新生儿高胆红素血症与听力损伤的相关性研究

Study on hearing loss in neonates with hyperbilirubinemia

【目的】 探讨高胆红素血症患儿听损伤的定位及与胆红素水平的关系。 【方法】 对照组足月新生儿 3 0例 ,高胆红素血症患儿 2 7例 ,出院前进行瞬态诱发耳声发射 (transientevokedotoacousticemissions ,TEOAE)及自动听性脑干反应 (automaticauditorybrainstemresponse ,AABR )检测。对TEOAE未通过者于生后 6周进行复筛 ,AABR未通过者于生后 3个月接受脑干听觉诱发电位 (auditorybrainstemresponse ,ABR)测试。 【结果】 99只耳通过TEOAE ,82只耳通过AABR ,3只耳 3个月随访仍未通过ABR ,确诊为听损伤 ,2只耳为轻度 ,1只耳为中度。听力筛查通过率随胆红素水平的上升而下降。TEOAE方法通过率各组差异无显著性 ,AABR通过率则与之不同 ,二者比较差异有显著性。合并酸中毒及感染降低AABR通过率。 【结论】 高胆红素血症患儿听损伤发生在耳蜗后 ,仅用TEOAE方法进行听力筛查易发生漏诊 ,采用AABR方法则能提高筛查阳性率。对胆红素 >2 5 .6μmol/L的患儿应积极干预。

Objective To audiologically clarify the lesion site and to explore relativity of hearing and serum unconjugated hyperbilirubin(UCB) level. Twenty-seven full term neonates with hyperbilirubinemia in the neonatal intensive care unit (NICU) were divided into three groups by serum bilirubinemia level, thirty babies in control group. They were tested with automatic auditory brainstem response (AABR) and transient evoked otoacoustic emissions (TEOAE) during hospitalization. The babies failed initial hearing screening received rescreening. Follow-up auditory brainstem response (ABR) tests were carried out in 3-month in the neonates who showed abnormal of no response on initial AABR. 99 ears passed TEOAE and 82 ears passed AABR. There was no significant difference between the four groups by the means of TEOAE. However, there was significant difference between the four groups by the means of AABR. There was significant difference between the two methods. 3 ears showed abnormal in auditory function at 3 months follow-up ABR. 2 ears were mild hearing loss and 1 ear was moderate hearing loss. The occurrence of failing AABR screening increased with the serun bilirubinemia level. The rate of passing AABR decreased because of coexisting acid toxicosis and infection. [Conclusions] The results indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia. AABR may reduce false negative. The babies with UCB>256.5 μmol/L should be treated actively.