新生儿听力筛查结果及高胆红素血症与多因素影响的分析

目的 分析新生儿听力筛查结果及高胆红素血症对新生儿听力的影响。方法 回顾2008-2012年我科所做的新生儿听力筛查资料,将产科出生正常足月新生儿2 677例（5 354耳）列为正常新生儿组;新生儿重症监护（NICU）高胆红素血症新生儿共368例,根据其合并的听力高危因素,分为单纯高胆红素血症组（244例,488耳）、高胆红素血症合并早产/低出生体重组（22例,44耳）、高胆红素血症合并肺炎组（35例,70耳）、高胆红素血症合并窒息组（26例,52耳）、高胆红素血症合并其他两项以上高危因素组（41例,82耳）,共六组。各组均采用瞬态诱发耳声发射（TEOAE）仪进行听力筛查,所有初筛结果未通过者于出生42d复筛;为避免迟发性听损,对高胆红素儿无论初筛通过与否均在42d进行复筛并联合自动听性脑干反应（AABR）检查。并对初筛结果进行分析报告。结果 各组初筛单耳通过率分别为：正常新生儿组92.32%、单纯高胆红素血症组87.09%、高胆红素血症合并早产组81.82%、高胆红素血症合并肺炎组78.57%、高胆红素血症合并窒息组75%、高胆红素血症合并其他两项以上高危因素组64.63%。高胆红素血症患儿听力筛查通过率明显低于正常新生儿组,高胆红素血症的基础上再合并其他高危因素者,其听力筛查通过率进一步下降,差异有统计学意义（P〈0.05）,而合并的高危因素增加到两项以上者,其通过率下降更显著（P〈0.01）。结论 高胆红素血症患儿听力损失风险明显高于正常人群,高危因素增加其风险亦相应增加,基层听力工作人员应高度重视此类患儿,重点复查随访,同时,应结合AABR检查,以防漏诊、误诊。

Multivariate analysis of the newborn hearing screening results and high bilirubin levels

Objective To analyze the newborn hearing screening results and hyperbilirubinemia（HBB） and various risk factors impact on the pass rate of newborn hearing screening. Method Data from 2008 to 2012 in our hospital was reviewed, during which the newborn hearing screening data from the obstetric and NICU, including normal fullterm newborns from obstetrics was total of 2677 cases （5354 ears）, newborns suffer from hyperbilirubinemia from NICU, 368 cases with hyperbilirubinemia based on the hearing risk factor was divided into pure hyperbilirubinemia group （244 cases, 488 ears）, HBB with premature delivery low birth weight group （22 cases, 44 ears）, with hyperbilirubinemia and pneumonia （35 cases, 70 ears）, hyperbilirubinemia with asphyxia group （26 cases, 52 ears）, HBB to merge two or more other risk factors group （41 cases, 82 ears）, each group adopt transient evoked oaes （TEO- AE） instrument for hearing screening, all failed receive another screening after 42 days later, hearing loss in high- risk children sifting through or not require joint automatic brainstem response （AABR） examination 42 days after. The result was the preliminary analysis report. Result At the beginning of each sieve monaural pass rate is respec- tively： normal newborn group 92.32%, pure HBB disease group 87.09%, high bilirubin merge the preterm group 81.82%, with hyperbilirubinemia and pneumonia in 78.57%, 75% with hyperbilirubinemia and suffocation, hyperbilirubinemia merged two or more other risk factors group was 64. 63%. Hyperbilirubinemia hearing screening in children with passing rate significantly lower than That of normal group, the hyperbilirubinemia merged other risk factors, on the basis of their hearing screening passing rate fall further. There was significantly difference （P〈0.05）, and combined to increase two or more risk factors, the passing rate decreased more significantly （P〈0.01）.Conclusion HBB blood disease in children with hearing loss risk is significantly higher than norm