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Screening for Hearing Impairment in High Risk Neonates: A Hospital Based Study
Muddasir Maqbool1, Bilal Ahmad Najar1, Imran Gattoo1
1Registrar, Department of Paediatrics, Government Medical College , Srinagar J&K, India .
Insights
Neonatal hearing loss affects speech and language development. This study found that risk factors like meningitis significantly predict hearing impairment in newborns, suggesting targeted screening is effective.
Area of Science:
- Neonatal care
- Audiology
- Pediatric neurology
Background:
- Early-onset hearing loss can severely impact a newborn's speech, language, social, emotional, and academic development.
- Early identification and intervention are crucial for improving outcomes in infants with hearing impairment.
- Hearing screening programs are widely recommended for newborns.
Purpose of the Study:
- To determine the incidence of neonatal hearing loss in high-risk infants.
- To identify clinical risk factors associated with hearing impairment in neonates.
- To evaluate the effectiveness of targeted hearing screening in resource-limited settings.
Main Methods:
- A prospective study screened 200 high-risk neonates in a NICU using Brainstem Auditory Evoked Response (BAER).
- Initial BAER was followed by a repeat test after one month for abnormal cases.
- Risk factors, including ototoxic medications, hyperbilirubinemia, perinatal asphyxia, and bacterial meningitis, were recorded.
Main Results:
- The initial incidence of hearing loss was 16%, with 15.25% in males and 17% in females.
- Bacterial meningitis was identified as a significant independent clinical risk factor.
- Hearing loss incidence increased with the number of risk factors present, from 4.2% with one factor to 33.3% with three factors.
Conclusions:
- Male gender and the presence of risk factors, particularly bacterial meningitis, are significant predictors of neonatal hearing loss.
- While universal screening is ideal, a targeted approach based on identified risk factors is a feasible strategy for resource-limited settings.
- The study supports the need for risk-factor-based hearing screening in high-risk neonates to improve early detection and intervention.
Background:
Hearing loss very early in life can have multiple deleterious effects on the new born most commonly being related to attainment of speech and language. Also, it can affect social, emotional and academic achievement of the child.Early identification of hearing impairment has been shown to improve prognosis and hence screening programs have been widely and strongly advocated.
Aims And Objectives:
To estimate the incidence of neonatal hearing loss in high risk neonates admitted in tertiary level teaching hospital and to determine the risk factors predictive of hearing impairment in them.
Materials And Methods:
It was a prospective study over a period of one year. We screened high risk neonates for hearing impairment admitted to NICU using Brain stem Auditory Evoked Response (BAER).The morphology of the response and wave and interwave latencies was examined in respect to age-appropriate forms. Follow up BAER after one month was performed in cases where initial BAER was abnormal. Babies who tested abnormal on the follow-up were referred for detailed audiology diagnostic work up.
Results:
A total of 200 cases comprising 118 males (59%) and 82 females (41%) were enrolled. On initial BAER testing, 18 (15.25%) males and 14 (17%) female neonates had hearing loss. Whereas 7 males (70%) and 3 females (30%) had hearing loss out of the total 10 hearing loss cases in the Follow up-BAER testing. Two out of the 6 neonates with birth weight <1500g had hearing loss in the follow up of BAER testing. Use of ototoxic medications, hyperbilirubinemia requiring exchange transfusion, perinatal asphyxia and bacterial meningitis were the major risk factors occurring in 45%, 30% and 26% and 10%. Five neonates had unilateral hearing loss and the rest five (5%) had bilateral impairment.Meningitis was the significant independent clinical risk factors for predicting hearing impairment in high risk neonates.The risk of BAER increased cumulatively with BAER abnormality rate of 4.2%, 22.2% and 33.3% with one two and three risk factors respectively.
Conclusion:
The overall incidence of hearing loss in initial BERA testing was 16%, in males it was 15.25% in males and in 17% in females,only 62.5% of neonates had a persistent abnormal BAER, with male gender a significant risk factor for this. The incidence of hearing loss increased with number of risk factors. The study highlights that although universal hearing screening programs are warranted; most newborns with a detected hearing loss can be identified based on the risk factors. Thus, a targeted approach for hearing screening may be more feasible in resource limited settings.
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