gms | German Medical Science

34. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP)
Dreiländertagung D-A-CH

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.

Bern, 14.09. - 17.09.2017

Prevalence and risk factors for hearing loss in a high-risk newborn population: an epidemiological study from a tertiary care center in North-Rhine

Vortrag

  • corresponding author presenting/speaker Kruthika Thangavelu - Universitätsklinikum Essen, Hals-Nasen-Ohren-Klinik, Essen, Deutschland
  • author Kyriakos Martakis - Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
  • author Silke Fabian - Funktionsbereich Neugeborenen-Hörscreening für Nordrhein, Köln, Deutschland
  • author Bernhard Roth - Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Köln, Deutschland
  • author Dirk Beutner - Uniklinik Köln, Hals-Nasen-Ohren Klinik, Köln, Deutschland
  • author Ruth Lang-Roth - Uniklinik Köln, Hals-Nasen-Ohren Klinik, Pädaudiologie und Phoniatrie, Köln, Deutschland

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie. 34. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP), Dreiländertagung D-A-CH. Bern, Schweiz, 14.-17.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocV22

doi: 10.3205/17dgpp36, urn:nbn:de:0183-17dgpp366

Published: August 30, 2017

© 2017 Thangavelu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Abstract

Background: In spite of universal screening programs, hearing loss continues to be a serious complication in high-risk babies. Several risk factors need statistical evidence from population-based studies to justify their role in hearing impairment in newborns. Such studies can also inform hearing screening programs and policies.

Materials and Methods: This is a retrospective cohort study and includes neonates screened under the universal newborn hearing screening program in the region of North-Rhine over a period of 6 years from January 2009 until December 2014, that were hospitalized in the University Children’s Hospital of Cologne. Statistical analyses were done using STATA 14.0.

Results: Over the 6-year period 4,512 newborns were screened. The prevalence of hearing loss was 1.6% (n=71). Among them 54.9% (n=39) had conductive hearing loss, 21.1% (n=15) had sensorineural and 26.8% (n=19) had combined hearing loss. We assessed the hearing loss against the following risk factors: craniofacial anomalies (1.3%), patent ductus arteriosus (6.6%), hyperbilirubinemia (28.3%), ototoxic drugs (9.7%), sepsis (5%), meningitis (0.3), perinatal infections (0.4%), hypoxia (2.4%), mechanical invasive ventilation (13.4%), CPAP ventilation (59.9%) and post natal oxygen supplementation (34.2%). Multivariate analyses showed that craniofacial anomalies (p=0.00, 95% CI 3.02, 4.43) and invasive mechanical ventilation (p=0.02, 95% CI 0.09, 1.36) were found to have statistically significant associations with hearing loss.

Discussion: The incidence of hearing loss in our population was higher than in the general population since it is a high-risk group. Our findings that craniofacial anomalies and invasive mechanical ventilation have significant associations with hearing loss, is consistent with previous studies. However, a commonly demonstrated risk factor, ototoxic drugs did not have a significant association with hearing loss.

Conclusion: The prevalence of hearing loss in our study group was found to be 1.6%. Craniofacial anomalies and invasive mechanical ventilation are important predictors for hearing loss in this population of newborns.


Text

Introduction

Hearing impairment in children across the world constitutes a particularly serious obstacle to their optimal development, education, and language acquisition.

According to studies conducted in different countries, around 0.5 to 5 out of every 1,000 neonates and infants have congenital or early childhood onset sensorineural deafness or severe-to-profound hearing impairment. The incidence of hearing impairment is significantly higher, by up to 20 or 30 times, in high-risk newborn populations. Targeted screening and follow-up based on risk factors play an important role in ensuring that these high-risk newborns are not left out of the screening program.

This study aims to determine the prevalence of hearing loss, as well as to analyze the risk factors for hearing impairment in a high-risk population in North-Rhine.

Materials and Methods

This is a retrospective cohort study conducted within the framework of the “Neugeborenen-Hörscreening Nordrhein” in Germany. We included data on neonates requiring hospitalization in the non-intensive ward or neonatal intensive care stay in the Children’s and Adolescents’ Hospital, University Hospital of Cologne. We analyzed data that covered a 6-year period from January 2009 to December 2014. All data had been documented prospectively in the respective neonatal databases of the University Hospital of Cologne. For this study, we extracted data regarding the treatment history of the newborns as well as information regarding various factors potentially associated with neonatal hearing impairment. The hearing screening results including the final diagnosis was retrieved from the database of the Neugeborenen-Hörscreening Nordrhein.

The collected data was statistically analyzed using STATA version 14.0 (StataCorp, Texas, USA). A univariate and bivariate logistic regression were performed. A two-sided p-value of <0.05 was used to indicate a statistical significance. The study was approved by the Ethics Committee of the Medical Faculty of the University of Cologne.

Results

A total of 4,512 newborns were screened for hearing loss through the newborn hearing screening program. Among them 2,589 (57.4%) newborns were male. The mean gestational age at birth was 35.5±4.2 weeks. The mean birth weight was 2,607±941 grams. In total, 71 (1.6%) newborns with hearing impairment were identified. Among them, 37 (52.1%) were diagnosed with unilateral and/or bilateral conductive hearing loss, 15 (21.1%) newborns with sensorineural hearing loss and 17 (23.9%) with combined hearing loss. Two newborns had a conductive hearing loss in one ear and a combined hearing loss on the other. Overall 97 (2.1%) newborns did not receive any hearing screening or were lost to follow-up at some point in the screening process. Three newborns died before the hearing screening was complete.

Univariate logistic analyses showed various risk factors having a statistically significant positive odds ratio. A final multivariate model adjusted for collinearity was created, which showed that craniofacial anomalies, phototherapy and treatment with exchange transfusion for extreme hyperbilirubinemia, and invasive mechanical ventilation had a statistically significant positive odds ratio for hearing loss in our high-risk newborn population. Other commonly demonstrated risk factors in literature such as ototoxic drugs, meningitis or perinatal infections did not have significant associations with hearing loss.

Discussion

The incidence of hearing loss in our population was, as expected, higher than that in the general population. Craniofacial anomalies, phototherapy or exchange transfusion for hyperbilirubinemia as well as invasive mechanical ventilation showed significant association with hearing loss, consistent with previous studies. We did not find such associations for other commonly demonstrated risk factors in literature, such as ototoxic drugs, meningitis or perinatal infections.

The newborns that were lost-to-follow-up form a relevant subpopulation among the high-risk neonatal population. Inclusion of the results of the lost-to-follow-up newborns could possibly alter the relevance of each factor associated with neonatal hearing impairment. Therefore, there is a need for more intensive and prolonged follow-up process in case of high-risk babies. Further studies involving larger cohorts of high-risk newborn populations are needed to confirm the findings.

Conclusions

Craniofacial anomalies, phototherapy or exchange transfusion for hyperbilirubinemia as well as invasive mechanical ventilation showed significant association with neonatal hearing loss. Such associations were not found for other commonly demonstrated risk factors in literature.


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