2893例早产儿听力筛查及随访研究
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摘要
目的了解早产儿听力状况,探讨早产儿听力筛查和随访的方法。方法对1 000例无高危因素足月儿(足月组)、1 021例低危早产儿(低危组)及1 872例高危早产儿(高危组)出院前(天龄2~32d)行TEOAE初筛,42天行TEOAE及AABR复筛,未通过者在3月龄、6月龄行听力学诊断,通过者也在3、6、9、12月龄采用TEOAE行听力随访,随访未通过者进行听力学诊断。结果足月组初筛未通过87例(8.70%),复筛未通过11例(1.10%),诊断听力障碍2例(0.20%),其中1例双侧轻度感音神经性聋,1例单侧极重度感音神经聋。低危组初筛未通过95例(9.30%),复筛未通过16例(1.57%),诊断听力障碍6例(0.58%),其中2例传导性聋(中耳积液),2例双侧中度感音神经性聋,2例单侧轻度感音神经性聋。高危组初筛未通过251例(13.40%),复筛未通过58例(3.10%),诊断听力障碍24例(1.28%),其中6例传导性聋(中耳积液),2例听神经病,4例双侧轻度感音神经性聋,2例双侧极重度感音神经性聋,2例双侧中度感音神经性聋,5例单侧轻度感音神经聋,2例单侧中度感音神经性聋,1例单侧极重度感音神经性聋。随访:低危组1例中耳积液自愈,1例单侧中度感音神经聋听力好转;高危组2例听神经病、2例迟发性感音神经性聋、1例中耳积液患儿病情加重。结论早产儿听力障碍发病率高,且存在听力波动及迟发性听力下降等,采用OAE联合AABR进行筛查及随访极其重要。
Objective To investigate the hearing characteristics of preterm infants,and to explore the methods of hearing screening and follow-up in preterm infants.Methods A total of 1 000 mature infants,1 021 lowrisk premature infants and 1 872 high-risk premature infants were screened by TEOAE before discharge,and all cases were re-screened by TEOAE and AABR in 42-day old.Those who failed were diagnosed at 3 months and 6 months of age.All the cases were followed up by TEOAE at 3,6,9 and 12 months of age.If they failed the follow-ups,the full audiologic diagnosis was referred.Results In the mature group,87(8.7%)failed in the first step,11(1.10%)failed in the second step,and 2(0.2%)were diagnosed as hearing loss:1 bilateral mild sensorineural deafness,and 1 unilateral extreme sensorineural deafness.In the low-risk group,95(9.30%)failed in the first step,16(1.57%)failed in the second step,and 6 cases(0.58%)were diagnosed:2 conduction deafness(middle ear effusion),2 bilateral moderate sensorineural deafness,and 2 unilateral mild sensorineural deafness.In the highrisk group,251(13.40%)failed in the first step,58(3.10%)failed in the second step,and 24(1.28%)hearing impairments were diagnosed:6 conduction deafness(middle ear effusion),2 auditory neuropathy,4 bilateral mild sensorineural deafness,2 bilateral extremely severe sensorineural deafness,2 bilateral moderate sensorineural deafness,and 5 unilateral mild sensorineural deafness,2 unilateral moderate sensorineural deafness,and 1 unilateral extremely severe sensorineural deafness.In the follow-up step,we found one middle ear effusion self-healing,and one unilateral moderate sensorineural deafness improving by self in the low-risk group.In the high-risk group,2 auditory neuropathy,2 delayed sensorineural hearing loss and one middle ear effusion aggravating were found.Conclusion The incidence of hearing impairment in premature infants is high,and there are hearing fluctuations and delayed hearing losses.Hearing screening by OAE combining with AABR and follow-up are very important for premature infants.
Objective To investigate the hearing characteristics of preterm infants,and to explore the methods of hearing screening and follow-up in preterm infants.Methods A total of 1 000 mature infants,1 021 lowrisk premature infants and 1 872 high-risk premature infants were screened by TEOAE before discharge,and all cases were re-screened by TEOAE and AABR in 42-day old.Those who failed were diagnosed at 3 months and 6 months of age.All the cases were followed up by TEOAE at 3,6,9 and 12 months of age.If they failed the follow-ups,the full audiologic diagnosis was referred.Results In the mature group,87(8.7%)failed in the first step,11(1.10%)failed in the second step,and 2(0.2%)were diagnosed as hearing loss:1 bilateral mild sensorineural deafness,and 1 unilateral extreme sensorineural deafness.In the low-risk group,95(9.30%)failed in the first step,16(1.57%)failed in the second step,and 6 cases(0.58%)were diagnosed:2 conduction deafness(middle ear effusion),2 bilateral moderate sensorineural deafness,and 2 unilateral mild sensorineural deafness.In the highrisk group,251(13.40%)failed in the first step,58(3.10%)failed in the second step,and 24(1.28%)hearing impairments were diagnosed:6 conduction deafness(middle ear effusion),2 auditory neuropathy,4 bilateral mild sensorineural deafness,2 bilateral extremely severe sensorineural deafness,2 bilateral moderate sensorineural deafness,and 5 unilateral mild sensorineural deafness,2 unilateral moderate sensorineural deafness,and 1 unilateral extremely severe sensorineural deafness.In the follow-up step,we found one middle ear effusion self-healing,and one unilateral moderate sensorineural deafness improving by self in the low-risk group.In the high-risk group,2 auditory neuropathy,2 delayed sensorineural hearing loss and one middle ear effusion aggravating were found.Conclusion The incidence of hearing impairment in premature infants is high,and there are hearing fluctuations and delayed hearing losses.Hearing screening by OAE combining with AABR and follow-up are very important for premature infants.
引文
1国家卫生和计划生育委员会办公厅.国家卫生计生委办公厅关于印发早产儿保健工作规范的通知[S].国卫办妇幼发[2017]9号文件,2~6.
2 Norton SJ,Gorga MP,Widen JE,et al.Identification of neonatal hearing impairment:summary and recommendations[J].Ear and Hearing,2000,21:529.
3 倪道风.低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用[J].中华耳鼻咽喉头颈外科杂志,2006,5:326.
4 林少莲,叶胜难,林有辉,等.1667例听力筛查转诊婴幼儿听力学诊断结果分析[J].听力学及言语疾病杂志,2015,21:225.
5 Calcutt TL,Dornan D,Beswick R,et al.Newborn hearing screening in Queensland 2009-2011:comparison of hearing screening and diagnostic audiological assessment between term and preterm infant[J].Journal of Pediatric and Child Health,2016,52:995.
6 李燕芳,刘云亮,张沁铭,等.28 304例正常产新生儿听力筛查结果报告及筛查体会[J].中国妇幼保健杂志,2014,29:2173.
7 布鲁斯通,著.孔维佳,译.儿童及婴幼儿中耳炎[M].第4版.北京:人民卫生出版社,2011.59~60,139~140.
8 王洪阳,李倩,谢林怡,等.新生儿听神经病谱系障碍的流行病学特征及其临床转归分析[J].中华耳科学杂志,2015,13:211.
9 吴金毛,叶炎林,王三南,等.重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查[J].中华耳科学杂志,2011,9:174.
10 许军,陈淑飞,郑周数,等.听力筛查未通过的婴儿听力追踪检查[J].临床耳鼻咽喉科杂志,2006,20:446.
11 Psarommatis I,Riga M,Douros K,et.al.Transient infantile auditory neuropathy and its clinical implications.[J].Int J Pediatr Otorhinolarygol,2006,70:1629.
12 Van Dyk M,Swanepoel de W,Hall JW.Outcomes with OAE and AABR screening in the first 48h-implications for newborn hearing screening in developing countries[J].Int J Pediatr Otorhinolaryngol,2015,79:1034.
13 Ozlem K,Aydan G,Togay M,et.al.Can automated auditory brainstem rsponse be used as an initial stage screening test in newborn hearing screening programs[J]?Int Adv Otol,2010,6:231.
14 陶泽璋,杨琨.儿童听力筛查的必要性[J].听力学及言语疾病杂志,2017,25:113.
2 Norton SJ,Gorga MP,Widen JE,et al.Identification of neonatal hearing impairment:summary and recommendations[J].Ear and Hearing,2000,21:529.
3 倪道风.低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用[J].中华耳鼻咽喉头颈外科杂志,2006,5:326.
4 林少莲,叶胜难,林有辉,等.1667例听力筛查转诊婴幼儿听力学诊断结果分析[J].听力学及言语疾病杂志,2015,21:225.
5 Calcutt TL,Dornan D,Beswick R,et al.Newborn hearing screening in Queensland 2009-2011:comparison of hearing screening and diagnostic audiological assessment between term and preterm infant[J].Journal of Pediatric and Child Health,2016,52:995.
6 李燕芳,刘云亮,张沁铭,等.28 304例正常产新生儿听力筛查结果报告及筛查体会[J].中国妇幼保健杂志,2014,29:2173.
7 布鲁斯通,著.孔维佳,译.儿童及婴幼儿中耳炎[M].第4版.北京:人民卫生出版社,2011.59~60,139~140.
8 王洪阳,李倩,谢林怡,等.新生儿听神经病谱系障碍的流行病学特征及其临床转归分析[J].中华耳科学杂志,2015,13:211.
9 吴金毛,叶炎林,王三南,等.重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查[J].中华耳科学杂志,2011,9:174.
10 许军,陈淑飞,郑周数,等.听力筛查未通过的婴儿听力追踪检查[J].临床耳鼻咽喉科杂志,2006,20:446.
11 Psarommatis I,Riga M,Douros K,et.al.Transient infantile auditory neuropathy and its clinical implications.[J].Int J Pediatr Otorhinolarygol,2006,70:1629.
12 Van Dyk M,Swanepoel de W,Hall JW.Outcomes with OAE and AABR screening in the first 48h-implications for newborn hearing screening in developing countries[J].Int J Pediatr Otorhinolaryngol,2015,79:1034.
13 Ozlem K,Aydan G,Togay M,et.al.Can automated auditory brainstem rsponse be used as an initial stage screening test in newborn hearing screening programs[J]?Int Adv Otol,2010,6:231.
14 陶泽璋,杨琨.儿童听力筛查的必要性[J].听力学及言语疾病杂志,2017,25:113.