Factores de riesgo relacionados con hipoacusia en recién nacidos mediante tamizaje neonatal auditivo en el departamento del Atlántico (Colombia), 2019-2020

Objetivos: Identificar los factores de riesgo relacionados con hipoacusia en recién nacido mediante tamizaje neonatal auditivo en el departamento del Atlántico (Colombia) en el periodo 2019-2020. Materiales y métodos: Estudio observacional, analítico, de casos y controles anidado en una cohorte. Los recién nacidos fueron atendidos en 4 instituciones de III nivel de complejidad en Atlántico entre 2019 y 2020. Se incluyeron 32 casos correspondientes a registros según criterios de la Organización Mundial de la Salud (OMS), sugestivos de alteración auditiva mediante la prueba de otoemisiones acústicas y 28 controles seleccionados de la misma población fuente, donde se originaron los casos en el mismo período. Se aplicaron los criterios de exclusión. Las variables cualitativas se presentaron en tablas de frecuencia y el análisis estadístico se realizó en el programa STATGRAPHICS versión 16. Para establecer diferencia entre los 2 grupos se utilizó la prueba (X2), calculándose su respectivo odds ratio, con un intervalo del 95 % de confianza. Resultados: Los principales factores de riesgo encontrados en recién nacido con alteración auditiva sugestiva de hipoacusia con significancia estadística (p<0,05) fueron la estancia en la Unidad de Cuidados Neonatales: OR 4,2 IC95 % (1,4-12,4) y uso de aminoglucósidos: OR 3,2 IC95 % (1,03-10,1). Conclusiones: Se encontró asociación entre la estancia en la Unidad de Cuidados Neonatales y uso de aminoglucósidos con alteración auditiva sugestivo de hipoacusia. Se debe tener en cuenta estos factores de riesgo para ser identificados en forma oportuna y realizar el manejo adecuado, como por ejemplo, disminuyendo tiempo de exposición.

Objectives: Identify risk factors related to hearing loss in newborns through neonatal hearing screening in the Department of Atlantic in the period 2019-2020. Materials and methods: Observational, analytical, case-control study nested in a cohort. Newborns were cared for in 4 level III of complexity health institutions in Atlantic between 2019 and 2020. 32 cases were included corresponding to records according to World Health Organization (WHO) criteria, suggestive of hearing impairment through the otoacoustic emissions test and 28 controls selected from the same source population, where the cases originated in the same period. Exclusion criteria were applied. The qualitative variables were presented in frequency tables and the statistical analysis was carried out in the STAT-GRAPHICS version 16 program. To establish the difference between the 2 groups, the (X2) test was used, calculating their respective odds ratio with a CI 95 %. Results: The main risk factors found in newborns with hearing impairment suggestive of hearing loss with statistical significance (p<0,05) were the stay in the Neonatal Care Unit: OR 4,2 CI95% (1,4-12,4) and use of aminoglycosides: OR 3,2 CI95 % (1,03-10,1). Conclusions: An association was found between the stay in the neonatal care unit and the use of aminoglycosides with hearing impairment suggestive of hearing loss. These risk factors must be taken into account to be identified in a timely manner and to carry out adequate management, such as reducing exposure time.

Brain stem auditory evoked potential response in neonates after recovery from hyperbilirubinemia: A neurophysiological approach to screening neuronal hearing loss

Objectives: Neonatal hyperbilirubinemia leads to neurological damages including encephalopathy and hearing loss. This study aimed to screen and evaluate the hearing loss in neonates after recovery from hyperbilirubinemia using the Brainstem evoked response audiometry (BERA) test. Materials and Methods: This cross-sectional comparative study was conducted in Physiology Department at Chitwan Medical College, Nepal. It included 20 age and sex-matched neonates recently recovered from hyperbilirubinemia and 20 normal healthy controls. The external acoustic canals of subjects were checked for any blockage or collapse before BERA testing. The BERA recordings were performed after the neonate’s natural sleep following a standard lab protocol explained by Taylor’s Evoked Potential in Clinical Testing. Results: The BERA wave latencies were delayed with a higher number of case group neonates I (IL-75%, IR-80%), III (IIIL-70%, III R-80%), and V (VL- 80%, VR-85%) than those of controls. The percentage of neonates with delayed interwave latencies was comparable between groups. The neonate’s hearing sensitivity assessed using the grades of hearing impairment by WHO revealed slight (threshold of hearing left ear [THL]-25% and threshold of hearing right ear [THR]-30%) and moderate (THL-40% and THR-35%) grades among cases whereas no impairment (THL-60% and THR-55%) in controls. The hearing thresholds were more in cases. Conclusion: The auditory pathway is highly sensitive to elevated serum bilirubin. BERA detects even a minute degree of hearing damage seen after complete treatment of hyperbilirubinemia. Therefore, BERA is a helpful tool in the early screening of hearing impairment in neonates. This improves prognosis by early management so that the neurosensory systems develop to their full extent and one can enjoy a normal social life.

Detección temprana de la hipoacusia con emisiones acústicas / Early hearing loss detection through otoacoustic emissions

Introducción: La hipoacusia neonatal es considerada un problema de salud pública. Su diagnóstico precoz y rehabilitación adecuada previenen la consecuencia más importante de la hipoacusia infantil: crecer sin un lenguaje. Objetivo: Analizar los resultados obtenidos en el Programa Universal de Detección Precoz de la Hipoacusia Infantil implementado en el Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria desde enero de 2007 hasta diciembre de 2013. Material y método: Se estudiaron 44.597 recién nacidos, mediante otoemisiones acústicas en ambas fases del programa. La fase diagnóstica es llevada cabo en la Unidad de Hipoacusia del Servicio de Otorrinolaringología. Resultados: Desde enero de 2007 y diciembre de 2013 nacieron 46.587 niños, se le practicaron el screening a 44.597, de los cuales, 41.621 presentan OEA positivas, 1.233 tienen OEA ausentes. En la segunda fase 8.193 presentaron otoemisiones positivas en ambos oídos, 649 no pasaron la segunda fase. Presentaron factores de riesgo para hipoacusia un total de 9.581 niños. La media de derivación a la fase diagnóstica fue de 5.69%, alcanzó una cobertura del 95,73%. 32 niños fueron diagnosticados entre los 6 y 8 meses ingresaron al Programa de Implantes Cocleares siendo intervenidos quirúrgicamente entre los 9 y 16 meses. Conclusión: El programa es adecuado a nuestro funcionamiento, alcanzando el mismo un porcentaje de cobertura superiordel 95% valor ampliamente satisfactorio teniendo en cuenta las recomendaciones de la CODEPEH.

Introduction: Neonatal hearing loss is a public health problem early diagnosis and (re) habilitation adequate prevent the most important consequence of infant hearing loss: growing up without a language. Aim: To analyze the results obtained in the Universal Program for Early Detection of Infant Hearing Loss implemented in the Complejo Hospitalario Universitario Insular Materno Infantil, in Las Palmas de Gran Canaria, from January 2007 to December 2013. Material and method: We studied otoacoustic emissions in both phases ofthe program for 44 597 newborns. The diagnostic phase was carried out at the Hearing Loss Unit, Department of Otorhinolaryngology. Results: Between January 2007 and December 2013, 46,587 children were born, 44,597 underwent screening, of which 41,621 have positive otoacustic emissions and in 1233 these are absent. In 8,193 the secondphase gave positive otoacustic emissions in both ears and 649 failed the second phase. 9,581 newborns presented risk factors associated with hearing loss. The average referral to diagnostic phase was 5.69%, the program reacheda coverage of 95.73%. 32 children diagnosedbetween 6and8months entered the Cochlear Implant Program being operated on between 9 and 16 months. Conclusion: The Program in our hospital has proved adequate, achieving a coverage rate above 95%, highly satisfactory value considering the recommendations of the CODEPEH.

Cochlear Implant

The development and improvement of cochlear auditory prostheses have radically reshaped the management of children and adults with significant hearing loss. Rapid evolution in the candidacy criteria and the technology has resulted in a large number of individuals who have benefited from implantation. Cochlear implants replace the normal inner ear by transforming acoustic sound signals into electric stimuli and deliver them to the auditory nerve. The decision to implant in a patient is a medical and surgical one. Candidacy issues, device selection, and planning for postoperative rehabilitation are complex, which require a dedicated cochlear implant team. Medical and surgical evaluation includes all aspects of cochlear implant candidacy, including critical analysis of hearing tests, motivation of the patient and family, and status of language development. Postoperative speech recognition results are variable. The expected results depend heavily on the environment in which cochlear implants are used, as well as on case selection. In children, implantation before the age of 2 years provides a distinct advantage over later implantation in cases of early-onset deafness. Postimplantation rehabilitation can be important for some adult implant recipients, but appears to be critical for children to optimize the usefulness of an implant. For early diagnosis of neonatal deafness and early implantation, a national neonatal hearing screening program is mandatory.

Incidence of hearing loss and importance of risk factors in the neonatal intensive care unit / 소아과

PURPOSE: To assess the incidence of neonatal hearing loss in a neonatal intensive care unit and the relative importance of risk factors for hearing imparement in a neonatal intensive care unit which the Joint Committee on Infant Hearing(JCIH) had recommended. METHODS: One thousand, two hundred and one newborns admitted to the Good Moonhwa Intensive Care Unit from May 2003 to December 2005 were assesed using the automated auditory brainstem response(AABR). The screening was performed on those aged more than 36 weeks and weighing more than 2,200 g. We divided the infants into two groups, 'pass' and 'refer'. The 'refer' group were retested one month later, and if classified as 'refer' during the retest, were referred to a hearing impairment clinic. RESULTS: From the 1,201 neonates, 1,187(98.8 percent) passed the test and 14(1.2 percent) failed. 293(24.4 percent) of the 1,201 neonates had a risk factor for hearing impairment; 282(96.2 percent) passed the test and 11(3.8 percent) failed. The group with risk factors were shown to have a higher incidence of hearing loss(P<0.001). The neonates in the refer group were shown to have a higher incidence of ototoxic drugs(P<0.001), low birth weight(<1,500 g)(P<0.001) and craniofacial anomalies(P=0.007). On the other hand, there were no statistical differences between the pass and refer groups in congenital infection, hyperbilirubinemia, bacterial meningitis, low Apgar scores, prolonged mechanical ventilation and syndromes known to include hearing loss. CONCLUSION: In order to identify hearing-impaired infants within an appropriate period, neonatal hearing screening tests and identification of the risk factors for neonatal hearing loss are important.

Evaluación auditiva neurosensorial en un grupo de prematuros del programa madre canguro / Sensorineural auditory evaluation in a group of preterm neonates

Entre agosto de 1989 y diciembre de 1991 se buscó asociación entre algunos factores de riesgo comunes a los prematuros con peso menor de 1.500 g al nacer y el hecho de presentar disminución de la agudeza auditiva, medida con los potenciales evocados del tallo cerebral a los 4 meses y luego entre los 8 y los 14 meses. Los factores de riesgo tenidos en cuenta en 133 prematuros del "Programa madre canguro" del Instituto de los Seguros Sociales, en Medellín, fueron: Peso inferior a 1.500 g, hiperbilirrubinemia superior a 10

A study was carried out to investigate the association between risk factors commonly found in preterm neonates with very low birth-weight (Iess than 1.500 g) and decreased auditory acuteness; the latter was measured according to brain stem evoked potentiaJs (BERA test) In 133 preterm neonates belonging to the "Kangaroo mother program", in 'Medellín,Colombla. The following risk factors we~ evaluated: Hyperbilirrubinemia, hyaline membrane, birth weight lower than 1.500g, fetal distress, hypoglycemia, use of aminoglycosldes, thlrd trimester hemorrhage, and maternal high blood presssure. Abnormal results in BERA test were found in 54 cases (40.6%) at 4 months and in only 10 (7.5%) in the final evaluation performed between 8 and 14 months of age. No association was found between risk factors and decreased auditory acuteness; the shift from abnormal to normal auditory acuteness can be explained by brain maturation factors In the preterm infant. Causes for final deficits remain to be investigated; follow-up programs including auditory tests in this group of children at risk should be established