Results of the Universal Neonatal Hearing Screening in a Tertiary Care Hospital in Mexico city.

INTRODUCTION: Universal Neonatal Hearing Screening (UNHS) includes as its main objective, that all Newborns (NB) receive an audiological evaluation during their first month of life. OBJECTIVE: To determine the prevalence of hearing loss in a population of healthy NB in a tertiary care hospital in Mexico City. MATERIAL AND METHODS: A prospective cross-sectional study was designed. The period was from October 1, 2011 to May 15, 2019. UNHS was performed with a flowchart in three phases using Transient Evoked Otoacoustic Emissions and Brainstem auditory evoked potentials. Data were analyzed using descriptive statistics. RESULTS: 14,000 NB were evaluated, 28,000 ears. Gender was distributed in n = 7038 (50.3%) males and n = 6962 (49.7%) females. The mean age at the time of the first UNHS study was 48.3 ± 22.2 days. Hearing loss was confirmed in n = 31 (0.22%) NB, in 20 (64%) of the cases with hearing loss there were no documented audiological risk factors. CONCLUSIONS: The prevalence of hearing loss was 2.2 per 1000 NB in a tertiary care hospital in Mexico City. Diagnosis and early habilitation of hearing loss in NB constitute quality indicators in health care and guarantee the best prognosis for NB with hearing loss.

Risk factors associated with sensorineural hearing loss in infants at the neonatal intensive care unit: 15-year experience at the National Institute of Perinatology (Mexico City).

BACKGROUND: Infants from neonatal intensive care units (NICU) are at high risk for sensorineural hearing loss (SNHL); however, risk factors may change from NICU to NICU and from country to country. Our objective was to describe the main causes associated with SNHL in infants from a tertiary level NICU in Mexico City and to show the associated audiometric profiles. METHODS: We performed a comparison of follow-up of infants from NICU with SNHL and a control group with the same history but with normal hearing. Infants were examined at birth by brainstem auditory evoked potentials (BAEP) and followed by audiometric tests. Hearing loss was associated with clinical variables. RESULTS: SNHL group had 146 children and the control group had 272 children. Mean weight at birth in the SNHL group was 1530+/-581 g and in the control group, 1723+/-805 g (p<0.01). Days spent at the NICU and under mechanical ventilation were higher in the SNHL group (p<0.001). In addition, serum bilirubin levels were higher in the SNHL group than in the control group (p<0.001). Blood exchange, intraventricular hemorrhage, and neonatal meningitis comprised the main SNHL-associated variables. Use of prenatal steroids and pulmonary surfactant demonstrates protection against SNHL. Audiometric profiles disclosed mainly severe SNHL. CONCLUSIONS: Low birth weight, longer stay in NICU and under mechanical ventilation, higher serum bilirubin levels, prevalence of blood exchange, intraventricular hemorrhage, and meningitis in high-risk newborns were the main risk factors associated with SNHL and merit hearing screening and early intervention in high-risk infants.

Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad

resumen está disponible en el texto completo

Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.

Association between intelligence quotient scores and extremely low birth weight in school-age children.

BACKGROUND: Extremely low birth weight (ELBW) has been associated with poor cognitive development in children. We performed this research to establish the association between ELBW and the influence of biological and socioeconomic factors in the intelligence quotient (IQ) score in school-age children. METHODS: This study comprised 184 children with mean and standard deviation of 6.9 +/- 0.8 years of age. The children were divided into four groups based on their birth weight as follows: group A (n = 25), < or =1000 g; group B (n = 52), 1001-1500 g; group C (n = 66), 1501-2500 g; and group D (n = 41), > or =2501 g. The Stanford-Binet after the Terman-Merril Intelligence Scale was used to determine IQ scores. RESULTS: Mean and standard deviation (SD) of IQ values were 95.3 +/- 11.3 for group A, 103.1 +/- 14.4 for group B, 105.1 +/- 12.3 for group C, and 106.8 +/- 11.7 for group D (p = 0.003). Frequencies of children with scores below normal distribution were the following: 28% in group A; 10% in group B; 15% in group C, and 5% in group D (chi(2) = 0.04). Bronchopulmonary dysplasia and parental education were associated with lower IQ scores (p <0.05). CONCLUSIONS: IQ scores of children born with ELBW were significantly lower when compared to children born with a higher birth weight. Additional studies are important to determine whether these neurodevelopmental delays persist into adulthood, and whether there are additional factors associated with catch-up and recovery.

[Cry analysis of hypoacoustic children and normal hearing children]. / Análisis del llanto del niño hipoacúsico y del niño normo-oyente.

OBJECTIVE: We analyzed the spectrograms of the cry of deaf children and compared the results with those of normal children. MATERIAL AND METHODS: Twenty deaf children (0-2 years of age, both sexes) and 20 normal hearing children of both sexes within the same age range were studied. The deaf cases were selected from patients with high-risk pregnancies who are followed up at the National Institute of Perinatology (INPer), Department of Human Communication. Brainstem evoked potential responses were carried out in order to corroborate hearing loss in the affected group and to verify normal hearing in the other group. During physical examination in the Human Communication Clinic of the Inper, the cry was recorded with a Fisher tape recorder and MK2 unidirectional microphone. Sonograms were analyzed in the "Laboratorio de Bioacústica" of the Institute of the Human Communication (CNR) using the Software Cool Edit 96. We registered the fundamental frequency and 6 harmonic F1 at F6 (Hz). The cry frequencies of the deaf children were compared and of the normal hearing children using one-way analysis of variance. A typology of frequencies was organized by means of cluster analysis by the method of Ward and was compared with the study groups by means of contingency analysis (chi square). RESULTS: No significant difference was demonstrated in the fundamental frequency or in the harmonic by means of the one-way analysis. With cluster analysis, 8 types were obtained that were not different when compared with the study groups. The hypothesis was rejected with the obtained data. CONCLUSIONS: Upon confirmation of the obtained results, analysis of the spectrogram of deaf children at early ages does not have the ability to identify the problem and thus cannot be used as a method for early detection of deafness.

Evaluación audiológica del niño con peso extremadamente bajo al nacer / Audiologic assessment of extremely low birth weiaght infants

Introducción. Los recién nacidos con peso extremadamente bajo al nacer presentan frecuencia elevada de hipoacusia. Objetivos: describir la frecuencia de hipoacusia en una cohorte de niños con peso al nacer igual o menor de 1 000 g. Identificar qué factores muestran asociación con esta lesión.Material y métodos. Durante 1990-2000 se incluyeron a 216 niños, con edad media de 35.6 ñ 27 meses. Se evaluaron algunas variables de riesgo para hipoacusia sensorio-neural. Se les realizó estudio de potenciales auditivos provocados de tallo cerebral (Paptc) y audiometrías. Las variables se analizaron mediante un análisis de regresión logística bivariada.Resultados. Se distribuyeron dos grupos: el grupo A con 187 niños (86.6 por ciento) con audición normal bilateral; y el grupo B con 29 niños (13.4 por ciento) con hipoacusia. El promedio de días de estancia en la unidad de cuidados intensivos neonatales fue significativamente mayor para el grupo B (21.5 ñ 19 vs 49.8 ñ 34 días, P =0.004). El promedio de días de ventilación mecánica fue significativamente mayor para el grupo B (10.8 ñ 12.7 vs 26.5 ñ 16 días, P =0.008).Se encontraron diferencias significativamente mayores en el grupo B en las variables: hiperbilirrubinemia (P =0.007), hemorragia intraventricular (P =0.005) y meningitis neonatal (P =0.005). Los Paptc resultaron sin respuesta en 8 por ciento de los casos.Conclusiones. La frecuencia de hipoacusia documentada en niños con peso al nacer igual o menor de 1 000 g fue de 13 por ciento. La etiología de esta lesión es posiblemente multifactorial.

Frecuencia de disfunción de oído medio en preescolares con historia de cuidados intensivos neonatales / Frequency of middle ear dysfunction in pre-school children with history of neonatal intensive care

Los recién nacidos egresados de las Unidades de Cuidados Intensivos Neonatales (UCIN) presentan con frecuencia disfunción de oído medio. Objetivo: Determinar la frecuencia de disfunción de oído medio en niños preescolares con antecedente de haber egresado de una UCIN y su posible asociación con algunas variables perinatales y ambientales. Material y métodos: Se seleccionaron a 90 niños preescolares con edad media de 4.6+- 0.8 años. Se les practicó timpanometría, reflejo estapedial ipsilateral y audiometría de tonos puros. Resultados: 42 niños presentaron oído medio normal bilateral (grupo A) y 48 disfunción de oído medio (grupo B). El promedio días de estancia en la UCIN fue de 12 +-9.1 días, 71 (0.79) niños fueron sometidos a ventilación mecánica. La morbilidad más frecuente en la (UCIN) fue la hiperbilirrrubinemia neonatal (n=61). El factor de riesgo ambiental para otitis media más frecuente fue acudir a estancia infantil (n=70), seguido de alimentación al seno materno menor a 3 meses (n=41). Los análisis de regresión logística bivariada por oído no mostraron significancia en ningún factor de riesgo para otitis media. Tres (0.03) niños resultaron con hipoacusia bilateral de tipo sensorio-neural. Conclusiones: La disfunción de oído medio documentada correspondió a un 44 por ciento de los oídos explorados. Los sujetos egresados de las UCIN constituyen una población de alto riesgo otológico y audiológico que amerita vigilancia médica durante su niñez.

Exploración otoneurológica en escolares egresados de una Unidad de Cuidado Intensivo Neonatal / Otoneurologic evaluation of school children discharged from a neonatal intensive care unit

Introducción. Objetivos: detectar y analizar alteraciones otoneurológicas en un grupo de niños escolares con antecedente de haber cursado en una Unidad de Cuidado Intensivo Neonatal (UCIN); determinar si la hipoacusia secundaria a factores adversos en período neonatal se asocia a disfunción vestibular. Material y métodos. En un estudio prospectivo, colaborativo entre dos instituciones de tercer nivel de atención, se incluyeron a niños escolares, pertenecientes a una clínica de seguimiento pediátrico longitudinal del recién nacido de alto riesgo en la Ciudad de México. Se les practicó audiometría de tonos puros, electronistagmografía y posturografía dinámica computadas. Se describen algunos factores de riesgo asociados con alteraciones otoneurológicas. Resultados. Se evaluaron a 35 niños (70 oídos explorados), con una edad media de 8.1 ñ 1.7 años. Estos se distribuyeron en el grupo A (n=14), constituido por niños con hipoacusia, y el grupo B (n=21), constituido por niños con audición normal. El promedio de días de estancia en la UCIN fue significativamente mayor para el grupo A, con una media de 21.5 ñ 11.3 días (P£0.004). El factor de riesgo (furosemide) mostró diferencias estadísticamente significativas entre ambos grupos con una P igual o menor de 0.001. El promedio de bilirrubina indirecta fue significativamente mayor para el grupo A, con una media de 18.5 ñ 3.4 mg/dL (P£0.001). El análisis de regresión logística sugiere riesgo atribuible a furosemide para explicar la lesión auditiva, no así la vestibular. La hipoacusia documentada en el grupo A (n=14) en todos los casos fue bilateral, simétrica de tipo sensorio-neural de grado severo-profundo, con mayor lesión en las frecuencias agudas. Las pruebas de electronistagmografía mostraron diferencias estadísticamente significativas en la modalidad nistagmo optoquinético a una velocidad angular de 40 grados con anormalidad en 79 por ciento del grupo A, y en 24 por ciento del grupo B ( P£0.001). Asimismo en las pruebas térmicas con anormalidad en 79 por ciento del grupo A, y en 19 por ciento del grupo B (P£0.000). Conclusiones. Se demuestra que los niños de alto riesgo egresados de UCIN con hipoacusia presentan disfunción vestibular en una proporción de 0.79 y los que tienen audición normal en una proporción del 0.24. Se sugiere para esta población de riesgo mayor enfoque de estimulación vestibular durante los programas de habilitación temprana, así como exploración otoneurológica en su oportunidad.

Perfil audiométrico del niño hipoacúsico egresado de una Unidad de Cuidado Intensivo Neonatal: análisis de 40 casos / Audiometric profiles of hipoacusic children six years after discharge from a Neonatal intensive care unit

Introducción. En este estudio se describe el perfil audiométrico del niño hipoacúsico egresado de una Unidad de Cuidado Intensivo Neonatal (UCIN).Material y métodos. En una clínica de seguimiento pediátrico longitudinal se estudiaron mediante potenciales auditivos evocados de tallo cerebral y audiometrías a 40 niños con hipoacusia adquirida durante su estancia en una UCIN; se describen algunos factores asociados con hipoacusia en el período neonatal, y sus características audiométricas a 6 años de seguimiento longitudinal.Resultados. La edad gestacional promedio al nacer fue de 32.4 semanas con peso promedio de 1 557.5 g. El 0.82 ameritó ventilación mecánica intermitente y el promedio de días estancia en UCIN fue de 22 días.El factor asociado más frecuente fue la exposición a amikacina en 0.95 de los casos, seguido de la hiperbilirrubinemia con 0.82. Se detectaron 5 factores promedio presentes en cada niño. Los resultados de los potenciales auditivos evocados de tallo cerebral indicaron 23 casos (0.57) sin respuesta bilateral y 6 casos (0.15) sólo registraron onda V a 95 dB. La audiometría tonal mostró 0.93 con hipoacusia bilateral, probablemente de tipo sensorio-neural, simétrica, de grado severo a profundo con mayor alteración en las frecuencias agudas; 0.05 presentaron hipoacusia unilateral profunda con audición normal en el lado contrario.Conclusión. Estas observaciones sugieren que en nuestro medio el recién nacido pretérmino con peso promedio de 1 500 g, con historia neonatal complicada, y exposición prolongada a aminoglucósidos e hiperbilirrubinemia está en alto riesgo de presentar hipoacusia, justificando valoración audiológica durante sus primeros meses de vida.

Factores de riesgo para hipoacusia y hallazgos audiométricos en una población preescolar egresada de cuidados intensivos neonatales / Risk factores for hypoacusis and audiometric findings in preschool children admitted to a neonatal intensive care unit

En un estudio de corte transversal se analizaron por audiometría de tonos puros entre las frecuencias de 125 a 8000 Hz, por condicionamiento operante, en 30 niños sobrevivientes de una unidad de cuidados intensivos neonatales, entre 36 y 72 meses de edad, encontrándose que tres padecían hipoacusia. Los factores de riesgo encontrados con mayor frecuencia en la muestra estudiada fueron hiperbilirrubinemia, asfixia al nacer y administración de fármacos ototóxicos. Todos los pacientes con hipoacusia tenían antecedente de parto pretérmino; además uno había sufrido hipoxia al nacimiento y otros dos hiperbilirrubinemia; los pacientes presentaron un promedio de 2.26 facotres de riesgo. Se concluye que el daño auditivo de origen perinatal es de etiología multicausal en la génesis de este tipo de hipoacusia

Thirty preschool children who survived from a neonatal intensive care unit were studied with pure tone audiometry between 125 to 8000 Hertz. Examinations were performed in a cross-sectional study at 36 to 72 postnatal months of age. Hypoacusis was found in three patients. Risk factors most frequently found in hypoacustic children were hyperbilirubinemia, hypoxia neonatorum and ototoxic exposure. All hypoacustic children had a history of preterm birth, one suffered hypoxia neonatorum, and two hyperbilirubinemia. The patients' group had an average of 2.26 risk factors. These data suggest that perinatal auditory damage occurs in the presence of additional hearing damage risk factors leading to hypoacusis.