窒息新生儿与正常新生儿听力筛查结果分析

The Comparison of Pass Rates between Asphyxia and Normal Newborn Hearing Screening

目的应用畸变产物耳声发射(DPOAE)对窒息新生儿与正常新生儿进行听力筛查,比较其听力损失的发生率。方法使用MAICO ERO SCAN新生儿筛查型耳声发射仪对195例窒息新生儿和3002例正常新生儿进行DPOAE听力筛查。根据1分钟Apgar评分,将195例窒息新生儿分为轻度(177例)和重度(18例)窒息。窒息新生儿初筛在病情稳定后进行,正常新生儿在出生后1～5天进行,窒息新生儿通过及未通过者均于出生后1、3、6、12个月分别再测试,监测有无迟发性耳聋的发生;正常新生儿未通过者在出生后42天进行复筛,两组两次检测仍未通过者在出生后3个月时用听性脑干反应(ABR)、40Hz-AERP和声导抗进行诊断性听力评估。采用SPSS10.0软件进行统计学分析。结果 195例窒息新生儿,初筛通过148例,初筛通过率为75.90%(148/195),未通过47例,未通过率为24.10%(47/195);3002例正常新生儿,初筛通过2504例,初筛通过率为86.41%(2504/3002),正常新生儿初筛通过率显著高于窒息新生儿(P<0.01)。轻度窒息新生儿177例,初筛通过138例,初筛通过率77.97%(138/177),重度窒息新生儿18例,初筛通过10例,初筛通过率55.56%(10/18),轻度窒息新生儿初筛通过率高于重度窒息新生儿(P<0.05)。窒息新生儿复筛通过率为92.59%(25/27),正常新生儿复筛通过率为97.49%,两者差异无统计学意义(χ2=0.916,P>0.05)。确诊窒息新生儿听力损伤1例,听力损失检出率5.13‰(1/195);正常新生儿听力损失6例,听力损伤检出率为2.00‰(6/3002),两者差异无统计学意义(χ2=0.574,P>0.05)。结论正常新生儿听力初筛通过率显著高于窒息新生儿,复筛通过率两组无差异,窒息新生儿与正常新生儿听力损失检出率无显著性差异,DPOAE可作为窒息新生儿与正常新生儿听力筛查的一种有效方法。

Objective Distortion product otoacoustic emission was used to screen the hearing of asphyxia and normal newborns for the comparison of the prevalence of hearing loss in the two groups.Methods DPOAEs were obtained from 195 neonatal asphyxia and 3 002 normal newborns in hearing screening.Based on the Apgar scores,195 neonatal asphyxia were divided into 2 groups：mild and severe asphyxia groups.The neonatal asphyxia received initial screening in a stable condition after birth and was re-screened at 1,3,6 and 12 months after birth respectively.The normal newborns received initial screening in 15 days after birth and those who did not pass the initial screening would receive re-screening in 42 days.Of both neonatal asphyxia and normal newborns,those infant referred for re-screening were screened by ABR in a diagnosis in 3 months.All the data were analyzed by SPSS10.0 software.Results 148 newborns passed the initial screening in 195 neonatal asphyxia and the pass rate was 75.90%,while 47 newborns failed the initial screening with the fail rate at 24.10%.Out of 3 002 normal newborns,2 594 passed the initial screening and the pass rate was 82.53%.There were significant differences of the pass rate in the above two groups（χ2=7.310,P〈0.01）.There were 138 and 10 newborns that passed the initial screening respectively in 177 mild asphyxia and 18 severe asphyxia.There were statistical differences in the pass rates between mild and severe asphyxia groups using DPOAE by Chi-square test（χ2=4.486,P〈0.05）,the pass rate in mild asphyxia group was higher than that in the severe asphyxia group.The pass rate of re-screening in asphyxia newborns was 92%,while for the normal newborns it was 97.5%.The pass rate of re-screening was not significantly different between asphyxia and normal newborns（χ2=0.916,P〉0.05）.In all neonatal asphyxia,1 newborn suffered from hearing impairment and the incidence was 5.13‰.6 newborns suffered from hearing impairment in all normal newborns and the incidence was 2.00‰.Of the above two groups,the incidence of hearing impairment had no statistics differences by Chi-square test（χ2=0.574 ,P〉0.05）.Conclusion DPOAE can be used as an effective method for hearing screening in asphyxia and normal newborns,helping us to identify auditory dysfunction as early as possible so that early interventions can be made accordingly.It had important social significance for prenatal and postnatal care and improving the quality of population to reduce the incidence of hearing impairment in infants.