严重高胆红素血症新生儿的听力学特征

The Audiologic Assessment of Severe Neonatal Hyperbilirubinemia

目的探讨严重高胆红素血症新生儿的听力学特点及其与血清总胆红素浓度峰值的相关性。方法对100名严重高胆红素血症新生儿(研究组)和30名正常新生儿(对照组)进行畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)和1 000 Hz探测音声导抗检查,于3月龄和6月龄时对研究组进行复查。比较两组结果并分析患儿血清总胆红素浓度峰值与ABR反应阈的相关性。结果①对照组ABR、DPOAE、声导抗检查均正常;②研究组中所有患儿鼓室导抗图均为A型,15人22耳有不同程度的听力损失(ABR异常),其中6人(40%,6/15)9耳DPOAE不能引出,9人(60%,9/15)13耳DPOAE引出。3月龄复查时,15人中听力损失改善3人(4耳),加重1人(2耳),6月龄复查时与3月龄时无改变;③研究组血清总胆红素浓度峰值与ABR反应阈呈浓度依赖性正相关,血清总胆红素>500μmol/dl是高胆红素致听力损失的风险因素。结论严重新生儿高胆红素血症导致的听力损失表现为单耳或双耳感音神经性聋,部分表现为听神经病的听力学特点,3～6月龄部分听力损失可逆转,部分听力损失可继续加重。

Objective To study the incidence and lesion site of hearing loss and the correlation between the peak of serum bilirubin levels and hearing thresholds in severe neonatal hyerbilirubinemia.Methods The prospective study was carried out in the neonatal intensive care unit of Wuhan Children’s Hospital from January in 2008 to April in 2009.100 neonates with severe hyperbilirubinemia as the only risk factor for hearing loss was determined and 30 normal neonates were recruited.Hearing tests included tympanometry,ABR and DPOAE and followed up at 3 months old and 6 months old.The peak of serum bilirubin levels and corresponding ABR thresholds were analyzed statistically.Results 15 neonates with 22 ears showed abnormal ABR or with no responses.Among them,6 neonates with 9 ears did not pass DPOAE,9 neonates with 13 ears passed DPOAE.3 neonates showed improved hearing thresholds for ABR at 3 months follow-up,1 neonate had poorer hearing thresholds than before.There were no changes in auditory function at 6 months.There was positive correlation between the peak of serum bilirubin levels and ABR threshold.Conclusion The results indicate that hyperbilirubinemia may lead to sensorneural deafness and the auditory disorders as neuropathy.Hearing loss may be undulatory.Some of them were recovery.It suggests that monitoring auditory development is critical.