| Objective: Through hearing test of the high-risk newborns in neonatal intensive care unit (NICU) and the normal newborn in maternity wards in our hospital to explore the risk factors which cause hearing impairment in newborn,to evaluate the characteristics and significance of transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) which applied to newborn hearing screening .Further, the most suitable method of high-risk newborn hearing screening will be discussed and the feasibility of Tracking high-risk neonatal follow-up hearing and giving timely intervention will be investigated.Methods: The target of this study is 128 cases of neonatal who were in hospital treatment in our hospital pediatric neonatal intensive care unit (NICU)This study is targeted from January 2009 to July 2009 in our hospital pediatric neonatal intensive care unit (NICU) in the hospital treatment of 128 cases of neonatal. According to strict clinical diagnostic criteria, 75 cases of premature children (gestational age 29 to 37 weeks),37cases of hyperbilirubinemia (serum bilirubin concentration>221μmol/L or a daily increase of more than 85μmol/L), neonatal asphyxia (16 cases of birth Apgar score≤7 points) and 150 cases of normal newborns has been screened out. There was no family history of congenital deafness or ear poison in pregnancy or history of infection ,and only single risk factor is exists. After TEOAE test and AABR test for the newborns in NICU and TEOAE test for normal newborns, which was implemented by experienced technicians in charge of ENT surgery, it is discovered that hearing loss persons have been carried out a regular review, follow-up and guidance of treatment and related work。As follows:TEOAE and AABR test for all the high-risk newborns have been implemented when the condition stable. TEOAE test for normal newborns in maternity wards have been implemented after about 48 hours after birth.The re-screening will be implemented after a month if the first screening is not pass. The screening results are grouped according to the difference of Risk factors, screening methods, screening and re-screening results. SPSS statistical software (version 16.0) is used for Statistical treatment.X2 test is used for comparison between the two groups.The difference is significant when P <0.05.Results:1 Comparison of hearing screening results between High-risk neonates and normal newborns.128 cases of high-risk neonates,256 ears were screened with TEOAE test. And pass number is 166 (Pass rate is 64.84%).150 cases of normal newborns, 300 ears were screened with TEOAE test. And pass number is 289 (Pass rate is 96.33%).Comparing high-risk neonates with normal newborn,the screening results had significant differences in each group( P < 0.05).It is that hearing screening pass rate of high-risk neonates is lower than normal newborn significantly.2 High-risk newborn hearing screening results128 cases of high-risk neonates,256 ears were screened with TEOAE test. In which,95 ears were passed in 75 Premature infant,150 ears(Pass rate is 63.33%).62 ears were passed in 37 newborn,74 ears with hyperbilirubinemia (Pass rate is 70.27%).And 19 ears were passed in 16 newborn,32 ears with asphyxia (Pass rate is 59.38%).128 cases of high-risk children,256 ears were screened with AABR test. And pass number is 182 (Pass rate is 71.09%).In which,117 ears ware passed in 75 Premature infant,150 ears(Pass rate is 78%).49 ears ware passed in 37 newborn,74 ears with hyperbilirubinemia (Pass rate is 66.21%). And 19 ears ware passed in 16 newborn,32 ears with asphyxia (Pass rate is 50%).3 Results comparison of screening and re-screening in high-risk neonatesRe-screening had been implemented for children after 30 to 42 days after birth who was failed passing screening with both two methods.In first screening with TEOAE,90 ears passed in 120 ears,60 cases (Pass rate is 25%). 92 ears passed in re-screening with TEOAE in 112 ears(Pass rate is 82.14%),4 cases lost in which.The difference was statistically significant ( P < 0.05).In first screening with AABR,30 ears passed in 104 ears,60 cases (Pass rate is 38.65%).87 ears passed in re-screening with AABR in 96 ears (Pass rate is 90.62%),4 cases lost in which.The difference was statistically significant ( P < 0.05).4 Comparison of this two screening methods TEOAE and AABR128 cases of high-risk neonates,256 ear were screened with TEOAE and AABR test separately.146 ears are both passed in AABR and in TEOAE.20 ears are passed in TEOAE but not in AABR.36 ears are passed in AABR but not in TEOAE.54 ears are neither passed in AABR nor in TEOAE.The difference was statistically significant (P<0.05). There are still seven ears ,of which were not adopted at first,were not adopted by the re-screening, such a high-risk children will be transferred to ENT of our hospital for further follow up and finally confirmed whether the hearing-impaired children or not.Conclusion:1 The hearing screening pass rate of the premature children, newborns with hyperbilirubinemia and asphyxia newborn in NICU is far lower than the normal newborn.High-risk newborn hearing screening should be routinely carried out.2 Auditory function of premature children is gradually maturity with the growing age; hearing impairment of newborns with hyperbilirubinemia and asphyxia newborn is also recovered with treatment and rehabilitation.3 There are some limitations both in TEOAE and in AABR,easily missed or misdiagnosed part of the hearing-impaired children. So these two methods should be applied to high-risk neonatal hearing screening jointly.4 Strict hearing screening procedures for high-risk neonatal should be developed.And closely track the follow-up is needed for those who did not pass screening,which will be help for detecting hearing impairment in children and implementing intervention as early as possible,and will alleviate the financial and psychological burden for patients and their families.
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