Influencing Factors Of Hearing Impairment In Neonates With Hyperbilirubinemia

Objective:By collecting the clinical data of neonatal hyperbilirubinemia and the occurrence of hearing impairment,and to find out the influencing factors of hearing impairment in neonatal hyperbilirubinemia,so as to provide clinical basis for early intervention and reduce hearing impairment.Methods: A total of 867 children with hyperbilirubinemia who were mainly indirectly elevated bilirubin in the full-term neonatal ward of Hunan Children's Hospital from October 2012 to May 2014 were enrolled.The abnormality of Brainstem Auditory Evoked Potential(BAEP)was used as an early basis for neurological hearing impairment.According to the results of BAEP,it was divided into normal hearing group,hearing light-moderate injury group,and hearing severe-very severe injury group.Retrospective analysis of the relationship between perinatal family status,timeliness of visits,related auxiliary data,clinical manifestations and hearing impairment in neonates with hyperbilirubinemia,in order to find out the factors affecting hearing impairment in children with hyperbilirubinemia.The statistically significant single factor was used as the independent variable,and the BAEP results as the dependent variable were included in the logistic regression analysis to explore the high risk factors and related prompting factors of hearing loss in neonates with hyperbilirubinemia.The Receiver Operating Curve(ROC)predicts the accuracy and cut-off analysis of severe-very severe hearing loss in hyperbilirubinemia.Result:1.There were no significant differences in birth weight,admission weight,hospital age,and feeding patterns between the normal hearing group and the hearing light-moderate injury group and the hearing severity-very severe injury group(P>0.05).The three groups were comparable.2.All the 164 patients had hearing impairment,and the injury rate was 18.90%,including 40 cases of light-to-moderate hearing(accounting for 4.60%),and 124 cases of hearing-very severe injury(accounting for 14.30%).3.The normal hearing group was compared with the light-to-moderate injury group and the severe-very severe injury group.The results showed: parity,mode of production,gender,gestational age,unconjugated bilirubin(UCB),peak bilirubin age,total biliary peak,acidosis,B/A ratio,sepsis,G6 PD deficiency,brain MRI,NBNA score,and related nervous system performance were statistically significant(P<0.05).4.When logistic regression analysis was performed on the statistically significant differences in the above-mentioned univariate analysis,the results showed total bilirubin peak,acidosis,B/A ratio,G6 PD deficiency,sepsis,brain MRI,and related neurological manifestations are statistically significant(P<0.05),in which total bilirubin peak,acidosis,B/A ratio increased,G6 PD deficiency,sepsis was an independent risk factor of severe-very severe hearing impairment in children with hyperbilirubinemia;5.The B/A ratio predicts the area under the ROC curve(ROC Area,AUC)for severe-very severe hearing impairment in children with hyperbilirubinemia: 0.767;the cut-off analysis of the ROC curve suggests that when the B/A ratio is 0.873,the sensitivity is 0.677,the specificity is 0.779,and the Yoden index is 0.46.Conclusion:1.The incidence of moderate to severe hearing impairment in neonates with hyperbilirubinemia is still high;2.Total bilirubin peak,acidosis,increased B/A ratio,G6 PD deficiency and sepsis are independent risk factors for severe-very severe hearing impairment in neonates with hyperbilirubinemia;3.When the B/A ratio is ?0.873,the risk of severe-very severe hearing impairment is significantly increased of hyperbilirubinemia.