Auditory brainstem response morphology and analysis in very preterm neonatal intensive care unit infants

Background and Aim: Studies have shown that several factors affect the hearing loss of infants hospitalized in the neonatal intensive care unit (NICU). These factors include hyperbilirubinemia, low birth weight, asphyxia, and prematurity. This study aimed to investigate the prevalence of hearing loss and its risk factors in NICU infants. Methods: This is a cross-sectional study. Samples were 159 infants admitted to the NICU in Fatemieh and Shahid Beheshti hospitals in Hamadan, Iran, who were selected using a convenience sampling method. Their hearing was screened using transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) tests; in case of failure in these tests, auditory brainstem response (ABR) was performed. Results: Of 159 infants, 9 (5.66%) were identified with different types of hearing loss where 4 (2.51%) had sensory-neural hearing loss, one (0.62%) had auditory neuropathy and 4 (2.51%) had conductive hearing loss. There was a statistically significant relationship between hearing loss and birth weight < 1500 g, hyperbilirubinemia, antibiotic therapy, family history of hearing loss, asphyxia and Apgar score < 5. Conclusion: Prevalence of hearing loss in NICU infants is noticeable so hearing assessment after discharge is necessary. Due to the presence of auditory neuropathy, simultaneous use of TEOAE and AABR tests in these infants is recommended. Keywords: Infant hearing screening; neonatal intensive care unit; auditory brainstem response

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Auditory Brainstem Response in Preterm Infants in the Neonatal Intensive Care Unit

Otolaryngology ◽

10.1177/0194599820955181 ◽

2020 ◽

pp. 019459982095518

Author(s):

Diogo Raposo ◽

João Orfão ◽

Marco Menezes ◽

Mafalda Trindade-Soares ◽

Ana Guimarães ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Preterm Infants ◽

Auditory Brainstem Response ◽

Neonatal Intensive Care ◽

Auditory Brainstem ◽

Term Infants ◽

Congenital Cytomegalovirus ◽

Brainstem Response

Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

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Temperature in very preterm infants from birth to neonatal intensive care unit admission

Acta Paediatrica ◽

10.1111/apa.16218 ◽

2021 ◽

Author(s):

Emma A. Dunne ◽

Colm P.F. O’Donnell ◽

Lisa K. McCarthy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Very Preterm Infants ◽

Very Preterm

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Analysis of the Risk Factors Associated with Hearing Loss of Infants Admitted to a Neonatal Intensive Care Unit: A 13-Year Experience in a University Hospital in Korea

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218082 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8082

Author(s):

Kyu Young Choi ◽

Bum Sang Lee ◽

Hyo Geun Choi ◽

Su-Kyoung Park

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Hearing Loss ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Significant Risk ◽

University Hospital ◽

Control Group ◽

Brainstem Response

Early detection of hearing loss in neonates is important for normal language development, especially for infants admitted to the neonatal intensive care unit (NICU) because the infants in NICU have a higher incidence of hearing loss than healthy infants. However, the risk factors of hearing loss in infants admitted to the NICU have not been fully acknowledged, especially in Korea, although they may vary according to the circumstances of each country and hospital. In this study, the risk factors of hearing loss in NICU infants were analyzed by using the newborn hearing screening (NHS) and the diagnostic auditory brainstem response (ABR) test results from a 13-year period. A retrospective chart review was performed using a list of NICU infants who had performed NHS from 2004 to 2017 (n = 2404) in a university hospital in Korea. For the hearing loss group, the hearing threshold was defined as 35 dB nHL or more in the ABR test performed in infants with a ‘refer’ result in the NHS. A four multiple number of infants who had passed the NHS test and matched the age and gender of the hearing loss group were taken as the control group. Various patient factors and treatment factors were taken as hearing loss related variables and were analyzed and compared. From the 2404 infants involved, the prevalence of hearing loss was 1.8% (n = 43). A comparison between the hearing loss group (n = 43) and the control group (n = 172) revealed that history of sepsis, peak total bilirubin, duration of vancomycin use, days of phototherapy, and exposure to loop-inhibiting diuretics were significantly different, and can be verified as significant risk factors for hearing loss in NICU infants.

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Wideband acoustic immittance for assessing middle ear functioning for preterm neonates in the neonatal intensive care unit

South African Journal of Communication Disorders ◽

10.4102/sajcd.v64i1.182 ◽

2017 ◽

Vol 64 (1) ◽

Author(s):

Nandel Gouws ◽

De Wet Swanepoel ◽

Leigh Biagio De Jager

Keyword(s):

Intensive Care Unit ◽

At Risk ◽

Hearing Loss ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Middle Ear ◽

Diagnostic Tool ◽

Neonatal Intensive Care ◽

Preterm Neonates ◽

Brainstem Response

Background: The primary aim of newborn hearing screening is to detect permanent hearing loss. Because otoacoustic emissions (OAEs) and automated auditory brainstem response (AABR) are sensitive to hearing loss, they are often used as screening tools. On the other hand, false-positive results are most often because of transient outer- and middle ear conditions. Wideband acoustic immittance (WAI), which includes physical measures known as reflectance and absorbance, has shown potential for accurate assessment of middle ear function in young infants.Objective: The main objective of this study was to determine the feasibility of WAI as a diagnostic tool for assessing middle ear functioning in preterm neonates in the neonatal intensive care unit (NICU) designed for premature and ill neonates. A further objective was to indicate the difference between the reflectance values of tones and click stimuli.Method: Fifty-six at-risk neonates (30 male and 26 female), with a mean age at testing of 35.6 weeks (range: 32–37 weeks) and a standard deviation of 1.6 from three private hospitals, who passed both the distortion product otoacoustic emission (DPOAE) and AABR tests, were evaluated prior to discharge from the NICU. Neonates who presented with abnormal DPOAE and AABR results were excluded from the study. WAI was measured by using chirp and tone stimuli. In addition to reflectance, the reflectance area index (RAI) values were calculated.Results: Both tone and chirp stimuli indicated high-power reflectance values below a frequency of 1.5 kHz. Median reflectance reached a minimum of 0.67 at 1 kHz – 2 kHz but increased to 0.7 below 1 kHz and 0.72 above 2 kHz for the tone stimuli. For chirp stimuli, the median reflectance reached a minimum of 0.51 at 1 kHz – 2 kHz but increased to 0.68 below 1 kHz and decreased to 0.5 above 2 kHz. A comparison between the present study and previous studies on WAI indicated a substantial variability across all frequency ranges.Conclusion: These WAI measurements conducted on at-risk preterm NICU neonates (mean age at testing: 35.6 weeks, range: 32–37 weeks) identified WAI patterns not previously reported in the literature. High reflective values were obtained across all frequency ranges. The age of the neonates when tested might have influenced the results. The neonates included in the present study were very young preterm neonates compared to the ages of neonates in previous studies. WAI measured in at-risk preterm neonates in the NICU was variable with environmental and internal noise influences. Transient conditions affecting the sound-conduction pathway might have influenced the results. Additional research is required to investigate WAI testing in ears with and without middle ear dysfunction. The findings of the current study imply that in preterm neonates it was not possible to determine the feasibility of WAI as a diagnostic tool to differentiate between ears with and without middle ear pathology.

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Pain-related stress during the Neonatal Intensive Care Unit stay and SLC6A4 methylation in very preterm infants

Frontiers in Behavioral Neuroscience ◽

10.3389/fnbeh.2015.00099 ◽

2015 ◽

Vol 9 ◽

Cited By ~ 42

Author(s):

Livio Provenzi ◽

Monica Fumagalli ◽

Ida Sirgiovanni ◽

Roberto Giorda ◽

Uberto Pozzoli ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Intensive Care Unit Stay ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Very Preterm Infants ◽

Very Preterm ◽

Related Stress

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Unexpected Hearing Loss in High-Risk Infants

PEDIATRICS ◽

10.1542/peds.78.3.417 ◽

1986 ◽

Vol 78 (3) ◽

pp. 417-422

Author(s):

Toni A. Nield ◽

Shirley Schrier ◽

Angela D. Ramos ◽

Arnold C. G. Platzker ◽

David Warburton

Keyword(s):

Intensive Care Unit ◽

Hearing Loss ◽

Intensive Care ◽

High Risk ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Auditory Brainstem ◽

Auditory Brainstem Responses ◽

Newborn Period ◽

High Risk Infants

Eleven high-risk infants who had normal auditory brainstem responses at the time of discharge from the neonatal intensive care unit were found on follow-up between 13 and 48 months later to have significant sensorineural hearing loss. All 11 infants were the products of high-risk pregnancies and deliveries. Birth weights ranged from 890 to 3,700 g, but seven had birth weights of more than 1,500 g. Gestational ages ranged from 28 to 42 weeks. The length of hospitalization ranged from 45 to 167 days. All of the infants had respiratory distress, requiring prolonged mechanical ventilation with resultant chronic lung disease. All of the infants had received pancuronium, morphine, ampicillin, and gentamicin, and ten had also received furosemide and chlorothiazide. Other frequent clinical complications included abnormal CNS findings during the neonatal intensive care unit stay (ten infants), acidosis (pH < 7.25) on the initial blood gas test (eight infants), and persistent fetal circulation in all seven infants with birth weights greater than 1,500 g. Developmentally, eight of nine children tested between 12 and 36 months of age were normal in all respects other than the hearing loss and the related language impairment. We conclude that infants who have been very ill in the newborn period, including term infants, may remain at risk for development of significant sensorineural hearing loss even though they have passed an initial auditory brainstem responses screening test in the newborn period.

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