新生儿重度高胆红素血症伴听力损伤预后相关因素研究

Prognostic factors related hearing impairment associated with neonatal severe hyperbilirubinemia

目的探讨影响重度高胆红素血症新生儿听力损伤预后情况的相关因素。方法选择2008年11月至2009年10月本院新生儿科收治的重度高胆红素血症患儿,进行脑干听觉诱发电位(BAEP)的检测,对异常者分别于生后1个月、3个月、6个月、1岁时复查BAEP,直至BAEP恢复正常或年龄至1岁。按照随访时BAEP能否恢复正常分为随访正常组和随访异常组。对随访异常的影响因素进行单因素分析,并对单因素分析有统计学意义的因素纳入Logistic回归模型进行多因素分析。结果 967例重度高胆红素血症患儿中BAEP异常168例,其中150例按时进行随访的患儿纳入本研究。至随访结束,94.2%的轻度听力损伤者、85.5%的中度听力损伤者和19.2%的重度听力损伤者恢复正常。单因素分析结果显示,酸中毒、B/A比值、黄疸持续时间、BAEP异常程度、胆红素脑病临床表现是随访异常的影响因素。多因素Logistic回归分析结果显示,BAEP重度异常(OR=9.291)和胆红素脑病临床表现(OR=9.176)是听力损伤的重度高胆红素血症患儿随访异常的危险因素。结论新生儿重度高胆红素血症伴轻中度BAEP异常者1年内大多可恢复正常,但当存在BAEP重度异常和胆红素脑病临床表现时,1年内听力持续异常的可能性大,需要给予更加积极的神经康复治疗。

Objective To explore how severe hyperbilirubinemia and associated conditions in infants impacts on the prognosis of hearing impairment. Methods Hospitalized infants with severe hyperbilirubinemia were enrolled during November 2008 to October 2009 in Hunan Children＇s Hospital.Brainstem auditory evoked potential（ BAEP） was performed to establish hearing impairment. For those infants with abnormal brainstem auditory response,BAEP was repeated at 1 month,3 months,6 months,1 year of age,until normality or age 1 year. The cohort was divided into. normal hearing follow-up group and abnormal hearing follow-up group. Risk factors were determined with t-test and χ^2-test. Logistic regression analysis was used to further analyze significance as determined by t-test and χ^2-test. Results There were 168 cases of infants with abnormal BAEP in 976 cases of severe hyperbilirubinemia,150 cases of children with completed follow-up were included in the study. Hearing had normalized at the end of 12 months follow-up in 94. 2% of those with mild hearing loss,85. 5% of those with moderate hearing impairment and 19. 2% of those with severe hearing impairment. Univariate analysis showed that： Acidosis,B /A ratio,duration of jaundice,BAEP degree of abnormality,the clinical manifestations of hyperbilirubinemia encephalopathy had a significant impact on hearing impairment. Logistic regression analysis showed severe BAEP abnormalities（ OR = 9. 291） and clinical manifestations of hyperbilirubinemia encephalopathy（ OR = 9. 176） were the key risk factors for persistent hearing impairment. Conclusions Neonatal Hyperbilirubinemia with mild to moderate abnormal BAEP mostly return to normal during 1 year follow up,but if with severe abnormal BAEP or the presence of hyperbilirubinemia encephalopathy,the possibility of persistent hearing impairment increases,requiring more aggressive neurodevelopmental rehabilitation.