不同日龄新生儿诱发性耳声发射测试

对20例正常新生儿在出生后第1～5天逐日行瞬态诱发性耳声发射(TEOAE)和畸变产物耳声发射(I)POAE)的测试。了解不同日龄新生儿畸变产物耳声发射(DPOAE)和瞬态诱发性耳声发射(TEOAE)的特征，探讨应用OAE作新生儿听力筛查的最佳时机。随新生儿日龄的增加，其TEOAE和DPOAE检出率和反应幅值逐步提高，新生儿生后第1～2天的检出率和反应幅值显著低于第3～5天，至生后第3～5天．TEOAE和DPOAE检出率接近或达到100％，反应幅值也趋于稳定。结论：应用TEOAE和DPOAE进行新生儿听力筛查时，其日龄至少应在3天或3天以上，测试TEOAE和DPOAE快速、方便，不失为普遍性新生儿听力筛查首选方法。     

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

OBJECTIVES: To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as a first stage in-hospital hearing screening tool in this population. STUDY DESIGN: The study group was a cohort of 346 VLBW infants born in 1998-2000 at The Sheba Medical Center. The prevalence of hearing impairment in the study group was compared with that of all other newborn infants participating in a universal newborn hearing screening programme during the same period. To evaluate the effectiveness of TEOAE, a control group of 1205 healthy newborns who had no known risk factors for hearing impairment was selected. The results and follow up of hearing screening for these infants were examined retrospectively. RESULTS: Only one VLBW infant (0.3%) was diagnosed with bilateral sensory-neural hearing loss. In addition, nine infants (2.7%) were diagnosed with conductive hearing loss. Bronchopulmonary dysplasia and low Apgar score were the most significant factors for predicting the occurrence of conductive hearing loss. The percentage of VLBW infants who successfully passed the in-hospital TEOAE screening was 87.2, compared with 92.2% in the full term control group. No false negative cases were detected on follow up. CONCLUSIONS: The study shows a low incidence of sensory-neural hearing loss in a cohort of VLBW infants and a relatively high incidence of conductive hearing loss. TEOAE screening was found to be an effective first stage in-hospital hearing screening tool in this population.     

Outcomes of neonatal screening for hearing loss by otoacoustic emission.

AIM: To assess universal neonatal screening for bilateral hearing impairments averaging 40 dBHL or worse in the better ear, using transient evoked otoacoustic emission screening (TEOAE) testing. METHODS: A three year cohort (14,353 infants born from January 1992 to 1995) was screened and subsequently followed up by hearing surveillance methods, including a distraction test screen from 7 months of age. The entire cohort was used to evaluate the outcome of the screen. A subcohort of 8172 district residents was used to evaluate the continuing worth of the distraction test programme. RESULTS: Nineteen infants (1.3/1000) with a targeted hearing impairment failed the neonatal TEOAE test. Six profoundly deaf infants identified by the TEOAE screen, were fitted with hearing aids at a median age of 16 weeks. One remained without an aid. Of 12 infants with a moderate impairment, only seven accepted hearing aid fitting and the median age of being fitted with an aid increased to 42 weeks. By the time of the analysis 22 children with a targeted hearing impairment (1.5/1000) had been identified from the cohort. Of the three missed neonatally, one was cared for elsewhere, another had a progressive loss, and the third had central deafness. Twenty children were ascertained with a congenital peripheral deafness. Of these, eight (40%) had risk factors identifiable neonatally. Only the child with central deafness was missed by TEOAE screening and subsequently identified by behavioural tests in infancy. The TEOAE screen outperformed the distraction test in terms of processes and yield and was 25% less expensive. CONCLUSIONS: The analysis confirmed the worth within the district of the TEOAE hearing screen. It will thus be continued as a universal neonatal screen with the distraction test being retained as a selective screen in the latter half of infancy.     

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.     

The Milan Project: a newborn hearing screening programme

Aim: Since 1997 a newborn hearing screening programme has been implemented by the U.O. Neurologia-Neurofisiopatologia and Dipartimento di Neonatologia of the Istituti Clinici di Perfezionamento ICP in Milan for both babies with no risk and those at risk of hearing impairment. This programme was named the Milan Project. Methods: The protocol for no-risk babies consisted of three stages: in the first two stages, newborns were tested with transient click-evoked otoacoustic emissions (TEOAE), in the third one with conventional auditory brainstem responses (ABR). The first TEOAE test was performed by 36 h of age, before discharge, the second one after 15-30 d in case of referral, and the third one, by ABR, for those babies who failed the second TEOAE stage. Newborns at audiological risk were submitted to conventional ABR before the third month of corrected age. Some of this latter population was also submitted to the TEOAE test. The entire tested population (no-risk babies and newborns at audiological risk) consisted of 19 777 babies: 19 290 without risk (“no risk”) and 487 at risk (“at risk”). Results: During the course of the Milan Project, hearing impairment (ABR threshold equal to or greater than 40 dB nHL) was identified in 63 newborns (19 from the no-risk and 44 from the at-risk population), with a prevalence of 0.32%. Bilateral hearing impairment (BHI) was found in 33 newborns (10 from the no-risk and 23 from the at-risk population), corresponding to 0.17%. Among infants with bilateral hearing impairment, 30.3% had no risk factors. The prevalence of hearing impairment was determined on days 15-30 after birth.

Conclusions: The results show that the implementation of a hospital-based, universal neonatal hearing screening programme for babies with and without audiological risk is feasible and effective. The effectiveness of the programme has increased as a function of the years since its inception, with a strong decrease in the referral rate. Further improvement is obtained if the TEOAE measurements are repeated in cases of referral scoring before discharge.     

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。     

Newborn oto-acoustic emission hearing screening tests: preliminary evidence for a marker of susceptibility to SIDS

OBJECTIVE: To evaluate the newborn transient evoked otoacoustic emission (TEOAE) hearing screening tests of infants later diagnosed with the sudden infant death syndrome (SIDS). STUDY DESIGN: In a case-controlled study, the newborn TEOAE hearing screens of 31 infants who subsequently died of SIDS were retrospectively compared to those of 31 newborn infants that survived the first year of life. SIDS cases were individually matched to surviving controls based on gender, term versus preterm age and NICU versus well baby nursery. RESULTS: The TEOAE screens of SIDS infants demonstrated significantly decreased signal to noise ratios at 2000, 3000, and 4000 Hz (p<0.05) on the right side compared to healthy control infants. CONCLUSION: Newborns at risk for SIDS are currently indistinguishable from other newborns and are only identified following a later fatal event. A unilateral difference in cochlear function is a unique finding that may offer the opportunity to identify infants at risk of SIDS during the early postnatal period with a simple non invasive hearing screen test. The ability to implement preventative measures well in advance of a potential critical incident would be an important breakthrough.     

Prediction of permanent hearing loss in high-risk preterm infants at term age

The aim of this series was to assess hearing screenings; auditory brainstem responses (ABR), transient evoked otoacoustic emissions (TEOAE) and free field auditory responses (FF) for the prediction of permanent bilateral hearing loss in high-risk preterm infants at term post-conceptional age. A total of 51 preterm infants (gestational age <34 weeks, birth weight <1500 g) underwent examinations at term and hearing, speech and neurological development were followed up until a corrected age of 18 months. Significant hearing defects were verified by broader ABR examinations under sedation and by clinical ward observation including responsiveness to sounds and enhancement of hearing using an amplification device. Seven bilateral fails in ABR were found, together with nine bilateral fails in TEOAE and four fails in FF screening at term age. Six preterm infants were later confirmed to have a significant permanent bilateral hearing loss, four of whom had also cerebral palsy. Bilateral failure in ABR screening predicted hearing loss with a sensitivity of 100% and a specificity of 98%, TEOAE with a sensitivity of 50% and a specificity of 84% and in the FF examination at the levels of 50% and 98%, respectively. Conclusion Transient evoked otoacoustic emissions alone seem not to be so applicable to the neonatal screening of hearing in high-risk preterm infants as shown earlier in full-term infants, possibly because a hearing defect may be due to retrocochlear damage. Consequently, auditory brainstem response screening seems to be more suitable for very low birth weight preterm infants. Received: 21 September 1999 / Accepted: 5 January 2000     

Comparison of costs and referral rates of 3 universal newborn hearing screening protocols

OBJECTIVE: To investigate the costs and referral rates of 3 universal newborn hearing screening programs: transient evoked otoacoustic emissions (TEOAE), automated auditory brainstem response (AABR), and a combination, two-step protocol in which TEOAE and AABR are used. STUDY DESIGN: Clinical outcomes (referral rates) from 12,081 newborns at 5 sites were obtained by retrospective analysis. Prospective activity-based costing techniques (n = 1056) in conjunction with cost assumptions were used to analyze the costs based on an assumed annual birth rate of 1500 births. RESULTS: Referral rates differed significantly among the 3 screening protocols (AABR, 3.21%; two-step, 4.67%; TEOAE, 6.49%; P <.01), with AABR achieving the best referral rate at discharge. Although AABR had the lowest referral rate at discharge and the highest pre-discharge costs, the total pre- and post-discharge costs per infant screened (AABR, $32.81; two-step, $33.05; TEOAE, $28.69) and costs per identified child (AABR, $16,405; two-step, $16,527; TEOAE, $14,347) were similar among programs. CONCLUSION: Although AABR incurs higher costs during pre-discharge screening, it has lower referral rates than either the TEOAE or two-step program. As a result, the total costs of newborn hearing screening and diagnosis are similar among the 3 methods studied.     

Universal hearing screening using transient otoacoustic emissions in a community health clinic

Since 1993, targeted screening of high risk Camden and Islington babies has been carried out in hospital using the transient otoacoustic emission (TEOAE) technique and auditory brainstem responses (ABR). Because targeted screening is difficult to implement, a community pilot study using TEOAE was started in 1995, covering 7% of the resident population. Although uptake has not been above 80%, client satisfaction has been high and numbers requiring more detailed tertiary assessment have been modest (0.5% of the population screened). A comparison was made between the cost of a universal neonatal screen using TEOAE and distraction testing at 7 months of age. The neonatal screen would be no more expensive to implement universally, even when equipment costs are included. A combination of a universal neonatal screen with distraction testing at 7 months for those not screened is likely to give 96% coverage of hearing screening in the first year of life.     

Universal hearing screening using transient otoacoustic emissions in a community health clinic

Since 1993, targeted screening of high risk Camden and Islington babies has been carried out in hospital using the transient otoacoustic emission (TEOAE) technique and auditory brainstem responses (ABR). Because targeted screening is difficult to implement, a community pilot study using TEOAE was started in 1995, covering 7% of the resident population. Although uptake has not been above 80%, client satisfaction has been high and numbers requiring more detailed tertiary assessment have been modest (0.5% of the population screened). A comparison was made between the cost of a universal neonatal screen using TEOAE and distraction testing at 7 months of age. The neonatal screen would be no more expensive to implement universally, even when equipment costs are included. A combination of a universal neonatal screen with distraction testing at 7 months for those not screened is likely to give 96% coverage of hearing screening in the first year of life.

     

Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment: coverage, positive predictive value, effect on mothers and incremental yield. Wessex Universal Neonatal Screening Trial Group

OBJECT: Congenital bilateral permanent childhood hearing impairment (PCHI) impairs communication skills and, in some cases, mental health and employment prospects. Management of PCHI within the first year of life can alleviate most of its adverse effects. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard Health Visitor Distraction Test (HVDT), would increase the rates of early diagnosis. METHODS: Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4-6 mo duration in each hospital. Babies did or did not undergo neonatal screening dependent on the periods during which they were born. We used a transient evoked oto-acoustic emissions (TEOAE) test followed, in infants who failed this test, by an automated auditory brainstem response (AABR) test on the same day. We referred babies with positive results for audiological assessment. RESULTS: 53,781 infants were included in the trial, including 25,609 born during periods of neonatal screening. The neonatal screen achieved 87% coverage of inborn births, with a false alarm rate of 1.5%, and an overall yield from the screen of 90 cases of bilateral PCHI > or = 40dB HTL per 100,000 target population, equivalent to 80% of the expected prevalence of the condition in the population. Seventy-one more babies with moderate or severe PCHI per 100,000 target population were referred before age 6 mo during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The false-negative rate of neonatal screening was significantly lower than that of HVDT screening (4% vs 27%). CONCLUSIONS: Neonatal screening is effective in identification of congenital PCHI and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.     

Universal neonatal hearing screening: the Siena (Italy) experience on 19,700 newborns

BACKGROUND: Hearing loss (HL) is likely to be the most common congenital abnormality in humans, with a reported prevalence of 1 to 3 per 1000 live births. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. As 33-50% of all congenital HLs cannot be detected in a selective hearing risk, use of universal neonatal hearing screening (UNHS) programs is expanding. AIMS: We tested the value of a UNHS protocol, based on a two-stage strategy of Transient Evoked Otoacoustic Emissions (TEOAEs) in all infants, followed by diagnostic auditory brainstem response (ABR) testing in those infants who did not meet TEOAE pass criteria and those infants at high risk for hearing loss. METHODS: TEOAES (292 DP Echoport OAE Analyzer) served as the initial screen, followed by diagnostic ABR (Amplaid MK12) in newborns that did not meet pass criteria for TEOAEs. Additionally, all infants at high audiologic risk according to the Joint Committee on Infant Hearing received a diagnostic ABR evaluation. Of 21,125 total live births, 19,700 were tested (April 1, 1998-July 31, 2006). Accuracy of the UNHS strategy in predicting congenital HL was evaluated by calculating sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Prevalence for all HLs in the neonatal period was 1.78/1000 l.b. (35/19,700), with bilateral HL in 1.42/1000 l.b. (28/19,700) [low risk rate: 0.43/1000 l.b. (8/18,356); high risk infants rate: 14.88/1000 l.b. (20/1344)]. All the HL infants were diagnosed <3 and received intervention <6 months age. ROC curves results showed 100% sensitivity (95% C.I.: 89.0-100) and 99.3% specificity (95% C.I.: 99.2-99.4) of the two-stage strategy in detecting congenital HLs [area under the ROC curve: 0.997 (95% C.I.: 0.995-0.997)]. CONCLUSIONS: (1) The epidemiology of congenital HLs widely justifies UNHS; (2) a two-stage TEOAE and diagnostic ABR screening for congenital HL is feasible, minimally invasive and accurate in the early detection of congenital HL; and (3) a congenital HL screening strategy based exclusively on the use of TEOAEs should always consider the possibility of false negative cases.     

Neonates presenting with temperature symptoms: Role in the diagnosis of early onset sepsis

Background: In this study, we aimed to evaluate the role of fever, hypothermia, and temperature instability in term and preterm newborns during the first 3 days of life and to identify risk factors for early onset sepsis (EOS) among newborns presenting with these temperature symptoms. Methods: In this retrospective cohort study set in our level III neonatal intensive care unit, we included all newborns hospitalized within the first 24 h of life from 2004 to 2007. Results: Of 851 newborns, 127 presented with temperature symptoms during the first 3 days of life (15%): 69 had fever, 69 had hypothermia, and 55 had temperature instability (8%, 8%, and 6%, respectively). Of 127 newborns presenting with temperature symptoms, 14 had culture‐proven EOS/pneumonia (33% of all 42 newborns with culture‐proven EOS/pneumonia), 67 had clinical EOS (30% of all 209 newborns with clinical EOS) and 46 were EOS‐negative (8% of all 600 EOS‐negatives). Factors associated with culture‐proven EOS/pneumonia in newborns presenting with temperature symptoms were maternal fever (P= 0.009), chorioamnionitis (P < 0.001), antibiotic therapy of the mother (P= 0.04), poor skin color (P= 0.001) and syndrome of persistent fetal circulation (P= 0.01). Conclusions: Every seventh newborn hospitalized at our neonatal intensive care unit developed fever, hypothermia and/or temperature instability during the first 3 days of life. Two‐thirds of them had culture‐proven or clinical sepsis. Temperature symptoms were rarely observed in EOS‐negative newborns (8%) but despite low sensitivity, were highly specific for bacterial infection in preterm and term newborns.     

Neonatal screening for citrullinaemia

In a period of 40 months (1st March 1999 to 30th June 2002) 610,000 blood samples were analysed in one screening centre for citrulline as a pilot study for neonatal screening using tandem mass spectrometry. Persistent hypercitrullinaemia (Cit >1.5 mg/dl or 85.5 micro mol/l, not corrected for recovery) was identified in 15 newborns. Four children were diagnosed with classical neonatal onset citrullinaemia and eight with persisting asymptomatic hypercitrullinaemia. In two asymptomatic newborns and in one symptomatic preterm patient, argininosuccinate lyase deficiency was identified as the cause of moderately elevated levels of citrulline (cases not described in this paper). Citrulline concentrations were only temporarily mildly elevated in two newborns and in these the results of the original neonatal screening were therefore regarded as false-positive; we did not find any other false-positives. The screening result allowed the introduction of immediate specific treatment in two cases of citrullinaemia and may have prevented metabolic decompensation in those with presumed mild citrullinaemia. In one child who developed severe hyperammonaemia on the 2nd day of life, sequelae could not be avoided. CONCLUSION: neonatal screening for citrullinaemia is more complex than expected and, with the actual logistics, results may be obtained too late in severe forms.     

Outcome and management of newborns with congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infection is the most common non-genetic cause of hearing loss and neurological disorder in children. Its overall prevalence is approximately 0.5% in Europe. In France, systematic screening during pregnancy is not recommended; screening is performed only if there are maternal or fetal symptoms suggestive of this infection. Approximately 90% of infected newborns are asymptomatic at birth, and among them the risk of neurosensory sequelae is 5–15%. By contrast, the prevalence of neurosensory impairment in symptomatic newborns at birth varies from 17% to 60%. Congenital CMV infection must be confirmed at birth before the 21st day of life by polymerase chain reaction (PCR) on saliva or urine samples. A complete clinical examination, blood tests (blood count, liver function test, CMV PCR), hearing tests, brain ultrasound and eye fundus examination should be performed. Neurological and auditory follow-up must be extended well beyond the neonatal period because the occurrence of neurosensory sequelae may be delayed. Oral valganciclovir is the recommended treatment in moderate or severe congenital CMV infections for a period of 6 weeks to 6 months; such treatment requires regular monitoring because of its possible side effects.     

Ligurian experience on neonatal hearing screening: clinical and epidemiological aspects

AIM: Early identification and rehabilitation of newborns with congenital hearing impairment (HI) by Universal Neonatal Hearing Screening (UNHS). METHODS: The neonatal population was divided into two groups: babies with No Audiological Risk (NAR), and babies With Audiological Risk (WAR). NAR neonates underwent OAE testing, and in case of a doubtful (Refer) result, ABR testing was carried out. All WAR newborns underwent ABR testing within the third month of life. RESULTS: Between February 1, 2002 and December 31, 2004, UNHS was carried out on 32 502 newborns at the 13 regional birth centres, representing 98.7% of the whole regional neonatal population. The prevalence of HI in the population we tested was estimated at about 1 per thousand, while Bilateral Hearing Impairment (BHI) was estimated at 0.65 per thousand. A 3.7% prevalence of HI and a 2.8% prevalence of BHI was observed among the WAR population. Median age at the end of the diagnostic procedures was 6.7 months in the WAR population and 6.9 months in the NAR population. CONCLUSIONS: Our project is based on two levels of testing, which resulted in a 0.28% false-positive rate with 100% sensitivity and 99% specificity. Our screening is the first Italian experience that has been extended to a whole region and the results prove that regional neonatal hearing screening is feasible.     

Universal newborn hearing screening: a 27-month experience in the French region of Champagne-Ardenne

OBJECTIVES: This article reports the creation of a Universal Newborn Hearing Screening (UNHS) program in a French region, Champagne-Ardenne, and the results of its first 27 months. MATERIALS AND METHODS: We introduced a UNHS program in all the Champagne-Ardenne maternities in order to screen all newborns in the region. We used a two-step strategy. The first test consists of automated transiently evoked otoacoustic emissions (TEOAE) and is performed before discharge by a nurse or a midwife. If TEOAE are absent in both ears (positive screening test), the baby is referred to the second test, which could be either TEOAE or automated auditory brainstem response (aABR) 15 days after discharge, by a physician in an outpatient clinic. If the retest is positive in both ears, the baby is referred to diagnostic tests in a reference centre. This procedure also applies to newborns in neonatal intensive care units but, in those cases, the first test procedure is aABR because of the higher incidence of auditory neuropathies in those units. UNHS data are recorded with the other neonatal screening tests in the Regional Neonatal Screening Center, which facilitates the follow-up of newborns. RESULTS: A total of 33 873 newborns were screened, which represents a coverage rate of 92.42%. In those babies, 33 431 had a negative first test and 429 were retested. There were 34 positive retests. Among those 34 children, 27 were actually deaf (0.08%). The median age at diagnosis was shortened from 17 months to 10 weeks. CONCLUSION: Those 27-month results demonstrate the validity of our UNHS program, which relies on the cooperation with maternities, an easy protocol and a strong follow-up procedure.     

NICU高危新生儿早期的听力研究

目的　探讨新生儿重症监护室 (NICU)中重症患儿及高危儿与听力障碍或丧失相关的危险因素及其发病率。方法　对 1999年 12月～ 2 0 0 1年 8月 ,入住我院NICU的 2 4 8例听力障碍高危儿 ,在病情稳定后或出院前用听性脑干反应进行听力评价。结果　全部受检患儿中有 72例呈阳性结果 ,该组新生儿初次检查听力异常的发生率为 2 9 0 3% ,其中 3例系重度以上听力障碍。听力障碍的发生率在窒息组为 4 0 0 0 % ;高胆红素血症组为 2 6 37% ;早产儿组为 34 0 9% ,出生体重 <15 0 0g者阳性率尤高 ;接受机械通气组为 4 0 0 0 % ;应用耳毒性药物组为 4 1 30 %。结论　在NICU住院的新生儿中 ,存在较多与听力障碍有关的高危因素 ,该组新生儿听力障碍的发生率较正常活产新生儿明显增高。所以 ,高危新生儿从NICU出院前应常规进行听力检查。