新生儿住院患儿听力损伤临床分析

Clinical analysis on hearing loss of hospitalized neonates

目的:探讨普通新生儿病房患儿听力损伤发生情况、病因及转归。方法:对2007年1月～2008年10月湖南省儿童医院普通新生儿科病房住院患儿采用瞬态诱发耳声发射(TEOAE)结合脑干听觉诱发电位检查进行常规听力筛查(日龄满1周后进行),对有听力损伤患儿出院后进行常规随访6个月以上或BAEP正常。结果:4 121例住院患儿完成听力筛查4 012例,筛查出听力损伤205例(5.12%)。耳声反射的假阴性率为46.83%(96/205),假阳性率为14.92%(568/3 807)。听力损伤的原因为新生儿高胆红素血症55例(26.83%)、缺氧缺血等各种原因所致脑损伤58例(28.29%)、宫内感染(CMV、梅毒等)26例(12.68%)、遗传代谢性疾病及先天性疾病10例(4.88%)、原因不明56例(27.32%)。205例听力损伤患儿完成随访149例,6个月时仍异常30例(疾病构成为高胆红素血症15/46例,缺氧缺血性脑损伤或其他原因致脑损伤3/44例,宫内感染8/21例,其他4/38例,遗传代谢性疾病及先天性疾病患儿均未完成随访),经χ2检验差异有统计学意义(χ2=15.70,P=0.001)。再经两两比较发现高胆红素血症组与宫内感染组间以及各种原因性脑损伤组与其他组间的差异没有统计学意义,对差异没有统计学意义的两组给予合并再行χ2检验示两组间差异有统计学意义(χ2=15.25,P=0.000)。结论:新生儿病房住院患儿听力损伤发生率远高于普通新生儿;耳声反射因假阴性率和假阳性率均较高,对住院患儿常规进行BAEP检查十分必要。高胆红素血症、各种原因所致脑损伤、宫内感染是常见病因;随访结果说明高胆红素血症、宫内感染所致听力损伤康复治疗效果较差。

Objective：To explore the occurrence,causes and prognosis of neonates with hearing loss from general neonatal wards.Methods：The neonates aged one week after birth from general neonatal wards in the hospital received routine hearing screening by transient evoked otoacoustic emission（TEOAE） and brainstem auditory evoked potential（BAEP） test from January 2007 to October 2008,the neonates with hearing loss were followed up for more than 6 months after leaving the hospital or with normal BAEP.Results：Among 4 121 hospitalized neonates,4 012 neonates finished the hearing screening,205 neonates were found with hearing loss,accounting for 5.12%.The false negative rate and false positive rate of TEOAE were 46.83%（96/205） and 14.92%（568/3 807）,respectively.The causes of hearing loss included neonatal hyperbilirubinemia（55 cases,26.83%）,cerebral injury induced by various reasons,such as ischemia or hypoxia（58 cases,28.29%）,intrauterine infection（such as CMV or syphilis）（26 cases,12.68%）,genetic and metabolic diseases,congenital diseases（10 cases,4.88%）,undetermined causes（56 cases,27.32%）.Among 205 neonates with hearing loss,149 neonates completed follow-up,30 neonates remained hearing loss at 6 months after leaving the hospital,including 15 neonates with hyperbilirubinemia,3 neonates with cerebral injury induced by various reasons,such as ischemia or hypoxia,8 neonates with intrauterine infection,4 neonates with other reasons,all the neonates with genetic and metabolic diseases,congenital diseases didn＇t finish the follow-up,there was significant difference（χ2=15.70,P=0.001）.There was no significant difference between hyperbilirubinemia group and intrauterine infection group,cerebral injury group and other groups in multiple comparison,the two groups without significant difference were combined,then significant difference was found between the two groups（χ2=15.25,P=0.000）.Conclusion：The incidence of hearing loss in hospitalized neonates from general neonatal wards is significantly higher than that of general neonates;the false negative rate and false positive rate of TEOAE both are high,routine BAEP test is necessary for hospitalized neonates.Hyperbilirubinemia,cerebral injury induced by various reasons and intrauterine infection are common causes;the results of follow-up indicate that the curative effect of hearing loss recovery is poor for the neonates with hyperbilirubinemia and intrauterine infection.