Analysis Of The Factors Correlated With Failed Hearing Screening In Newborns

Objective: To explore the factors correlated with failed hearing screening in newborns,and to supply the reference for large-scale neonatal hearing screening and follow-up of infants with high risk factors for hearing impairment.Methods: The clinical datum of 719 term infants, admitted in Children's Hospital of Chongqing Medical University from January 2009 to July 2009 and undergone hearing screening, were analyzed retrospectively by univariate analysis and multivariate Logistic regression analysis, and to filter the factors correlated with failed hearing screening in newborns. Gender, birth parity, gestational age, delivery method, birth weight, fetal distress,birth asphyxia, history of common cold in early and medial gestation , history of drugs during gestation, abnormality of umbilical cord, pregnant complications, family history of congenital hearing loss, household environment, craniofacial anomalies, respiratory secretion, blood glucose, jaundice, bilirubin encephalopathy, hypoxic-ischemic encephalopathy(HIE), pulmonary hypertension, sepsis, purulent meningitis, congenital intrauterine infection(TORCHES), pneumonia and neonatal behavioral neurological assessment(NBNA), were recorded.Results:1. Of the 719(1438 ears) newborns, 160(22.3%) failed hearing screening, in which 48 (6.7%) cases were left, 28 (3.9%) right, and 84 (11.7%) bilateral.2. Among 160 cases failed in the initial hearing screening, 58 cases (36.2%) redid hearing screening at 42 days after birth, with an attrition rate of 63.8%. Of the rescreening cases, 18 (31.0%) were failed, including 13 (22.4%) unilateral and 5(8.6%) bilateral.3. Positive serous CMV antibody was detected in 338 cases of 719 newborns (47.0%), of whom 335 cases were IgG positive and 3 were positive both in IgG and IgM. Positive polymerase chain reaction (PCR) of serous CMV deoxyribonucleic acid (DNA) in urine specimens of 102 infants were two (2.0%).4. Of the 160 infants who failed in hearing screening, NBNA is 36±2 score, apparently lower than that of infants passing hearing screening(37±1score),which are significantly different (t =3.841, P<0.01). For lowest NBNA score group (score≤31), lower NBNA score group (score = 32-35) and higher NBNA score group (score≥36), the incidences of failed hearing screening were 63.6%, 37.2% and 19.5%, respectively.5. Hyperbilirubinemia above the threshold of exchange transfusion, bilirubin encephalopathy, positive serous CMV antibody, small for gestational age infant, NBNA score≤35, hemolytic jaundice, early onset jaundice (appear within first 24 hours of life), craniofacial anomalies were the factors correlated with failed hearing screening in newborns (P <0.05) by one way analysis. Gender, household environment, delivery method, birth parity, gestational age, birth weight, common cold in early and medial gestation, drugs during gestation, abnormality of umbilical cord, pregnant complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, large amount of secretion in airway, pneumonia, sepsis, purulent meningitis were not factors correlated with failed hearing screening (P>0.05).6. Multivariate Logistic regression analysis indicated that hyper- bilirubinemia above the threshold of exchange transfusion, positive serous CMV antibody, NBNA score≤35, craniofacial anomalies were factors correlated with failed hearing screening (the OR were 5.913, 2.861, 0.031, 1.623; 95%CI were 1.852-18.87, 1.067-7.669, 1.037-2.135, 1.123-2.347, respectively).Conclusions:1. For newborns hospitalized in our hospital, the failed rate in the initial hearing screening was 22.3%, whereas the rate in the rescreening was 31.0%.2. Hyperbilirubinemia above the threshold of exchange transfusion, positive serous CMV antibody, NBNA score≤35,craniofacial anomalies were the factors correlated with failed hearing screening in newborns. Gender, household environment,delivery method, birth parity, gestational age, birth weight, common cold in early and medial gestation, drugs during gestation, abnormality of umbilical cord,pregnant complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, large quantity of secretion in airway, pneumonia, sepsis, purulent meningitis were not correlated factors.3. The lower the NBNA score was, the higher incidence of failed hearing screening was.4. Because of limited medical resources, including manpower management, it is hard to perform large-scale neonatal hearing screening. Therefore, it is recommened that the newborns possess the factors correlated with failed hearing screening, including hyperbilirubinemia above the threshold of exchange transfusion, positive serous CMV antibody, NBNA score≤35 and craniofacial anomalies, should be concerned, and undergo hearing screening and closely follow-up.