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Unexpected hearing loss in high-risk infants
Insights
High-risk infants with normal newborn hearing tests can develop sensorineural hearing loss later. This study highlights the need for ongoing auditory monitoring in vulnerable infants post-neonatal intensive care unit discharge.
Area of Science:
- Neonatal Medicine
- Audiology
- Pediatric Neurology
Background:
- High-risk infants often undergo auditory screening before neonatal intensive care unit (NICU) discharge.
- Sensorineural hearing loss (SNHL) is a significant concern in this population.
- The long-term auditory outcomes of infants passing initial screenings are not fully understood.
Purpose of the Study:
- To investigate the incidence of delayed-onset SNHL in high-risk infants who passed initial auditory brainstem response (ABR) screening.
- To identify risk factors associated with the development of SNHL in this cohort.
Main Methods:
- Follow-up audiological assessments were conducted on 11 high-risk infants between 13 and 48 months of age.
- Infants were products of high-risk pregnancies and deliveries, with varying birth weights and gestational ages.
- Clinical data, including NICU complications and medications, were reviewed.
Main Results:
- All 11 infants developed significant SNHL on follow-up, despite normal ABRs at NICU discharge.
- Common complications included respiratory distress, chronic lung disease, and need for mechanical ventilation.
- Other factors included abnormal central nervous system findings, acidosis, and persistent fetal circulation.
Conclusions:
- High-risk infants, including term infants, remain susceptible to developing SNHL post-NICU discharge, even after passing newborn hearing screenings.
- Prolonged illness and interventions in the NICU may contribute to delayed auditory impairment.
- Regular, long-term audiological monitoring is crucial for high-risk infants.
Abstract:
Eleven high-risk infants who had normal auditory brainstem responses at the time of discharge from the neonatal intensive care unit were found on follow-up between 13 and 48 months later to have significant sensorineural hearing loss. All 11 infants were the products of high-risk pregnancies and deliveries. Birth weights ranged from 890 to 3,700 g, but seven had birth weights of more than 1,500 g. Gestational ages ranged from 28 to 42 weeks. The length of hospitalization ranged from 45 to 167 days. All of the infants had respiratory distress, requiring prolonged mechanical ventilation with resultant chronic lung disease. All of the infants had received pancuronium, morphine, ampicillin, and gentamicin, and ten had also received furosemide and chlorothiazide. Other frequent clinical complications included abnormal CNS findings during the neonatal intensive care unit stay (ten infants), acidosis (pH less than 7.25) on the initial blood gas test (eight infants), and persistent fetal circulation in all seven infants with birth weights greater than 1,500 g. Developmentally, eight of nine children tested between 12 and 36 months of age were normal in all respects other than the hearing loss and the related language impairment. We conclude that infants who have been very ill in the newborn period, including term infants, may remain at risk for development of significant sensorineural hearing loss even though they have passed an initial auditory brainstem responses screening test in the newborn period.