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Prognostic value of newborn hearing screening in patients with myelomeningocele
David Satzer1, Daniel J Guillaume
1Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
Insights
Failure of newborn hearing screening (NHS) may indicate future brainstem dysfunction in infants with myelomeningocele (MMC). This finding can aid in early assessment and surgical planning for these patients.
Area of Science:
- Pediatric Neurology
- Neonatal Care
- Neurosurgery
Background:
- Brainstem dysfunction affects a subset of myelomeningocele (MMC) patients, often associated with Chiari Type II malformation.
- Early identification and intervention, such as craniocervical decompression, are crucial for reducing mortality in at-risk MMC patients.
- Auditory brainstem response abnormalities are common in children with MMC.
Purpose of the Study:
- To investigate if failed newborn hearing screening (NHS) can predict brainstem dysfunction in neonates with myelomeningocele (MMC).
- To assess the utility of NHS as a screening tool for identifying MMC patients at risk for neurological complications.
Main Methods:
- Retrospective chart review of 40 newborns with MMC and 50 controls in a neonatal intensive care unit.
- Examination of NHS results, brainstem symptoms, demographics, and surgical history.
- Analysis of differences in brainstem symptom presence and onset based on NHS outcomes.
Main Results:
- Failure of NHS was significantly more common in MMC newborns who developed brainstem symptoms (31%) compared to controls (0%).
- MMC patients who failed NHS showed a higher incidence of brainstem symptoms (80%) versus those who passed (26%).
- Delayed respiratory symptom onset was observed in MMC patients who failed NHS (median 16 months) compared to those who passed (median 0 months).
Conclusions:
- Newborn hearing screening (NHS) results may serve as a predictive indicator for brainstem dysfunction in myelomeningocele (MMC) patients.
- Incorporating NHS outcomes into prognostic assessments could enhance surgical decision-making for MMC patients.
- NHS failure warrants further investigation for potential neurological complications in infants with MMC.
Object:
Brainstem dysfunction occurs in a minority of patients with myelomeningocele (MMC), most of whom have Chiari Type II malformation. Some surgeons advocate early identification of these patients for craniocervical decompression to avoid significant mortality. The auditory brainstem response has been found to be abnormal in most children with MMC. The present study examines whether failure of routine newborn hearing screening (NHS) predicts brainstem dysfunction in MMC patients.
Methods:
The charts of 40 newborns with MMC and 50 newborns without MMC who stayed in the neonatal intensive care unit were reviewed. Results of NHS, brainstem symptoms, birth demographics, and surgical history were retrospectively examined. Differences in the presence and onset of brainstem symptoms by NHS result were assessed.
Results:
Failure of NHS was more common among newborns with MMC who developed brainstem symptoms (31%, 4 of 13 patients) than among newborns without MMC (0%, 0 of 50 patients; p = 0.001). Among the 40 newborns with MMC, brainstem symptoms were more common in those who failed NHS (80%, 4 of 5 patients) than in those who passed (26%, 9 of 35 patients; p = 0.031). Respiratory symptom onset occurred later in patients who failed NHS (median 16 months) than among those who passed (median 0 months; p = 0.022). The positive and negative predictive values of NHS for brainstem dysfunction in MMC were 0.80 and 0.74, respectively.
Conclusions:
Results of NHS may help predict future brainstem dysfunction in patients with MMC and may be useful to incorporate into prognostic assessment and surgical decision making.
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