自动听性脑干反应及耳声发射联合使用在新生儿听力筛查中临床意义

Combined Automatic Auditory Brainstem Response and Otoacoustic Emissions Hearing Screening in Newborns with Different Disease statuses and Gestational Ages

目的探究自动听性脑干反应(automatic auditory brainstem response,AABR)及耳声发射(otoacousticemisson,OAE)联合听力筛查在不同病情、胎龄新生儿中的临床意义。方法本研究选取2015年1月~2017年6月我院新生儿病区收治的846例新生儿作为研究对象,按其入院时的病情分为:危重新生儿组(危重新生儿有听损高危因素的416例)、普通新生儿组(普通性疾病排除听损高危因素的430例)、健康对照组(健康体检新生儿178例);另外按新生儿胎龄分为足月儿组(胎龄≥37周,体重≥2500g的402例)、早产儿组(胎龄<37周但>28周,体重<2500g的444例)。不同组别的新生儿均在病情稳定情况下接受AABR、OAE检测,统计不同组别新生儿在三种筛查模式(仅测试AABR、仅测试OAE、联合测试AABR及OAE)下的听力筛查未通过率。结果危重新生儿组、普通新生儿组和正常新生儿组经OAE测试后的未通过率分别为11.78%、7.93%和6.87%,经AABR测试后的未通过率分别为12.38%、8.36%和7.03%,经OAE联合AABR测试后的未通过率分别为17.67%、13.45%和7.89%,OAE、AABR、OAE联合AABR的未通过率在每组之间比较,差异均有统计学意义(χ~2=10.82,11.39,20.29,P均﹤0.05),危重新生儿组OAE、AABR、OAE联合AABR的未通过率均分别高于其他两组(OAE:与普通新生儿组比较χ~2=7.16,P﹤0.05,与正常新生儿组比较x2=6.87,P﹤0.05;AABR:与普通新生儿组比较χ~2=7.32,P﹤0.05,与正常新生儿组比较χ~2=7.44,P﹤0.05;OAE联合AABR:与普通新生儿组比较χ~2=5.62,P﹤0.05,与正常新生儿组比较χ~2=19.07,P﹤0.05);危重新生儿、普通新生儿组的OAE、AABR、OAE联合AABR测试后的未通过率比较,差异均有统计学意义(危重新生儿组χ~2=14.57,普通新生儿组χ~2=18.46,P﹤0.05),且危重新生儿、普通新生儿组OAE联合AABR明显高于单独OAE测试和单独AABR测试(危重新生儿:与OAE比较χ~2=11.49,P﹤0.05,与AABR比较χ~2=9.11,P﹤0.05;普通新生儿:与OAE比较χ~2=14.02,P﹤0.05,与AABR比较χ~2=11.50,P﹤0.05);足月儿组、早产儿组经OAE测试后的未通过率分别为6.23%、10.59%,经AABR测试后的未通过率分别为13.64%、19.14%,经OAE联合AABR测试后的未通过率分别为15.64%、21.85%,OAE、AABR、OAE联合AABR的未通过率分别在两组之间比较,差异有统计学意义(χ~2=5.17,4.56,5.24,P均﹤0.05),且早产儿组均高于足月儿组(P>0.05);每组的OAE、AABR、OAE联合AABR未通过率比较,差异均有统计学意义(足月儿组χ~2=19.55,早产儿组χ~2=21.56,P﹤0.05)),OAE联合AABR的未通过率均高于单独OAE、单独AABR,且差异具有统计学意义(足月儿组:与OAE比较χ~2=18.43,P﹤0.05,与AABR比较χ~2=3.13,P﹤0.05;早产儿组:与OAE比较χ~2=20.72,P﹤0.05,与AABR比较χ~2=2.95,P﹤0.05)。结论 OAE联合AABR筛查模式可对单一方法筛查模式进行有效补充,在危重新生儿及早产儿中的筛查未通过率较高,应积极在早产儿及危重新生儿群体中推广应用。

Objective To report results of hearing screening combining automated auditory brainstem responses(AABRs)and otoacoustic emissions(OAEs)in newborns with different disease statuses and gestational ages.Methods In this study,846 newborns admitted to the neonatal ward from January 2015 to June 2017 were selected and divided into two groups based on the condition upon admission:i.e.critically ill(high risk group,n=416)or stable with no risk factors for hearing loss(non-critically ill group,n=430),to be compared to a control group of 178 healthy newborns.The babies were further categorized as term(gestational age≥37 weeks and body weight≥2500g,n=402)and preterm(gestational age 28-37 weeks,body weight<2500g,n=444)neonates.AABR and OAE screening was conducted when allowed by the babies’conditions,and the rate of failing was compared by AABR only,OAE only and AABR and OAE combined.Results The rate of failing OAE test was 11.78%in critically ill neonates,7.93%in non-critically ill neonates and 6.87%in healthy neonates,respectively.The rate of failing AABR test was 12.38%,8.36%and 7.03%,respectively;while that of failing combined OAE/AABR screening was 17.67%,13.45%and 7.89%,respectively.The rates of failing OAE,AABR or combined OAE/AABR screening were all higher in critically ill neonates than in the other two groups of neonates(P<0.05).The rate of failing combined OAE/ABR screening was higher than that of failing OAE or AABR only screening(P<0.05).The rate of failing AABR test was 13.64%in full-term neonates and 19.14%in pre-term neonates,slightly higher than that of failing OAE screening(P<0.05).The rate of failing combined OAE/AABR test was 15.64%and 21.85%in full term and pre-term neonates(P<0.05),respectively.The failure rates of all three screening modes were higher in premature neonates than in full-term neonates(P<0.05),with combined OAE/AABR screening showing consistently higher failure rates than OAE or AABR only screening(P<0.05).Conclusions Compared with single OAE or ABR screening,combined OAE/AABR screening can be an effective alternative,especially in critically ill newborns and premature neonates.