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。

Early detection of hearing impairment in high-risk infants of NICU

Objective Hearing impairment or loss is a common disorder at birth. Many perinatal conditions may also cause hearing impairment. The present study aimed at investigating the incidence and morbidity of hearing impairment in critically ill neonates with high risk factors in neonatal intensive care unit (NICU). Methods Patients were evaluated using the auditory brain-stem response (ABR) to detect hearing impairment or loss in 248 neonates stabilized or before discharge from the NICU during the period from Dec. 1999 to Aug. 2001 in SCMC. In this article, high risk factors of hearing loss included severe asphyxia, hyperbilirubinemia and very low birth weight, persistent pulmonary hypertension or on a ventilator, exposed to ototoxic medications such as aminoglycosides and diuretics, a family history of hearing loss, meningitis and craniofacial anomalies, etc. Screening test was performed with a 70 dB(SPL) hearing level click stimulus to each ear. Results Seventy-two newborns had detectable hearing impairment in all the patients studied, the incidence of hearing impairment was 29.03%. Among them 3 cases had serious hearing loss. Twenty cases were among the 50 asphyxiated newborns (40.0%); 24 were from the 91 neonates with hyperbilirubinemia (26.37%); 15 were from the 44 premature infant group (34.09%), three of 4 premature cases with birth weight less than 1 500 g had hearing impairment. Six cases were among the 15 newborns who used mechanical ventilation (40.0%); 19 cases were among the 46 newborns who received ototoxic agents (41.30%). Conclusions Critically ill neonates with some specific high risk factors had a significantly high incidence of hearing impairment. Early hearing screening is necessary for neonates who are discharged from NICU.