新生儿外科病房先天性畸形患儿听力筛查结果分析

Hearing Screening of the Infants with Congenital Malformation in the Neonatal Surgical Ward

目的分析外科病房中先天性畸形新生儿的听力筛查结果,探讨外科先天性畸形是否为听力损失的高危因素。方法选择2008年1月～2009年12月新生儿外科病房中有先天性畸形但不具备国家颁布的13项听力损失高危因素的574例(腹壁及消化系统畸形205例,心脏与大血管畸形98例,神经系统畸形51例,泌尿及其他系统畸形48例,多发畸形172例)新生儿作为研究组,以6 698例同期产科病房正常新生儿为对照组。研究组在出院前采用AABR和TEOAE进行听力筛查,任意项筛查未通过的患儿3月龄时作全面听力学评估,包括ABR、OPOAE和高频声导抗;对照组出生3～5天采用TEOAE初筛,未通过者在生后1月至42天复筛,仍未通过者进行听力学评估,比较两组听力损失的检出率。结果研究组TEOAE单项未通过12例,AABR单项未通过4例,两项同时未通过30例,有45例进行了听力学诊断,最终2例4耳诊断为听力损失,先天性听力损失的检出率为3.48‰(2/574)。对照组初筛未通过率2.28%(153/6 698),复筛未通过率为1.57%(105/6 698),105例行听力学诊断,最终诊断先天性听力损失15例,检出率为2.24‰(15/6 698),两组先天性听力损失的检出率差异无统计学意义(P>0.05)。结论排除了13项听力损失高危因素以外的外科先天性畸形并不是听力损失的高危因素。

Objective To explore the prevalence of hearing loss in the infants with congenital malformation in the neonatal surgical ward and to determine whether the congenital abnormality are the risk factors of the hearing loss and which screening mode is suitable to these infants.Methods The study group comprised 574infants with congenital malformation beyond risk factors of hearing loss published by Chinese Ministry of Health in neonatal surgical ward in Wuhan Women and Children Medical Care Center from January 2008to December 2009.The control group included 6 698healthy neonates born in the obstetrical department in the same hospital and in the same period.Before discharged,infants in the study group were employed with AABR and TEOAE for hearing screening.The infants referred to hearing screening would have a hearing test set including high frequency（1 000Hz）tympanometry（HFT）,ABR and DPOAE when they were 3months old.The infants in the control group were used TEOA for the first hearing screening.The infants referred to screening were rescreening when they were one month to 42 days old.The same hearing test set were performed in infants who still referred to rescreening.The prevalence of hearing loss in the two groups were compared.Results The infants who failed screening in study group with TEOAE was 7.3%（42/574）and those with AABR was 5.9%（34/574）.Fourtyfive infants were performed hearing test set and two of them were diagnosed with hearing loss.The prevalence of hearing loss was 3.48‰（2/574）.There was 2.28%（153/6 698）of infants in the control group failed in first screening and 1.57%（105/6 698）of infants failed in rescreening.And 105infants were performed hearing test set and 15of them were diagnosed with hearing loss.The prevalence of hearing loss was 2.24‰.There was no significantly statistical difference in the prevalence of hearing loss between the two groups.The failure rate of TEOAE in the study group was statistically higher than that of in control group.Conclusion The congenital malformation in this study was not a risk factor of hearing loss.The infants with the malformation should be performed the same hearing screening mode as normal neonates do,but the failure rate may be higher,thas a follow-up is necessary.