早产儿听力筛查异常的危险因素分析

Investigation of risk factors for hearing impairment in premature infants

摘要:

目的 探讨早产儿听力筛查异常的危险因素。方法 对2010年1 ~ 12月入住新生儿重症监护病房（NICU）的 895例早产儿应用耳声发射（DPOAE）技术进行听力检测。进行多因素逐步回归分析以明确听力筛查未通过的危险因素。结果 初次筛查未通过率为38.4%，第 2次筛查未通过率为 18.3%，生后3个月进行听觉脑干反应（ABR） 检查时未通过率为22.2%。胎龄28~29⁺⁶周初筛未通过率60.5%，出生体重1 001~1 499 g 者初筛未通过率48.1%，出生体重≤1 000 g者初筛未通过率70.0%；应用有创呼吸机未通过率45.0%，重度窒息未通过率53.8%，血清总胆红素≥340 μmol/L未通过率47.9%，新生儿败血症未通过率54.6%。Logistic多因素回归分析表明，胎龄、出生体重、高胆红素血症及败血症均为听力初筛和复筛未通过的独立风险因素。结论 早产儿由于各器官、组织发育不成熟，血脑屏障功能不完善，对高胆红素血症、感染等因素敏感而易产生听力损伤 。对早产儿进行早期的听力检测及跟踪随访，及时给予必要的干预是必要的。

Abstract:

Objective To investigate the risk factors for hearing impairment in premature infants. Methods A total of 895 premature infants who were admitted to the neonatal intensive care unit from January to December 2010 were evaluated using distortion product otoacoustic emission to detect hearing impairment. The failure rates in initial screening and secondary screening were recorded. The risk factors for failure to pass hearing screenings were elucidate using multivariate logistic regression analysis. Results The failure rate in initial screening was 38.4%, and the failure rate in secondary screening was 18.3%. In the auditory brainstem response test conducted at three months after birth, the failure rate was 22.2%. In premature infants with a gestational age of 28-29⁺⁶ weeks, 60.5% did not pass the initial screening; 48.1% of the premature infants with a birth weight of 1 001-1 499 g failed the initial screening; 70.0% of the premature infants with a birth weight of ≤1 000 g failed the initial screening; 53.8% of the premature infants who had severe asphyxia failed the initial screening; 45.0% of the premature infants who used invasive ventilation failed the initial screening; 47.9% of the premature infants with a total bilirubin of ≥340 μmol/L failed the initial screening; 54.6% of the premature infants with septicemia failed the initial screenings. The multivariate logistic regression analysis revealed the following independent risk factors for failing the initial and secondary hearing screenings: gestational age, birth weight, hyperbilirubinemia and septicemia. Conclusions Premature infants are susceptible to hearing impairment because they have immature organs and tissues and incomplete blood-brain barrier function and are sensitive to such factors as hyperbilirubinemia and infection. Early hearing screening and follow-up are necessary for premature infants to ensure timely interventions.