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。

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

Objective To investigate the character difference and clinical meaning of distortion product otoa-coustic emissions(DPOAE)and auditory brainstem response(ABR)in hearing screening of infants with hyperbilirubinemia.Methods DPOAE and ABR were recorded with Smart-EP and Smart-OAE in 197(394 ears)infants with hyperbilirubinemia.Follow-up was undertaken in 3 or 4 months after birth.Results Of 197(394 ears)newborns,none of them showed obvious manifestations of bilirubin encephalopathy.The incidence of DPOAE abnormality was 14.47%(57/394 ears),whereas the incidence of ABR abnormality was 76.65%(302/394 ears).The level of serum bilirubin concentration was associated with abnormal rates of ABR(P < 0.01),but not DPOAE.Potential high risk facts often exist in those with abnormal DPOAE.Of infants with severe ABR abnormality,around 40.7% had no improvement in 3 or 4 months after birth.Conclusions Neonatal hyperbilirubinemia without obvious manifestations of bilirubin encephalopathy shows high incidence of ABR abnormality.First ABR then DPOAE,or combination of ABR and DPOAE is recommended in hearing screening of neonates with hyperbilirubinemia.