Neonatal Neurology: Clinical Research
Neonatal Neurology 1: Clinical 1
Charlie Boyle, MD (he/him/his)
Resident Physician
SSM Cardinal Glennon Children's Medical Center
St. Louis, Missouri, United States
This is a retrospective, observational study in which data were collected on neonates admitted to the institutional level 3 or 4 NICU between December 2018 and January 2020. Infants with craniofacial or syndromic anomalies were excluded. Hearing loss was defined as involvement of either or both ears. Ototoxic medications included ones described in literature. Data were analyzed using t-test and logistic regression.
189/2146 (8.8%) and 41/2146 (1.9%) of neonates admitted during the study period failed their hearing screen at discharge and had persistent hearing loss respectively. 41/189 (21.6%) of those who failed hearing screen had persistent hearing loss on Auditory Brainstem Response (ABR) testing 6 to 12 months after NICU discharge. Neonates who failed their hearing screen had significantly lower GA (p< 0.001) and birth weight (p< 0.01), had lower APGAR scores at 1 minute (p< 0.01) and 5 minutes (p< 0.01). They had higher likelihood of bronchopulmonary dysplasia (p< 0.001), intraventricular hemorrhage (p=0.014), exposed to ototoxic drugs (p< 0.001), and received furosemide (p=0.004), hydrocortisone use (p=0.027) and dexamethasone (p< 0.001) (Table 1). In regression analyses, BPD (p=0.009) and the number of ototoxic agents (p=0.003) were significantly associated with failed hearing screening whereas exposure to inhaled nitric oxide (p=0.01) was associated with lower likelihood of failed screening (Table 2). However, the only significant factor that was associated with persistent hearing loss was a failed hearing screen (OR 180; 95% CI 54, 620; p< 0.01) (Table 3).
Conclusion(s):
While the prevalence of persistent hearing loss is low (1.9%), a failed hearing screen at NICU discharge is the single most important predictor of persistent hearing loss. Hearing screen failures were associated with BPD and exposure to ototoxic medications. The association of inhaled nitric oxide with fewer failed screens should be explored in larger cohorts.