Analysis Of The Risk Facyors Of Failed Hearing Screening In Premature

Objectives: To explore the risk factors of failed hearing screening inpremature, and to provide the consultation for following up of large-scalehearing screening of premature and hearing impairment at higher risk.Methods: In the Center of Diagnosis and Treatment of Newborn ofChildren’s Hospital of Chongqing Medical University from January1st2012to August31th2012, we collected the results of665cases ofpremature underwent otoacoustic emission hearings screening. Prematurewere taken initial transient evoked otoacoustic mission(TEOAE) at3daysafter birth and redid TEOAE at about42days after birth，then they finishedAuditory brainstem response(ABR) examination in3months after birth.All the following factors of premature were recorded: Gender, birth parity,gestational age, small for gestational age(SGA), birth weight,hyperbilirubinemia, bilirubin encephalopathy, acute respiratory distresssyndrome(NRDS), positive serum human anti-cytomegalovirusImmunoglobulin G(CMV-IgG), urine human cytomegalovirusdeoxyribonucleic acid polymerase chain reaction(CMV-DNA-PCR)abnormalities, sepsis, neonatal pneumonia, intracranial hemorrhage, neonatal hypoxic-ischemic encephalopathy (HIE), pulmonary hypertension,respiratory failure, mechanical ventilation, neonatal syphilis, phylogenicmeningitis, congenital heart disease, anemia, hypoglycemia, infection earlyand mid-pregnancy, pregnancy complications, fetal distress, neonatalasphyxia, premature rupture of membranes and placenta previa. The thesisis to screen the risk factors which may influence hearing ability ofpremature by the way of univariate analysis of Chi-square test andmultivariate Logistic regression model.Results:1.665(1330ears) premature were taken initial hearing screening,138cases (20.8%) failed hearing screening, in which39(5.9%) cases were left,35(5.3%) right, and64(9.6%) bilateral.2. In138cases who failed in the initial TEOAE,98cases(70.0%)redid TEOAE at42days after birth, with a dropout rate of30.0%.39cases(39.8%) failed, in which left ears were13cases (13.3%). The right earswere10patients (10.2%), binaural were16cases (16.3%).3.35cases received ABR check in which39patients failed twiceTEOAE, with an attrition rate of10.3%.16patients (45.7%) are abnormal,including5cases (14.3%) left ear,4cases (11.4%) right ear,7casesbinaural (20.0%).4. Univariate analysis showed that: gestational age, birth weight,hyperbilirubinemia, bilirubin encephalopathy, neonatal HIE, neonatal syphilis, purulent meningitis, neonatal asphyxia were factors correlatedwith failed hearing screening (P <0.05).5. The multivariate analysis showed that: gestational age, birth weight,hyperbilirubinemia, HIE, syphilis, asphyxia (the OR were2.927,2.627,1.956,7.813,5.971,1.906;95%CI were1.944～4.405,1.202～5.739,1.371～2.791,1.424～42.878,1.984～17.974,1.047～3.47，respectively).Conclusions:1. For hospitalized preterm children in this study, the failed rate in theinitial TEOAE is20.8％，unpassing rate of rescreening is39.8％and therate in the ARB is45.7%in this study.2. Gestational age <34weeks, birth weight<1500g,hyperbilirubinemia, HIE, neonatal syphilis, neonatal asphyxia were riskfactors of failed hearing screening in premature. Because of limitedmedical resources, including manpower financial and other causes, it ishard to perform large-scale neonatal hearing screening. Therefore,emphasis should be put on the preterm children with risk factors of hearingimpaired mentioned above and necessary and appropriate measures aresupposed to take in order to reduce the damage to their hearing ability.