高危兒聽力篩查及隨訪研究①

呂攀攀，董榮芝，劉芳，王娜娜，徐沖鋒，邴衛(wèi)衛(wèi)，耿立蒙

高危兒聽力篩查及隨訪研究①

呂攀攀，董榮芝，劉芳，王娜娜，徐沖鋒，邴衛(wèi)衛(wèi)，耿立蒙

目的探索高危兒聽力篩查情況及聽力障礙的發(fā)生、變化及轉歸。方法2015年3月～2016年3月，采用耳聲發(fā)射(OAE)、聽性腦干反應(ABR)及腦干聽覺誘發(fā)電位(BAEP)的方法，對336例高危兒分別于生后0～1、3、6、12個月進行聽力監(jiān)測。結果336例高危兒中，0～1個月內初檢時29例未通過；3月齡復檢時37例聽力未通過；6月齡27例恢復正常；12月齡復檢7例恢復正常，3例(0.89%)確診耳聾。結論OAE、ABR結合BAEP檢查高危兒聽力損傷可獲得較全面的診斷，連續(xù)聽力監(jiān)測可有效動態(tài)觀察高危兒聽力損傷的發(fā)生、變化及轉歸。

高危兒；聽力篩查；耳聲發(fā)射；聽性腦干反應；腦干聽覺誘發(fā)電位；隨訪

[本文著錄格式]呂攀攀，董榮芝，劉芳，等.高危兒聽力篩查及隨訪研究[J].中國康復理論與實踐,2016,22(12):1459-1461.

CITED AS:LüPP,Dong RZ,Liu F,etal.Hearing screening and follow-up of high risk infant[J].Zhongguo Kangfu Lilun Yu Shijian, 2016,22(12):1459-1461.

新生兒及嬰幼兒聽力篩查在許多發(fā)達國家已成為常規(guī)制度[1-2]，在我國發(fā)達地區(qū)也已列入常規(guī)。新生兒及嬰幼兒聽力篩查，特別是高危新生兒的聽力追蹤評估非常重要。國內外報道均顯示，高危新生兒聽力障礙的發(fā)生率為2%～4%，遠高于正常新生兒，是聽力損傷的高發(fā)人群[3-5]。高危兒聽力障礙既可能是疾病本身所造成，也可能是由于出生后治療引起。為探索本院就診高危兒聽力損傷情況，我們對2015年3月～2016年3月本院新生兒科及產科出院的高危新生兒進行連續(xù)聽力監(jiān)測，以進一步了解高危兒聽力障礙的發(fā)生、變化及轉歸情況。

1 資料與方法

1.1 一般資料

收集本院新生兒科及產科2015年3月～2016年3月出院的新生兒，符合下列指征之一者均為監(jiān)測對象：羊水異常；胎盤異常；妊娠期高血壓；妊娠期糖尿?。蛔阍滦觾?；早產；低出生體質量；過期產；新生兒高膽紅素血癥；新生兒黃疸；新生兒缺氧缺血性腦病，符合韓玉昆等新生兒缺氧缺血性腦病診斷分度標準[6]；新生兒肺炎。排除標準：先天性并發(fā)癥；先天性畸形；其母孕期耳毒性藥物使用史及肝腎疾病史；耳聾及其他遺傳性疾病家庭史。符合指征作為檢測對象的高危新生兒共336例。

1.2 方法

檢查在聽力篩查室由專門人員進行，采用耳聲發(fā)射(otoacoustic em issions,OAE)、聽性腦干反應(auditory brainstem response,AABR)及腦干聽覺誘發(fā)電位(brainstem auditory evoked potential,BAEP)三種方法。OAE采用CD-RW Vser Cuide測定儀(丹麥)，AABR使用MB11快速聽性腦干反應測試儀(德國MAIKO)。BAEP使用丹迪全功能肌電誘發(fā)電位儀KEYPOINT(丹麥)。OAE用于出生后1個月內聽力初篩，AABR用于復查，BAEP用于聽力障礙患兒確診。所有高危兒均在生后0～1、3、6、12個月各聽力測查1次。

1.3 統(tǒng)計學分析

應用M icrosoft Excel2000進行數據錄入和統(tǒng)計學分析。

2 結果

336例(672耳)1個月內篩查未通過者34耳，初篩未通過率5.06%，其中雙耳未通過5例，未通過率1.49%。3個月AABR復查未通過者50耳，復查未通過率7.44%，其中雙耳未通過13例，未通過率3.87%。6個月復查AABR和BAEP未通過者14耳，復查未通過率2.08%，其中雙耳未通過4例，未通過率1.19%。12個月AABR和BAEP復查雙耳未通過者3例，復查未通過率0.89%。說明本研究中聽力損傷兒6個月后恢復正常，0.89%確診耳聾患兒，轉為耳鼻喉診治。見表1。

表1 高危兒聽力篩查情況(n)

回顧分析高危因素，最后確診聽力障礙患兒3例中，1例為新生兒缺氧缺血性腦病，1例為早產低出生體質量，1例為高膽紅素血癥。

3 討論

聽力障礙是常見的出生缺陷。據國內外報道，高危新生兒聽力障礙的發(fā)生率遠高于正常新生兒[3-5]。正常新生兒中雙側聽力障礙的發(fā)生率約0.1%～0.3%[7-8]。高危新生兒的聽力障礙可能由宮內感染、低出生體質量、窒息、缺氧缺血性腦損傷、肺部疾病、顱內出血、高膽紅素血癥等疾病引起[9-11]，特別是早產兒[12]。也存在遺傳因素[13]。各種高危因素導致高危兒的聽力損失多為中樞性的[14]，臨床上應用OAE、AABR及其他相關專業(yè)的檢查如BAEP可以確診[15-17]，大部分損傷是可逆的[18-19]。但是有部分高危新生兒聽力損傷具有獲得性或進展性的特點，遲發(fā)型聽力損傷的發(fā)病年齡最早可出現在8～12個月[20]，最晚為4～5歲及以后[21-22]，故對該人群聽力進行定期聽力監(jiān)測和隨訪，顯得尤為重要[23-24]。

國內報道正常新生兒聽力障礙發(fā)生率為0.3%；經重癥監(jiān)護病房搶救的新生兒，聽力障礙發(fā)生率高達22.6%[25]。本組高危兒最后確診耳聾3例，發(fā)生率為0.89%，顯示高危兒聽力障礙發(fā)生率比正常新生兒高，但其聽力損傷多為可逆性，故其最終耳聾發(fā)生率與正常新生兒基本一致。

本研究表明，應用OAE初篩有部分高危兒漏診，復檢采用AABR監(jiān)測為陽性，進一步采用BAEP確診，故采用OAE、AABR和BAEP可獲得較全面的診斷。對出生時通過篩查的高危兒應提高警惕，因為他們亦有可能發(fā)生遲發(fā)性或獲得性聽力損傷，所以連續(xù)的聽力檢測尤為重要[26-27]。

及時發(fā)現，早期干預，可以改善患兒聽力，刺激言語功能的發(fā)育，最終達到減少聾啞發(fā)病率的目的[28-30]。

高危兒聽力損傷后有一段恢復期，不要過早下結論，造成家長思想負擔過重，因為部分高危兒可恢復正常。本研究結果表明，通過實行聽力監(jiān)測可有效動態(tài)觀察到高危兒聽力障礙的發(fā)生、變化及轉歸，同時使有聽力障礙高危兒及早得到干預，有效得到康復治療，故建議在建立新生兒聽力篩查同時，對高危兒要實施聽力監(jiān)測。

[1]Cavalcanti HG,Guerra RO.The role ofmaternal socioeconomic factors in the commitment to universal newborn hearing screening in the Northeastern region of Brazil[J].Int JPediatr Otorhinolaryngol,2012,76(11):1661-1667.

[2]Palmer SB,Bednarz SE,Dilaj KA,et al.Universal newborn hearing screening in m idw ifery education:a survey[J].JM idwiferyWomensHealth,2016,61(4):435-441.

[3]Erenberg A,Lemons J,Sia C,et al.Newborn and infant hearing loss:detection and intervention.American Academy of Pe-diatrics.Task Force on Newborn and Infant Hearing,1998-1999[J].Pediatrics,1999,103(2):527-530.

[4]Tanaka Y,Enomoto H,Takada K,et al.[Newborn Hearing Screening and Subsequent Diagnostic Evaluation:Analysis and Outcomes of 6,063 Infants Born in a Community Hospital][J].[in Japanese].Nihon Jibiinkoka Gakkai Kaiho,2016, 119(3):187-195.

[5]聶文英,宮露霞,劉玉俊,等.10501例新生兒聽力篩查結果[J].中華醫(yī)學雜志,2003,83(4):274-277.

[6]中華醫(yī)學會兒科學會新生兒學組.新生兒缺氧缺血性腦病診斷依據和臨床分度[J].中華兒科雜志,1997,35(2):99-100.

[7]Cubillana-Herrero JD,Pelegrin-Hernandez JP,Soler-Valcarcel A,et al.The assessment of the Newborn Hearing Screening Program in the Region of Murcia from 2004 to 2012[J].Int J Pediatr Otorhinolaryngol,2016,88:228-232.

[8]CavalcantiHG,Melo LP,Buarque LF,etal.Overview of newborn hearing screening programs in Brazilianmaternity hospitals[J].Braz JOtorhinolaryngol,2014,80(4):346-353.

[9]Barreira-Nielsen C,Fitzpatrick E,Hashem S,etal.Progressive hearing loss in early childhood[J].Ear Hear,2016,37(5): e311-e321.

[10]Colella-Santos MF,Hein TA,de Souza GL,et al.Newborn hearing screening and early diagnostic in the NICU [J]. Biomed Res Int,2014,2014:845308.

[11]Marlow ES,Hunt LP,Marlow N.Sensorineural hearing loss and prematurity[J].A rch Dis Child Fetal Neonatal Ed,2000, 82(2):F141-F144.

[12]Calcutt TL,Dornan D,Besw ick R,et al.Newborn hearing screening in Queensland 2009-2011:Comparison of hearing screening and diagnostic audiological assessment between term and preterm infants[J].J Paediatr Child Health, 2016.[Epub ahead of print]

[13]Lang-Roth R.Hearing impairment and language delay in infants:Diagnostics and genetics[J].GMSCurr Top OtorhinolaryngolHead Neck Surg,2014,13:c5.

[14]Mehl AL,Thomson V.The Colorado newborn hearing screening project,1992-1999:on the threshold of effective population-based universal newborn hearing screening[J].Pediatrics, 2002,109(1):E7.

[15]de Kock T,Swanepoel D,Hall JR.Newborn hearing screening at a community-based obstetric unit:Screening and diagnostic outcomes[J].Int J Pediatr Otorhinolaryngol,2016,84: 124-131.

[16]Khoza-Shangase K,Harbinson S.Evaluation of universalnewborn hearing screening in South African primary care[J].Afr J Prim Health Care Fam Med,2015,7(1).doi:10.4102/phcfm. v7i1.769.

[17]Kemaloglu YK,Gokdogan C,Gunduz B,etal.Newborn hearing screening outcomes during the first decade of the program in a reference hospital from Turkey[J].Eur Arch Otorhinolaryngol,2016,273(5):1143-1149.

[18]Mcgurgan IJ,Patil N.Neonatal hearing screening of high-risk infants using automated auditory brainstem response:a retrospective analysis of referral rates[J].Ir JMed Sci,2014,183 (3):405-410.

[19]van Dyk M,Swanepoel DW,Hall JR.Outcomes w ith OAE and AABR screening in the first 48 h－implications for newborn hearing screening in developing countries[J].Int JPediatr Otorhinolaryngol,2015,79(7):1034-1040.

[20]Caluraud S,Marcolla-Bouchetemble A,de Barros A,et al. Newborn hearing screening:analysis and outcomes after 100000 births in Upper-Normandy French region[J].Int JPediatrOtorhinolaryngol,2015,79(6):829-833.

[21]Stika CJ,Eisenberg LS,Johnson KC,et al.Developmental outcomes of early-identified children who are hard of hearing at 12 to 18 months of age[J].Early Hum Dev,2015,91(1): 47-55.

[22]Ching TY,Dillon H,Marnane V,etal.Outcomesof early-and late-identified children at 3 years of age:findings from a prospective population-based study[J].Ear Hear,2013,34(5): 535-552.

[23]A laee E,SiratiM,Taziki MH,et al.Risk factors for sensorineural hearing loss among high-risk infants in Golestan Province,Iran in 2010-2011[J].Iran Red CrescentMed J,2015,17 (12):e20419.

[24]Okano T,IwaiN,TaniguchiM,etal.[A clinicalstudy on 106 infant caseswho received detailed hearing tests after newborn hearing screening][J].[in Japanese].Nihon Jibiinkoka Gakkai Kaiho,2014,117(10):1249-1257.

[25]徐秀,王穗芬,彭詠梅,等.上海地區(qū)2378名新生兒聽力篩查分析[J].中華兒科雜志,2006,35(1):571-573.

[26]Mann T,Cuttler K,Campbell C.Newborn hearing screens may give a false sense of security[J].JAm Acad Audiol,2001, 12(4):215-219,220-221.

[27]Hunter LL,Meinzen-Derr J,Wiley S,et al.Influence of the WICProgram on loss to follow-up fornewborn hearing screening[J].Pediatrics,2016,138(1).pii:e20154301.

[28]M ukherjee SS,M ukherjee S,Sarkar KD.Prevalence of hearing loss in high risk infants ofmediocre socio-economic background ataround one yearof ageand their correlation with risk factors[J].Indian J Otolaryngol Head Neck Surg,2013,65 (Suppl3):598-603.

[29]Finckh-Kr?mer U,GrossM,Bartsch M,etal.[Hearing screening of high risk newborn infants][J].[in German].HNO,2000, 48(3):215-220.

[30]沈曉明.新生兒聽力篩查工作中需要重視的幾個問題[J].中華醫(yī)學雜志,2004,84(6):441.

Hearing Screening and Follow-up of High Risk Infant

LüPan-pan,DONGRong-zhi,LIU Fang,WANGNa-na,XU Chong-feng,BINGWei-wei,GENG Li-meng
Departmentof Pediatrics,TheA ffiliated Hospitalof Binzhou MedicalUniversity,Binzhou,Shandong 256603,China

ObjectiveTo explore the hearing screening,and the change and outcome of hearing impairmentof high risk infants.MethodsFrom March,2015 to March,2016,336 high risk infantswere screened w ith otoacoustic emissions(OAE),auditory brainstem response (ABR)and brainstem auditory evoked-potential(BAEP)0-1,3,6,12months after born,respectively.ResultsAmong the 336 high risk infants,29 failed theexam inationsw ithin the1stmonth,37 cases failed in the3rdmonth,27 cases recovered in the9thmonth,and 7 cases recovered in the 12thmonth,3 caseswere finally diagnosed as deafness(0.89%).ConclusionOAE,ABR combining with BAEPexamination may obtain com prehensive diagnosis of hearing impairment for high risk infants,continuous listening com prehensionmonitoring can effectively dynam ically observe thehearing impairment,changesand outcomeof high risk infants.

high risk infants;hearing screening;otoacoustic emissions;auditory brainstem response;brainstem auditory-evoked potential;follow-up

10.3969/j.issn.1006-9771.2016.12.021

R246.81

B

1006-9771(2016)12-1459-03

2016-08-24

2016-09-05)

濱州市科技發(fā)展計劃項目(No.2014ZC0155)。

濱州醫(yī)學院附屬醫(yī)院兒科，山東濱州市256603。作者簡介：呂攀攀(1985-)，女，漢族，山東淄博市人，碩士，醫(yī)師，主要研究方向：高危兒篩查及早期干預。E-mail:lvpanpan163@163.com。