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Hearing Loss after Cardiac Surgery in Infancy: An Unintended Consequence of Life-Saving Care
Madison A Grasty1, Richard F Ittenbach2, Carol Knightly3
1Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Hearing loss affects over 20% of infants after heart surgery, significantly impacting neurodevelopment. Younger gestational age, genetic anomalies, and longer hospital stays are key risk factors for this hearing impairment.
Area of Science:
- Pediatric cardiology
- Audiology
- Developmental pediatrics
Background:
- Congenital heart disease repair in infancy can have long-term consequences.
- Neurodevelopmental outcomes are a critical concern for these children.
Purpose of the Study:
- To determine the prevalence of hearing loss post-infancy cardiac surgery.
- To identify patient and operative factors linked to hearing loss.
- To examine the relationship between hearing loss and neurodevelopmental outcomes.
Main Methods:
- Prospective study of 348 children undergoing congenital heart disease repair.
- Audiologic and neurodevelopmental evaluations at 4 years of age.
- Statistical analysis to identify risk factors and outcome associations.
Main Results:
- Hearing loss prevalence was 21.6%, significantly higher than the general population.
- Conductive and sensorineural hearing loss were the most common types.
- Younger gestational age, genetic anomalies, and longer hospital stay were associated with hearing loss.
Conclusions:
- Infants undergoing cardiac surgery face a substantially elevated risk of hearing loss.
- Early identification and intervention are crucial given the neurodevelopmental impact.
- Further research into preventative strategies and long-term effects is warranted.
Objectives:
To investigate the prevalence of hearing loss after cardiac surgery in infancy, patient and operative factors associated with hearing loss, and the relationship of hearing loss to neurodevelopmental outcomes.
Study Design:
Audiologic and neurodevelopmental evaluations were conducted on 348 children who underwent repair of congenital heart disease at the Children's Hospital of Philadelphia as part of a prospective study evaluating neurodevelopmental outcomes at 4 years of age. A prevalence estimate was calculated based on presence and type of hearing loss. Potential risk factors and the impact of hearing loss on neurodevelopmental outcomes were evaluated.
Results:
The prevalence of hearing loss was 21.6% (95% CI, 17.2-25.9). The prevalence of conductive hearing loss, sensorineural hearing loss, and indeterminate hearing loss were 12.4% (95% CI, 8.8-16.0), 6.9% (95% CI, 4.1-9.7), and 2.3% (95% CI, 0.6-4.0), respectively. Only 18 of 348 subjects (5.2%) had screened positive for hearing loss before this study and 10 used a hearing aid. After adjusting for patient and operative covariates, younger gestational age, longer postoperative duration of stay, and a confirmed genetic anomaly were associated with hearing loss (all P < .01). The presence of hearing loss was associated with worse language, cognition and attention (P <.01).
Conclusions:
These findings suggest that the prevalence of hearing loss in preschool children after heart surgery in infancy may be 20-fold higher than in the 1% prevalence seen in the general population. Younger gestational age, presence of a genetic anomaly, and longer postoperative duration of stay were associated with hearing loss. Hearing loss was associated with worse neurodevelopmental outcomes.
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