Risk patterns associated with transient hearing impairment and permanent hearing loss in infants born very preterm: A
Wen-Hao Yu1,2, Yung-Chieh Lin2, Chi-Hsiang Chu3
1Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Infants born very preterm who fail hearing screenings face risks of transient or permanent hearing loss. Hemodynamic and respiratory instability, along with severe intraventricular hemorrhage, are key risk factors for hearing impairment.
Area of Science:
- Neonatal care
- Audiology
- Developmental pediatrics
Background:
- Infants born very preterm are at high risk for hearing impairment.
- Hearing loss in this population is often detected through newborn hearing screenings.
- Understanding risk factors is crucial for early intervention and improved outcomes.
Purpose of the Study:
- To identify risk patterns associated with transient hearing impairment (THI) and permanent hearing loss (PHL) in very preterm infants who failed initial hearing screenings.
- To characterize the factors contributing to different hearing outcomes in this vulnerable group.
Main Methods:
- A cohort of 646 infants born at or before 30 weeks' gestation were enrolled.
- Auditory brainstem response screening was performed at term-equivalent age.
- Principal component analysis (PCA) and propensity score matching were used to analyze risk patterns and associations.
Main Results:
- Of 646 infants, 90.4% had normal hearing, 6.5% had THI, and 3.1% had PHL.
- Both THI and PHL groups showed higher rates of neurodevelopmental impairment compared to normal hearing infants.
- Severe hemodynamic and respiratory instability, and severe intraventricular hemorrhage (IVH) were significant risk factors, particularly for PHL.
Conclusions:
- The severity and duration of hemodynamic and respiratory instability are critical risk factors for both THI and PHL in very preterm infants.
- Severe IVH represents an additional significant risk factor for developing permanent hearing loss.
- These findings highlight the importance of monitoring and managing cardiorespiratory stability and IVH in preterm infants to mitigate hearing loss risk.
Aim:
To determine the risk patterns associated with transient hearing impairment (THI) and permanent hearing loss (PHL) of infants born very preterm who failed hearing screenings.
Method:
We enrolled 646 infants (347 males, 299 females) born at no more than 30 weeks' gestation between 2006 and 2020 who received auditory brainstem response screening at term-equivalent age. Audiological examinations of infants who failed the screening revealed THI, when hearing normalized, or PHL, defined as a persistent unilateral or bilateral hearing threshold above 20 dB. Principal component analysis (PCA) was used to characterize risk patterns.
Results:
Among the 646 infants, 584 (90.4%) had normal hearing, 42 (6.5%) had THI, and 20 (3.1%) had PHL. Compared with the group with normal hearing, the THI and PHL groups had significantly higher rates of neurodevelopmental impairment at 24 months corrected age. PCA of risk patterns showed the THI group and especially the PHL group had more severe haemodynamic and respiratory instability. Moreover, severe intraventricular haemorrhage (IVH) was also a risk for PHL. Propensity score matching revealed an association of haemodynamic and respiratory instability with PHL.
Interpretation:
In infants born preterm, the severity and duration of haemodynamic and respiratory instability are risk patterns for both THI and PHL; severe IVH is an additional risk for PHL.
What This Paper Adds:
Neurodevelopmental delay was more common in infants born preterm who failed hearing screening. Principal component analysis revealed the risk patterns associated with hearing impairment. Haemodynamic-respiratory instability was associated with transient and permanent hearing impairment outcomes. Severe haemodynamic-respiratory instability and intraventricular haemorrhage was associated with permanent hearing loss.
