自动脑干诱发电位技术在高胆红素血症新生儿听力筛查中的应用

目的探讨自动脑干诱发电位技术(AABR)在高胆红素血症新生儿听力筛查中的可行性和效果。方法选择2007年1月至2011年1月本院就诊并接受新生儿听力初筛和复筛的高胆红素血症足月新生儿(血清总胆红素值>220μmol/L)为观察组,同时在我院产科正常分娩的足月新生儿为对照组。听力初筛与复筛均使用AABR的两阶段模式,初筛时间为生后2～3天,无论通过与否均于出生后42～60天来我院进行复筛;复筛未通过的患儿,于生后3个月时回院行听性脑干反应(ABR)及听性稳态反应(ASSR)检测,并同时行第3次AABR检查。结果观察组1258例(2516耳),初筛通过1540耳,初筛通过率61.2%;对照组1514例(3028耳),初筛通过2913耳,初筛通过率96.2%,两组差异有统计学意义(χ2=1053.42,P<0.001)。观察组复筛通过2003耳,复筛通过率79.6%;对照组复筛通过2970耳,复筛通过率98.1%,两组差异有统计学意义(χ2=507.64,P<0.001)。轻度、中度、重度高胆红素血症患儿复筛通过率分别为87.9%、82.9%、69.4%,差异有统计学意义(χ2=81.49,P<0.001)。经ABR及ASSR检测,对照组2例患儿(2耳)、观察组29例患儿(38耳)确诊为听力障碍。结论高胆红素血症新生儿听力障碍发生率明显高于对照组;血清胆红素水平越高,听力筛查通过率越低。高胆红素血症患儿应进行听力筛查。

Auto-auditory brainstem response in hyperbilirubinemia neonatal hearing screening

Objective To study the feasibility and effect of auto-auditory brainstem emission (AABR)technology in hyperbilirubinemia newborns hearing screening.Methods The AABR-AABR two stage mode is used in both the preliminary screening and repeated screening.Full term newborns with hyperbilirubinemia(serum total bilirubin value>220μmol/L)in Yuying Children’s Hospital Affiliated of Wenzhou Medical College from January 2007 to January 2011 who accepted newborn preliminary screening and repeated screening are selected as the research objects.Meanwhile full term newborns with normal serum total bilirubin value are selected as the control group.Newborn screening for the first time was done on 2-3 days after the birth.The repeated screening was done 42-60 days after their birth no matter they passed the preliminary screening or not.The newborns who didn’t passed the repeated screening should come back to get auditory brainstem response(ABR)and auditory steady-state evoked response(ASSR)examinations 3 months after birth,when a AABR test for the third time would be done. Results All of 1540 ears out of 1258 cases of hyperbilirubinemia passed the preliminary screening, passing rate were 61.2%.2913 ears out of 1514 newborns in control group passed the preliminaryscreening,the passing rate was 96.2%,difference has statistics meaning(χ2=1053.42,P<0.001). 2003 ears out of 1258 cases of hyperbilirubinemia passed the repeated screening,passing rate was 79.6%;2970 ears out of 1514 cases in Control Group got through the repeated screening,passing rate was 98.1%(χ2=507.64,P<0.001).While the newborns were divided into mild,moderate,and severe hyperbilirubinemia,the passing rate of repeated screening were 87.9%,82.9%and 69.4%respectively (χ2=81.49,P<0.001).As a result,2 ears of 2 cases in the control group,38 ears of 29 cases in the hyperbilirubinemia newborns,were diagnosed hearing disorder.Conclusions Incidence of neonatal hyperbilirubinemia hearing impairment is obviously higher than that of the control group;When serum bilirubin level gets higher,the passing rate of hearing screening goes lower.Newborns of hyperbilirubinemia should do the hearing screening.