ON THE QUESTION OF HEARING IMPAIRMENT IN PREMATURE CHILDREN WHO HAVE EXPERIENCED OXIDATIVE STRESS AT BIRTH

Abstract

Introduction. Hearing impairment (HI) occupies an important place among perinatal pathology. According to theWHO, the frequency of severe hearing impairment is observed in 1–2 per 1000 newborns and in 15% of newborns whorequired intensive therapy after birth. Mild and moderate HI occurs in 1–2% of children with perinatal pathology.The aim of the work is to study the predictors of hearing impairment and the factors that determine the severityof deafness in children aged 2–3 months who suffered oxidative stress at birth.Material and methods. 131 cases of observation of newborns of 27–36 weeks of gestation with HI in Communalnonprofit enterprise «City perinatal center» Kharkiv city council were analyzed. Children whose families had casesof HI were excluded from the study. During the observation, the audiological examination was carried out in thenewborn period (primary examination) and at 2–3 months of age. To meet the aim of the work, alternative groupswere formed: Group I (n=51) with unilateral and Group II (n=80) with bilateral hearing impairment.To determine the predictors of the severity of PS in the comparison groups, the factors determining deafnesswere studied, and their prognostic informativeness was established. The t-Student and φ-Fisher criteria weredetermined, the Wald-Henkin heterogeneous sequential procedure algorithm was used, predictive coefficients (PC)and informativeness (I) were determined.By decision of the Bioethics Commission № 3 dated March 21, 2023, the study materials comply with the TokyoDeclaration of the World Medical Association, the International Recommendations of the Helsinki Declaration onHuman Rights, the Council of Europe Convention on Human Rights and Biomedicine, the Laws of Ukraine, and therequirements of the Code of Ethics of a Doctor of Ukraine.The study was carried out within the framework of the scientific research work of the Department of Pediatrics№ 3 and Neonatology of KhNMU «Study of peculiarities of the course of oxidant stress diseases in newborns» 2022–2024 (state registration № А22U000025).Results. Factors of obstetric and somatic anamnesis of the mother did not influence the nature of HI in the child.Among the complications of pregnancy and childbirth in the anamnesis of children with bilateral HI, dysfunction ofplacenta was more often observed 33.8 and 13.7 % (р<0.001), threat of abortion 30.0 and 17.6 % (<0.05), anemiapregnant women 31.2 and 13.7 % (p<0.001), fetal distress 56.2 and 37.3 % (p<0.01), cesarean delivery 68.8 and 47.1% (p <0.001), especially regarding fetal distress – 67.3 and 29.2 % (р<0.001).The frequency of bilateral HI in children is inversely proportional to gestational age and birth weight and isassociated with a low Apgar score. Sexual dimorphism was revealed: girls predominated in the group with bilateralhearing loss, 56.2 and 35.3 % (р<0.001). Children with bilateral HI more often required surfactant therapy 78.8 and33.3 % (p<0.001), as well as longer respiratory support and oxygen therapy.In the study, bilateral HI was more common in children with diseases whose pathogenesis is closely relatedto oxidative stress: periventricular leukomalacia 55.0 and 7.8 % (<0.001); bronchopulmonary dysplasia (BPD)of the 2nd and 3rd degree: 23.7 and 2.0 % (p<0.001) and 23.7 and 0 % (p<0.001), respectively; retinopathy ofprematurity grade 2–3 42.5 and 17.6 % (р<0.001); with an PDA 81.3 and 41.2 % (p<0.001), including when surgicalclosure was necessary, 18.5 and 9.5 % (p<0,05). The highest informativeness of hearing impairment in childrenwho have undergone oxidative stress belongs to the following characteristics: gestational age (6.14), total durationof mechanical ventilation (5.54), body weight (5.44), BPD (5.4), duration of mechanical ventilation in mode ofnormoventilation (4.1), duration of oxygen therapy (3.91), PDA (3.72).The most significant prognostic factors of bilateral hearing impairment: the presence of BPD 2–3 stages. (-13.8);intraventricular hemorrhage (IVH) 2–3 st. (-12.4); total duration of ventilator ≥21 days (-10.33); gestation period≤29 weeks (-8.6); periventricular leukomalacia (PVL) 2–3 st. (-8.48); duration of oxygen therapy ≥21 days (-7.38);body weight (-6.94).Conclusions: The most significant prognostic factors of bilateral hearing impairment: the presence of BPD 2–3st. (-13.8); IVH 2–3 st. (-12.4); total duration of ventilator ≥21 days (-10.33); gestation period ≤29 weeks (-8.6);periventricular leukomalacia 2–3 st. (-8.48); duration of oxygen therapy ≥21 days (-7.38); body weight (-6.94), etc.Bilateral hearing impairment is predicted in newborns based on the presence of gestational immaturity (gestationalterm ≤ 29 weeks), BPD grade 2–3, IVH grade 2–3, total duration of mechanical ventilation and oxygen therapy > 21days, PVL grade 2–3. In our study, no reliable relationship was found between the nature of the hearing impairment of aprematurely born child and the somatic and obstetric anamnesis of the mother. Gender characteristics among prematureinfants with bilateral HI were characterized by the predominance of the female gender, 56.2 and 35.3 % (р<0.001).