重度高胆红素血症新生儿的听力损伤分析

目的探讨重度高胆红素血症新生儿的听力损伤特点及其影响因素。方法35例重度高胆红素血症新生儿根据临床是否实施换血治疗分为两组,A组(换血治疗)21例;B组(未换血治疗)14例,所有患儿予听性脑干诱发电位(ABR)检测,异常者于3个月后随访。结果A组听反应阈为(57.14±19.91)dBnHL,B组为(63.93±20.97)dBnHL(P>0.05)。两组ABR反应阈增高、ABR全波缺失及重度耳发生率的差异有显著性(P均<0.05)。在90dBnHL短声刺激下,两组Ⅰ波潜伏期及Ⅰ~Ⅴ波间期异常的差异有显著性(P均<0.05)。3个月后随访,两组ABR异常恢复率的差异有显著性(P<0.05)。结论换血患儿ABR发生异常程度轻于未换血患儿,且3个月后的恢复率亦好于未换血患儿。重度高胆红素血症患儿达到换血指征时,及早进行换血治疗能减轻听力损伤程度,有必要对重度高胆红素血症患儿进行早期的听力检测以及跟踪随访。

A study of neonatal hearing loss induced by severe hyperbilirubinemia

Objective To evaluate the characteristic pattern and risk factors of hearing loss in neonates with severe hyperbilirubinemia.Methods Auditory brain-stem response(ABR) was measured in 35 neonates with severe hyperbilirubinemia.They were assigned in group A(21 cases,receiving exchange transfusion treatment) and group B(14 cases,receiving no exchange transfusion treatment).Those hearing impaired neonates were rechecked via ABR after 3 months.Results In group A,the mean hearing threshold was(57.14±19.91)dBnHl,and group B was(63.93±20.97)dBnHL,there was no statistical difference(P>0.05).The mean hearing threshold of ABR,full wave deletion of ABR and incidence of severe abnormality in group A were lower than those in group B(P<0.05).In 90dBnHL short sound stimulation,the abnormality of wave Ⅰ and interpeak latencies Ⅰ～Ⅴ waves were significant differences(P<0.05).A follow-up of 3 months showed that the recovery of ABR abnormality was significant difference between these two groups(P<0.05).Conclusion The incidence of ABR abnormality in neonates receiving exchange transfusion was less than those without exchange transfusion,and there were higher recovery rate of ABR abnormality in neonates receiving exchange transfusion.Early exchange transfusion can relieve abnormal degree of ABR.It is necessary to carry out early hearing screening and periodic follow-up in neonates with severe hyperbilirubinemia.