评估,病程满12个月、脱离最低意识状态、死亡为评估止点。结果 52例患儿在病程1年内有27例恢复意识,意识恢复率为51.2%,各种病因所致的严重意识障碍患儿的意识恢复率差异无统计学意义(P0.05)。首次SEP检查分级越高,意识恢复率越低(P0.001);首次SEP检查分级为Ⅰ级的患儿24例,其中20例意识恢复,有4例(3例多次复查SEP均为1级,1例转为3级)在病程1年时其意识仍未恢复。首次SEP检查为Ⅱ级或Ⅲ级的患儿28例,有3例患儿由Ⅱ级转为Ⅰ级,其中2例意识完全恢复,有2例患儿由Ⅲ级转为Ⅰ级,其中有1例意识完全恢复。其余23例持续为Ⅱ级或Ⅲ级,在病程1年时最终只有3例意识完全恢复。52例患儿中有50例BAEP检查正常,Ⅱ级、Ⅲ级各1例。结论 SEP可以作为恢复期严重意识障碍患儿意识是否恢复的有效预测指标。BAEP对于处于恢复期的严重意识障碍患儿的意识是否恢复缺乏预测性。     

Visual and brainstem auditory evoked potentials in children with headache

Background: Headache is a common problem in the pediatric population. The purpose of the present study was to evaluate visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with headache. Methods: Thirty‐seven children fulfilling the International Headache Society Criteria for a diagnosis of migraine, 35 children with tension‐type headache and 40 healthy children (control group) were enrolled in the study. Results: The mean age of patients and controls was 10.4 years. P100 latency and amplitudes of migraine patients were significantly higher than children with tension‐type headache and control subjects. Children with tension‐type headache also had higher P100 latency and amplitude values than control subjects but there was no statistical difference. BAEP responses were similar between all groups. Conclusion: Measurement of VEP latency and amplitude is a valuable and reliable test for the diagnosis of migraine and can be used safely in childhood.     

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。     

Follow-up study of auditory brainstem responses in hyperbilirubinemic newborns treated with exchange transfusion

Changes in auditory brainstem responses (ABR) were studied and followed in hyperbilirubinemic newborns before and after exchange transfusion (ET), in order to check their usefulness in the early detection of acute and chronic bilirubin encephalopathy. ABR were measured in 10 newborns with marked hyperbilirubinemia (total bilirubin concentration [TBC] ≧ 20 mg/dL, direct bilirubin concentration < 2 mg/dL) before and after ET. The means of birthweight, gestational age, and day of life on admission were 3267 g, 38.2 weeks and 3.4 days, respectively. The ABR measurements were performed before ET and 6.0 days (the mean) after the ET. The follow-up of ABR was performed at 3 months of life. In comparison with the control values, the mean latencies of ABR were significantly prolonged (I, I-III, and I-V: P < 0.05) and the mean amplitudes were significantly decreased (I, III and V: P < 0.001) before ET. Significant improvement of ABR was noticed after the ET, especially in the shortening of the latency of wave I (P < 0.02) and in increasing the amplitudes of wave III and V (P < 0.02 and (P < 0.01, respectively), though the recovery of the latency of I-V (P < 0.02) and the amplitudes of I, III and V wave (P < 0.001, P < 0.001 and P < 0.01, respectively) were delayed in comparison to the control. The follow-up data of ABR showed that, in two of nine infants (one was lost from the follow-up), there were still abnormal findings at 3 months of age. Only one of these, who prolonged the recovery of ABR until 5 years of age, developed a border intelligence. Though ET is effective for improvement of acute bilirubin encephalopathy with impaired ABR, a complete recovery of the ABR might be delayed in marked hyperbilirubinemia. The delay in improvement of ABR abnormalities might be possibly used as an early predictor for following chronic bilirubin encephalopathy.