Permanent childhood hearing impairment in infants admitted to the neonatal intensive care unit: nested case-control
Vrinda Nair1,2, Sundaram Janakiraman1,2, Sarah Whittaker3
1James Cook University Hospital, Middlesbrough, UK.
Insights
Infants in neonatal intensive care units (NICUs) have a higher prevalence of permanent childhood hearing impairment (PCHI). Key risk factors include ventilation, seizures, and congenital anomalies, aiding parental counseling.
Area of Science:
- Neonatology
- Pediatric Audiology
- Public Health
Background:
- Permanent childhood hearing impairment (PCHI) affects 1-2/1000 infants in the UK.
- Infants admitted to neonatal intensive care units (NICUs) for over 48 hours have a significantly higher PCHI prevalence (1 in 100 live births).
- Identifying NICU-specific risk factors is crucial for early detection and management of hearing loss in infants.
Purpose of the Study:
- To determine the prevalence of PCHI in infants requiring NICU admission for over 48 hours.
- To identify specific risk factors associated with PCHI in this high-risk infant population.
- To provide data for improved parental counseling regarding hearing loss risks in NICU infants.
Main Methods:
- A case-control study was conducted between 2005 and 2019, including infants admitted to the NICU for over 48 hours.
- Cases were infants diagnosed with PCHI via formal audiology, matched 1:4 with controls (no PCHI) based on gestation, birth place, and NICU.
- Regression analysis was used to identify significant risk factors for PCHI across all gestational ages.
Main Results:
- The prevalence of PCHI in NICU infants was 6.3%, significantly higher than the general population (0.25%).
- Significant risk factors for PCHI in infants of all gestational ages included ventilation episodes, seizures, and major congenital anomalies.
- Preterm infants (<32 weeks) receiving furosemide showed higher PCHI prevalence, while antenatal magnesium sulphate use was associated with lower prevalence.
Conclusions:
- The study confirms a high prevalence of hearing loss in infants admitted to the NICU.
- Specific risk factors, including ventilation, seizures, congenital anomalies, and medication use (furosemide, magnesium sulphate), were identified.
- These gestation-specific findings are vital for effective parental counseling and risk stratification in high-risk infant populations.
Abstract:
The prevalence of permanent childhood hearing impairment (PCHI) in infants admitted to a neonatal intensive care unit (NICU) is higher than that in the general population. Our study objective was to identify risk factors associated with PCHI in infants who required admission to the NICU for more than 48 h. We performed a case-control study, including infants of all gestational ages who were admitted to NICU for more than 48 h and who underwent newborn hearing screening between 2005 and 2019. Infants admitted to NICU and diagnosed with PCHI by formal audiology were classified as "cases". The "controls" were infants who were admitted to NICU and did not have PCHI. Cases and controls (1:4) were matched based on their birth gestation, birthing place, and treating NICU. The prevalence of PCHI in infants admitted to NICU was 6.3% as compared with our general population prevalence of 0.25%. There were 77 cases and 269 controls during the study period. The median age at diagnosis of PCHI in these infants was 132 days (interquartile range 75.5-518.5). Using regression analysis, "any ventilation episodes", presence of seizures, and major congenital anomalies were significantly associated with PCHI in infants of all gestational ages. There were higher prevalence of PCHI in preterms (<32 weeks) who received furosemide and lower prevalence with antenatal use of magnesium sulphate.Conclusions: In our study, the prevalence of hearing loss was high in infants admitted to NICU. Gestation-specific risk factors identified in this case-control study would help in counselling of parents. What is Known: • In the UK, 1-2/1000 infants are born with hearing loss and infants admitted to the neonatal unit for 48 h or more have increased prevalence of hearing loss (1 in 100 live births). • Identification of risk factors in infants admitted to neonatal unit would help with risk stratification and further management. What is New: • In our study, infants admitted to the neonatal unit had higher prevalence of hearing loss (6.3 in 100 live births). • In infants across all gestational age "any ventilation episodes", presence of seizures, and severe congenital anomalies were associated with a statistically significant increase in prevalence of hearing loss. Higher prevalence of hearing loss was noted in preterm infants (<32 weeks) who received furosemide treatment and lower prevalence was noted with antenatal use of magnesium sulphate.
