182例高胆红素血症新生儿听力筛查诊断结果临床分析

目的:通过对高胆红素血症新生儿听力筛查诊断结果临床分析,了解高胆红素血症对新生儿听力的影响,并就ABR和TEOAE联合筛查诊断早期发现高胆红素血症导致的听神经病进行大致探讨。方法:以2006年6月～2009年6月182例高胆红素血症新生儿为研究对象,按照血清胆红素水平分为A、B两组,按1∶3的比例随机抽取同期的正常新生儿546例为对照组;初筛复筛均采用筛查型OAE,复筛未通过新生儿转诊听力诊断中心行听力学评估和医学诊断。结果:A组(血清胆红素浓度≥342μmol/L)81例,男53例,女28例,听力筛查初筛未通过率30.86%(25/81),ABR异常率70.37%(57/81),确诊听力障碍23例,确诊率28.39%(23/81);其中11例为TEOAE初复筛通过、ABR检测为缺失或严重异常、高度怀疑听神经病的患儿现已纳入重点随访对象。B组(血清胆红素浓度<342μmol/L)101例,男66例,女35例,听力筛查初筛未通过率17.82%(18/101),ABR异常率43.56%(44/101),确诊听力障碍9例,确诊率8.91%(9/101)。对照组(血清胆红素浓度<220.6μmol/L)546例,男317例,女229例,听力筛查初筛未通过率8.79%(48/546),ABR异常率1.28%(7/546)。结论:高胆红素血症是导致新生儿听力障碍的高危因素,新生儿胆红素水平与听力损失程度成正相关。ABR和TEOAE联合应用对高胆红素血症新生儿特别是听神经病患儿听力的早期评估比单独TEOAE测试应用更准确和全面。

Clinical analysis on hearing screening results of 182 neonates with hyperbilirubinemia

Objective:To understand the effect of hyperbilirubinemia on neonatal hearing,and explore ABR and TEOAE screening in early finding of auditory neuropathy induced by hyperbilirubinemia by analyzing hearing screening results of neonates with hyperbilirubinemia.Methods:182 neonates with hyperbilirubinemia born from June 2006 to June 2009 were selected and divided into A group and B group,then 546 normal neonates were selected randomly according to 1∶3 as control group;screening-based OAE was used in preliminary screening and secondary screening,then the neonates failing in secondary screening were sent to aural diagnostic center for audiological evaluation and medical diagnosis.Results:A group(serum bilirubin concentration≥342 μmol/L,81 cases)included 53 boys and 28 girls,the failing rate in preliminary screening was 30.86%(25/81),the abnormal rate of ABR was 70.37%(57/81),the definite diagnostic rate of hearing impairment was 28.39%(23/81);11 neonates passing TEOAE preliminary screening and secondary screening,deletion or severe deletion of ABR,high suspicion of auditory neuropathy were subsumed in focus of follow-up.B group(serum bilirubin concentration<342 μmol/L,101 cases)included 66 boys and 35 girls,the failing rate in preliminary screening was 17.82%(18/101),the abnormal rate of ABR was 43.56%(44/101),the definite diagnostic rate of hearing impairment was 8.91%(9/101).Control group(serum bilirubin concentration<220.6 μmol/L,546 cases)included 317 boys and 229 girls,the failing rate in preliminary screening was 8.79%(48/546),the abnormal rate of ABR was 1.28%(7/546).Conclusion:Hyperbilirubinemia is a high risk factor of neonatal hearing impairment,there is a positive correlation between neonatal bilirubin concentration and the degree of hearing loss.Combined application of ABR and TEOAE is superior to single TEOAE test in early evaluation of neonatal hyperbilirubinemia,especially in children with auditory neuropathy,the former is more accurate and comprehensive.