新生儿重度高胆红素血症与听力损伤的相关性研究

Correlation of severe neonatal hyperbilirubinemia and hearing damage

目的·探讨重度高胆红素血症患儿听力损伤相关高危因素和随访预后。方法·对2015年6月至2016年6月上海儿童医学中心新生儿科收治的106例重度高胆红素血症患儿,按照胆红素水平分为3组:重度高胆红素血症组[血清总胆红素(TSB)峰值大于342.0μmol/L且小于427.5μmol/L]、极重度高胆红素血症组(TSB峰值范围427.5~513.0μmol/L)、危险性高胆红素血症组(TSB峰值大于513.0μmol/L)。在出院前用自动脑干听觉诱发电位(AABR)进行听力筛查,对筛查未通过的患儿于3月龄时进行诊断性脑干听觉诱发电位(ABR)检查,并对所有患儿(3月龄和6月龄)随访听性行为反应观察状况。结果·3组患儿共106例,出院前AABR筛查未通过33例(33/106,31.13%),其中重度高胆红素血症组未通过22例(22/86,25.58%),极重度高胆红素血症组未通过9例(9/16,56.25%),危险性高胆红素血症组未通过2例(2/4,50.00%),各组之间差异有统计学意义(均P<0.05)。通过专人负责定期宣教,出院前AABR筛查未通过的33例患儿全都于3月龄时来院接受诊断性ABR检查,结果 2例患儿被诊断为轻度听力损伤,但其中1例考虑为中耳炎所致。同时,全部106例重度高胆红素血症患儿完成3月龄和6月龄听性行为反应观察,结果状况良好。结论·重度高胆红素血症是新生儿听力损伤的高危因素之一,TSB水平越高,听力损伤也越明显。重度高胆红素血症引起的听力损伤可能可逆,但也提示听力随访计划有待完善。重度高胆红素血症造成的听力损伤可能对患儿日常生活无明显影响,仍需对患儿进行长期随访。

Objective · To investigate the risk factors of hearing damage in child patients with severe neonatal hyperbilirubinemia （NHB） and follow up their prognosis. Methods · Clinical data of 106 newborns with severe NHB in neonatal ward of Shanghai Children’s Medical Center from June 2015 to June 2016 were retrospectively analyzed. According to total serum bilirubin （TSB） level, they were divided into three groups, severe NHB group （342.0 μmol/L〈TSB peak 〈427.5 μmol/L）, very severe NHB group （TSB peak range 427.5-513.0 μmol/L）, and fatal NHB group （TSB peak 〉 513.0 μmol/L）. Automatic auditory brainstem response （AABR） was used to evaluate the hearing ability of children in hospital, while those who got abnormal results would undergo diagnostic test of auditory brainstem response （ABR） when 3 months old. Auditory behavioral response of all 106 child patients at 3 and 6 months old were followed up. Results · There were totally 106 cases in three groups, among which 33 cases （33/106, 31.13%） got abnormal results at hearing screening in hospital, 22 cases （22/86, 25.58%） in severe NHB group, 9 cases （9/16, 56.25%） in very severe NHB group, and 2 cases （2/4, 50.00%） in fatal NHB group. The difference between groups was statistically significant （all P〈0.05）. All 33 patients not passing AABR in hospital came to undergo diagnostic test of ABR through regular education by a specially assigned person when 3 months old. Two children were diagnosed mild hearing damage. One of them was considered being caused by tympanitis. All children had good situation of auditory behavioral response at 3 and 6 months old in follow-up. Conclusion · Severe NHB is one of the high risk factors of hearing damage in neonates. The morbidity of hearing damage was higher with the increase of TSB level. The hearing damage caused by severe NHB might be reversible. It also suggested that the follow-up plan should be improved. The hearing damage caused by severe NHB might have no obvious effect on children in daily life, but long term follow-up of these children is still needed.