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Birth weight, ototoxic medication, and surgical history predict individual hearing loss risks: a systematic review
Hanwen Luo1,2, Jianghua He1,2, Dapeng Chen1,2
1Department of Pediatrics, West China Second University Hospital, Chengdu, Sichuan, China.
Insights
Neonatal hearing loss (HL) risk factors in the NICU include very low birth weight, ototoxic drugs, PDA ligation, craniofacial anomalies, family history, and TORCH infections. Other factors like prematurity and sepsis were not significant.
Area of Science:
- Neonatal Health
- Audiology
- Public Health
Background:
- Infants in neonatal intensive care units (NICUs) face higher risks of hearing loss (HL) due to congenital anomalies and exposure to risk factors.
- Specific determinants of neonatal HL remain a subject of ongoing research and debate.
Purpose of the Study:
- To systematically review and conduct a meta-analysis to identify risk factors associated with hearing loss in neonates admitted to the NICU.
- To provide evidence-based insights into the causes of hearing impairment in high-risk newborns.
Main Methods:
- A comprehensive search of major databases (PubMed, Cochrane Library, Embase, Web of Science) was performed for English-language retrospective studies.
- Studies employing multivariate logistic regression to assess potential HL risk factors in NICU neonates were included.
- Meta-analyses were conducted using STATA, with pooled estimates reported as odds ratios or relative risks and 95% confidence intervals.
Main Results:
- The meta-analysis included 21 studies with 21,143 participants.
- Significant risk factors for neonatal HL identified were: very low birth weight (<1,500g), exposure to ototoxic drugs, surgical ligation of patent ductus arteriosus (PDA), craniofacial anomalies, family history of HL, and TORCH infections.
- Factors not significantly correlated with HL included low Apgar score, prematurity, low birth weight (1,500-2,500g), vancomycin exposure duration, sex, and sepsis.
Conclusions:
- Key risk factors for hearing loss in NICU neonates are craniofacial anomalies, family history, TORCH infections, PDA surgical ligation, hyperbilirubinemia, ototoxic drug exposure, mechanical ventilation, and very low birth weight.
- Low Apgar score, preterm birth, and sepsis were not found to be significantly associated with hearing loss in this population.
Background:
Hearing loss (HL) impairs sound perception and includes sensorineural, conductive, and mixed subtypes. Compared with healthy newborns, infants admitted to the neonatal intensive care unit (NICU) are at substantially increased risk of congenital anomalies and exposure to HL-related risk factors. However, the specific determinants of neonatal HL remain controversial.
Objective:
This systematic review and meta-analysis seeks to identify risk factors linked to HL in neonates admitted to the NICU.
Methods:
PubMed, the Cochrane Library, Embase, and Web of Science were systematically searched from March 26, 1996, to February 25, 2025. Eligible studies were English-language retrospective studies employing multivariate logistic regression to evaluate potential risk factors for HL in NICU neonates. Meta-analyses were conducted using STATA, and pooled estimates were reported as odds ratios or relative risks (OR/RR) with 95% confidence intervals (CI).
Results:
This study included 21 retrospective studies with a total of 21,143 participants. Meta-analysis indicated that very low birth weight (<1,500 g), exposure to ototoxic drugs (aminoglycosides, loop diuretics), history of the surgical ligation of patent ductus arteriosus (PDA), craniofacial anomalies, family history of HL, and TORCH infections were significantly associated with HL in NICU neonates (all P ≤ 0.05). In contrast, low Apgar score, prematurity, low birth weight (1,500-2,500 g), duration of vancomycin exposure, sex, and sepsis were not significantly correlated. The findings were robust, and no evident publication bias was detected.
Conclusion:
Statistically significant risk factors for HL included craniofacial anomalies, family history of HL, TORCH infections, and surgical ligation of PDA, as well as hyperbilirubinemia, exposure to loop diuretics and other ototoxic drugs, mechanical ventilation, and very low birth weight (<1,500 g) (all P ≤ 0.05). In contrast, low Apgar score, preterm birth, and sepsis were not significantly linked to HL.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/search, PROSPERO CRD420250653476.
