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Cumulative risk factors contributing to hearing loss in preterm infants
Kathy Chant1, Maria Bitner-Glindzicz2, Neil Marlow3
1Department of Neonatology, UCL Institute for Women's Health, University College London, London, UK.
Insights
Neonatal hearing loss is linked to physiological risks and cumulative exposure to ototoxic medications like gentamicin, vancomycin, and furosemide. Close monitoring of these factors during critical care is essential for prevention.
Area of Science:
- Neonatal Medicine
- Ototoxicity Research
- Pediatric Audiology
Background:
- Hearing loss is a significant concern in neonatal intensive care.
- Premature infants (<32 weeks gestation) are particularly vulnerable to hearing impairment.
- Identifying modifiable risk factors is crucial for improving neonatal outcomes.
Purpose of the Study:
- To investigate individual and combined risk factors for hearing loss in neonates.
- To identify specific medications and physiological conditions associated with neonatal hearing impairment.
- To evaluate the role of the m.1555A>G mutation in neonatal hearing loss.
Main Methods:
- A case-control study was conducted with 237 premature infants (born <32 weeks gestation).
- 57 infants with hearing loss were compared to 180 infants with normal hearing, matched for sex, gestation, and birth year.
- Clinical records were reviewed for risk factors, medication exposure (gentamicin, vancomycin, furosemide), and physiological parameters.
Main Results:
- Infants with hearing loss exhibited lower birth weight for gestational age and more severe neonatal illness.
- Increased exposure to inotropes, steroids, gentamicin, vancomycin, and furosemide was observed in infants with hearing loss.
- Each day of physiological risk (OR 1.15) and medication exposure (OR 1.23) independently increased the likelihood of hearing loss.
Conclusions:
- Cumulative exposure to ototoxic medications and the presence of physiological risk factors are independent contributors to neonatal hearing loss.
- The m.1555A>G mutation was not found to be a significant factor in this cohort.
- Close monitoring of concurrent therapies and physiological status is recommended for at-risk neonates.
Objective:
To investigate individual and concomitant risk factors for hearing loss during neonatal care.
Design:
Case-control study.
Setting:
Community.
Population:
237 children born <32 weeks of gestation; 57 with hearing loss and 180 with normal hearing born between 2009 and 2013, matched for sex, gestation and year of birth.
Main Outcome Measures:
Data were abstracted from clinical records for overall risk factors daily for the first 14 days and then weekly until discharge from neonatal care. All infants were screened for the presence of m.1555A>G mutation.
Results:
Children with hearing loss had lower birth weight for gestational age, more severe neonatal illness, with increased exposure to inotrope, steroid, gentamicin, vancomycin and furosemide, and more frequent physiological risk, elevated bilirubin and creatinine levels and acidosis, but no index child was found to have the m.1555A>G mutation, compared with one among controls. The duration of gentamicin, vancomycin or furosemide administration in the first 14 days was associated with impaired hearing (OR per dose: 1.25; 95% CI 1.14 to 1.38). Multivariate analyses revealed independent risks for hearing loss for each day when there was physiological risk (OR per day 1.15 (1.05 to 1.27)) and each day of medication exposure (OR 1.23 (1.1 to 1.37)).
Conclusion:
Although the relative contribution of underlying illness and medication cannot be identified by this study, cumulative use of ototoxic medication and the presence of physiologic risk factors independently increased the likelihood of hearing loss, warranting close monitoring of coincident therapy throughout neonatal critical care.
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