Automated Auditory Brainstem Response Research Articles

Covid-19 infection in pregnant women: Auditory evaluation in infants.

Recent studies showed that COVID-19 infection can affect cochleo-vestibular system. The possibility of a vertical transmission is controversial. Some studies suggested that it is possible but unlikely, others find no evidence of vertical transmission. The objective of this study was to investigate whether exposure to COVID-19 during pregnancy or at birth has an impact on the hearing of the offspring. As part of the national hearing screening program, we performed in all newborns between January 2022 and February 2023, TEOAEs (Transient Evoked Otoacoustic Emissions) at birth and at 3 months. For those "REFER" at the third month test, we performed aABR (Automatic Auditory Brainstem Response) at 6 months. We analysed separately result between infants born to COVID-positive mothers during pregnancy and those born to COVID-negative mothers. To statistical verify differences we performed "Chi-square test". We enrolled a total of 157 infants, of whom 16 were born to mothers who had a molecular PCR test positive for COVID-19. In the latter we tested a total of 32 ears and only 1 ear (3,1%) resulted "REFER". On the other hand, in the control group we tested a total of 282 ears and 22 (7,8%) were found to be "REFER". Our study showed no significant differences in audiological assessment between newborns exposed to COVID-19 infection during pregnancy or at birth compared to the unexposed group. However, further studies with a larger patient's sample will be necessary for a more comprehensive evaluation.

Newborn and infant hearing screening for early detection of hearing loss in Nairobi, Kenya

Background: Early detection of hearing loss and subsequent intervention leads to better speech, languageand educational outcomes giving way to improved social economic prospects in adult life. This can be achieved through establishing newborn and infant hearing screening programs. Objective: To determine the prevalence of hearing loss in newborns and infants in Nairobi, Kenya. Methods: A cross-sectional pilot study was conducted at the National hospital and at a sub county hospital immunization clinic. A total of 9,963 babies aged 0-3 years, were enrolled in the hearing screening program through convenient sampling over a period of nine months. A case history was administered followed by Distortion Product Oto-acoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) hearing screening. Results: The screening coverage rate was 98.6% (9963/10,104). The referral rate for the initial screen was 3.6% (356/ 9,963), the return rate for follow-up rescreening was 72% (258 babies out of 356) with a lost to follow-up rate of 28% (98/356). The referral rate of the second screen was 10% (26/258). All the 26 babies referred from the second screen returned for diagnostic hearing evaluation and were confirmed with hearing loss, yielding a prevalence of 3/1000. Conclusions: Establishing universal newborn and infant hearing screening programs is essential for early detection and intervention for hearing loss. Data management and efficient follow-up systems are an integral part of achieving diagnostic confirmation of hearing loss and early intervention. Keywords: Hearing screening; newborn; infant; hearing loss; early detection; Kenya.

Newborn Hearing Screening Results for Infants With Prenatal Opioid Exposure in Southern Appalachia.

Infants prenatally exposed to opioids exhibit withdrawal symptomology that introduce physiological noise and can impact newborn hearing screening results. This study compared the referral rate and physiological noise interpreted by number of trials rejected due to artifact on initial newborn hearing screenings of infants with prenatal opioid exposure (POE) and infants with no opioid exposure (NOE). Furthermore, within the POE group, it examined the relationship of referral rates with severity of withdrawal symptomology, and with maternal and infant risk factors. This study used a retrospective cohort design of electronic medical records from six delivery hospitals in South-Central Appalachia. Newborn hearing screenings were conducted using automated auditory brainstem response (ABR) for 334 infants with POE and 226 infants with NOE. Severity of withdrawal symptomology was measured using the Modified Finnegan Neonatal Abstinence Scoring Tool, which includes observation of behaviors that introduce physiological noise. There was no significant difference in newborn hearing screening referral rate between infants with POE and infants with NOE. Referral rate was not affected by maternal or infant risk factors. Infants with POE had statistically significant higher artifact (defined as rejected ABR sweeps) than infants with NOE. There was a strong positive correlation between Finnegan scores and artifact but not referral rates. Sensitivity and specificity analysis indicated artifact decreased substantially after Day 4 of life. Referral rates of infants with POE were similar to those of infants with NOE. Nevertheless, the withdrawal symptomology of infants with POE introduces physiological noise reflected as artifact on ABR, which can affect efficiency of newborn hearing screenings.

Newborn and Infant Hearing Screening for Early Detection of Hearing Loss in Nairobi, Kenya

Background: Early detection of hearing loss and subsequent intervention leads to better speech, language and educational outcomes giving way to improved socioeconomic prospects in adult life. This can be achieved through establishing universal newborn hearing screening (UNHS) programs. The objectives of this study were to assess the feasibility of implementing a UNHS program and to also determine the prevalence of hearing loss in newborns in Nairobi, Kenya.
 Materials And Methods: A cross-sectional pilot study was conducted at the National Hospital and a sub-county hospital immunization clinic. A total of 9,963 babies aged 0-3 years, were enrolled in the hearing screening program through convenient sampling over nine months. A case history was administered followed by Distortion Product Oto-acoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) hearing screening.
 Results: The screening coverage rate was 98.6% (9963/10,104). The referral rate for the initial screen was 3.6% (356/ 9,963), and the return rate for follow-up rescreening was 72% (258 babies out of 356) with a loss to follow-up rate of 28% (98/356). The referral rate of the second screen was 10% (26/258). All 26 babies referred from the second screen returned for diagnostic hearing evaluation and were confirmed to have hearing loss, yielding a prevalence of 3/1000.
 Conclusions: Establishing universal newborn and infant hearing screening programs in Kenya is feasible and essential for early detection and intervention for hearing loss. Data management and efficient follow-up systems are an integral part of achieving diagnostic confirmation of hearing loss and early intervention.

Como a hiperbilirrubinemia deve ser considerada na definição do protocolo da triagem auditiva para neonatos de risco?

ABSTRACT Purpose To analyze hyperbilirubinemia as an indicator for the definition of risk protocol in newborn hearing screening (NHS) and in auditory monitoring in full-term and preterm neonates. Methods This is an observational, cross-sectional and retrospective study. A total of 554 children born in a public maternity hospital were included and divided into two groups: (G1) with 373 full-terms neonates; (G2) with 181 preterm neonates. Data were collected from the participant’s medical records to obtain information regarding the result of the NHS, performed by recording the automated auditory brainstem response (AABR), birth conditions, clinical characteristics, interventions performed, and results of the first test of total bilirubin (TB) and indirect bilirubin (IB) as well as the peak of TB and IB. A descriptive statistical analysis of the results was performed, and the level of significance adopted was 5%. Results On the NHS test, quotes of retest referral rates were smaller in G1 when compared to G2. There was no significant difference between the groups regarding type of delivery, gender, presence of Rh and ABO incompatibility, G6PD enzyme deficiency, and performance of phototherapy. TB and IB levels at the first exam and at peak time did not differ between neonates with “pass” and “fail” results on the NHS test in both groups. Conclusion Bilirubin levels in the neonatal period below the recommended values for indication of exchange transfusion are not directly related to the “fail” result on the NHS tests in term and preterm neonates.

How should hyperbilirubinemia be considered in the definition of the hearing screening protocol for neonates at risk?

To analyze hyperbilirubinemia as an indicator for the definition of risk protocol in newborn hearing screening (NHS) and in auditory monitoring in full-term and preterm neonates. This is an observational, cross-sectional and retrospective study. A total of 554 children born in a public maternity hospital were included and divided into two groups: (G1) with 373 full-terms neonates; (G2) with 181 preterm neonates. Data were collected from the participant's medical records to obtain information regarding the result of the NHS, performed by recording the automated auditory brainstem response (AABR), birth conditions, clinical characteristics, interventions performed, and results of the first test of total bilirubin (TB) and indirect bilirubin (IB) as well as the peak of TB and IB. A descriptive statistical analysis of the results was performed, and the level of significance adopted was 5%. On the NHS test, quotes of retest referral rates were smaller in G1 when compared to G2. There was no significant difference between the groups regarding type of delivery, gender, presence of Rh and ABO incompatibility, G6PD enzyme deficiency, and performance of phototherapy. TB and IB levels at the first exam and at peak time did not differ between neonates with "pass" and "fail" results on the NHS test in both groups. Bilirubin levels in the neonatal period below the recommended values for indication of exchange transfusion are not directly related to the "fail" result on the NHS tests in term and preterm neonates.

Analysis of audiological outcomes of children referred from a universal newborn hearing screening program over 9 years in Beijing, China

Universal newborn hearing screening (UNHS) and audiological diagnosis are crucial for children with congenital hearing loss (HL). The objective of this study was to analyze hearing screening techniques, audiological outcomes and risk factors among children referred from a UNHS program in Beijing. A retrospective analysis was performed in children who were referred to our hospital after failing UNHS during a 9-year period. A series of audiological diagnostic tests were administered to each case, to confirm and determine the type and degree of HL. Risk factors for HL were collected. Of 1839 cases, 53.0% were referred after only transient evoked otoacoustic emission (TEOAE) testing, 46.1% were screened by a combination of TEOAE and automatic auditory brainstem response (AABR) testing, and 1.0% were referred after only AABR testing. HL was confirmed in 55.7% of cases. Ears with screening results that led to referral experienced a more severe degree of HL than those with results that passed. Risk factors for HL were identified in 113 (6.1%) cases. The main risk factors included craniofacial anomalies (2.7%), length of stay in the neonatal intensive care unit longer than 5 days (2.4%) and birth weight less than 1500 g (0.8%). The statistical data showed that age (P < 0.001) and risk factors, including craniofacial anomalies (P < 0.001) and low birth weight (P = 0.048), were associated with the presence of HL. This study suggested that hearing screening plays an important role in the early detection of HL and that children with risk factors should be closely monitored.

Case history factors and audiological screening outcomes in HEU and HIV unexposed neonates at a district level hospital in Gauteng, South Africa

While progress has been made in reducing vertical Mother to Child Transmission (MTCT) of HIV, limited research exists on the health needs of HIV-exposed uninfected (HEU) neonates, particularly in the field of audiology. This lack of research and evidence could impact early detection and intervention efforts. This study aimed to establish relationships and compare outcomes between case history factors and audiological screening results in HEU and HIV-unexposed neonates at a district-level hospital in Gauteng, South Africa. A non-experimental quantitative, descriptive, cross-sectional, comparative research design was employed. Data was collected with a sample size of 212 participants (100 HEU, 112 HIV-unexposed neonates) recruited using quota sampling. The hearing screening process involved case history assessment, medical file review, otoscopy, tympanometry testing, Distortion Product Evoked Otoacoustic Emissions (DPOAE), and Automated Auditory Brainstem Response (AABR) measurements. Descriptive and inferential statistics, including measures of central tendency and parametric tests, were used for data analysis. The findings indicated that 43% of HEU neonates exhibited refer findings on DPOAE, and 43% on AABR, compared to 26% and 25% respectively in the HIV-unexposed neonatal group. Therefore, a statistically significant relationship was established when comparing audiological results between the HEU and HIV-unexposed groups. Case history factors such as mode of delivery, birth weight, and Apgar scores were not associated with hearing loss in either group. However, in the HEU group, a higher proportion of participants referred on the overall screening in the maternal Retroviral Disease (RVD) stage IV group, although statistical significance was not established. This study fills an evidence gap regarding HEU neonates and highlights the need to include this vulnerable population in policy and clinical guidelines related to early hearing detection, intervention, and preventive audiology initiatives.

Characteristics of hearing loss-associated gene mutations: A multi-center study of 119,606 neonates in Gannan.

HL is the second most common congenital disability in China, and its high incidence brings a serious burden of medical and educational sequelae. HL genetic screening enables the identification of individuals with inherited HL and carriers in a large scale. This study aimed to measure the detection rates of hearing loss (HL)-associated gene mutations in the Gannan population. The molecular etiology and risk factors of hereditary HL were also analyzed. In total, 119,606 newborns from 18 districts of Gannan were enrolled in this multi-center study conducted between April 2019 and April 2021. Otoacoustic Emission (OAE) was used for primary hearing screening 3 days after birth in quiet conditions, and OAE combined with automated auditory brainstem response (AABR) was applied 29-42 days after birth for those who failed or missed the initial screening. Meanwhile, high-throughput sequencing of hotspot HL-associated mutations in GJB2, GJB3, MTRNR1, and SLC26A4 were performed. Among the 119,606 newborns, 7796 (6.52%) failed the hearing screening. Genetic screening revealed that 5092 neonates (4.26%) carried HL-associated mutations. The detection rate of GJB2, SLC26A4, MTRNR1 and GJB3 mutations were 2.09%, 1.51%, 0.42% and 0.24%, respectively. The most prevalent variant was GJB2 c.235delC (1.74%). The second most prevalent variant was SLC26A4 c.919-2A>G (0.93%). The population who failed the hearing screening had a lower proportion (24.64%) of SLC26A4 gene variants compared to the population who passed (37.46%). Genetic screening identified 4612 (3.86%) carriers who were normal in hearing screenings. The concurrent hearing and genetic screening identified 480 (0.40%) neonates at high risk for hereditary HL. The results of this study suggest that the concurrent hearing screening and high-throughput genetic screening would greatly improve the effectiveness of newborn HL programs. This integration also facilitates the management of congenital HL, and aids in the prevention of aminoglycoside antibiotics-induced HL.

Neonatal hearing screening - does failure in TEOAE screening matter when the AABR test is passed?

PurposeNewborns who fail the transient evoked otoacoustic emissions (TEOAE) but pass the automatic auditory brainstem response (AABR) in universal newborn hearing screening (UNHS), frequently have no further diagnostic test or follow-up. The present study aimed to investigate whether hearing loss might be missed by ignoring neonatal TEOAE failure in the presence of normal AABR.MethodsA retrospective analysis was conducted in newborns presenting between 2017 and 2021 to a tertiary referral centre due to failure in the initial UNHS. The main focus was on infants who failed TEOAE tests, but passed AABR screening. The clinical characteristics and audiometric outcomes were analysed and compared with those of other neonates.ResultsAmong 1,095 referred newborns, 253 (23%) failed TEOAE despite passing AABR screening. Of the 253 affected infants, 154 returned for follow-up. At 1-year follow-up, 46 (28%) achieved normal audiometric results. 32 (21%) infants had permanent hearing loss (HL) confirmed by diagnostic ABR, 58 (38%) infants had HL solely due to middle ear effusion (MEE), and for 18 (12%) infants HL was suspected without further differentiation. The majority of permanent HL was mild (78% mild vs. 13% moderate vs. 9% profound). The rate of spontaneous MEE clearance was rather low (29%) leading to early surgical intervention in 36 children. The profile of the risk factors for hearing impairment was similar to that of newborns with failure in both, TEOAE and AABR; however, there was a stronger association between the presence of risk factors and the incidence of HL (relative risk 1.55 vs. 1.06; odds ratio 3.61 vs. 1.80).ConclusionIn newborns, the discordance between a “refer” in TEOAE and a “pass” in AABR screening is associated with a substantial prevalence of hearing impairment at follow-up, especially in the presence of risk factors.

Our results of hearing screening in newborns

Objectives: The newborn hearing screening test results with the automated auditory brainstem responses (AABR) test in our hospital was discussed in the light of current literature. Patients and Methods: The data of 379 newborn babies (202 boys, 177 girls) who underwent AABR test as a newborn hearing screening test between September 1, 2020, and September 1, 2021, were retrospectively scanned through hospital records, and the results were analyzed. Results: Fifty babies could not pass the first test. One baby did not come to the second test, and the family could not be reached. Three out of 49 babies failed the second test and were referred to the reference center. Although 28 babies passed the first or second test, they were referred to the reference center since they had risk factors. Conclusion: Hearing loss of newborn babies should be diagnosed in the first three months, necessary intervention should be made within six months, and both fitting aids and training should be started. Increasing the number of reference centers and the development of follow-up systems that provide feedback from referred patients will make screening programs more successful.

Comparison of different auto-detection methods for wave V with a wireless automated auditory brainstem response (AABR) measurement system

The wireless automatic auditory brainstem response measurement system developed in the previous research uses Kalman filter with exponential weight averaging method (Kalman filter with EWA) to filter signal and used the differential method to detect the Wave V of ABR. However, the signals are too noisy to be accurately determined. Therefore, this study compares the Wavelet Kalman filter and Moving average to the Kalman filter with EWA, and the fitted parametric peak (FPP) to the differential method, respectively. The simulation results showed that the signal-to-noise ratio of ABR is the highest after Wavelet Kalman filtering, and the audiologist can mark the waves III and V of ABR the most. The latency of the wave V detected by FPP was used to calculate the Pearson product-moment correlation coefficient with the audiologist’s manual mark. The two latencies are highly correlated, and the correlation coefficient is higher than the differential method. Therefore, the Wavelet-Kalman filter and FPP algorithm were implemented in the AABR measurement system. To evaluate the accuracy of the algorithm in this study, subjective experiments were conducted with four normal hearing subjects. The Mann-Whitney U test was used to test thedifference between the average value of automatic detection and reproducibility.

Correlation between Hearing Loss with Acute Encephalitis Syndrome in Indonesian Children

OBJECTIVE: The study aimed to correlate hearing loss and clinical characteristics in children following Acute Encephalitis Syndrome. METHODOLOGY: This cross-sectional study was conducted in the pediatric neurology outpatient clinic and audiology outpatient clinic of Dr. Soetomo Hospital Surabaya from August 2018 to January 2019. Written informed consent was obtained from parents before the study. Cases of AES with ages three months to 18 years were included. Age, fever, seizures, decreased consciousness and brain edema were analyzed. Hearing loss was evaluated by using Otoport Automated Auditory Brainstem Response (ABR). Statistical analysis was done by using the Fisher Exact test. RESULTS: A total of 25 children were enrolled in the study, 60 % male and 52% aged &lt; 12 months. There was a diagnosis of meningoencephalitis in 52% of patients, and hearing loss occurred in 5 patients. Age, fever, seizure, decreased consciousness and brain edema were evaluated as clinical characteristics of hearing loss. Fever &gt; 39°C (p = 0,046), seizure ≥ 30 minutes (p = 0,038) and decreased consciousness (Glasglow Coma Scale (GCS) ≤ 8) (p = 0.002) were significantly correlated with hearing loss in AES. CONCLUSION: Fever, seizure and decreased consciousness correlated with hearing loss in children with AES. KEYWORDS: Acute Encephalitis Syndrome, Children, Consciousness, Disease, Hearing loss, Infection

A Comparison of the Human Voice (“Baah”) Test and the Automated Auditory Brainstem Response in Detecting Neonates with Hearing Loss in a Community Setting

Objective. To assess the usage of the “Baah” Test compared to the AABR (Automated Auditory Brainstem Response) in detecting hearing loss of neonates in the community setting.Methods. This is a retrospective cross-sectional study. The targeted sample population are infants less than a month old who underwent screening at a testing facility in Malolos, Bulacan spanning the years 2011 and 2012.Results. A total of 201 infants were included in the study, with a mean age of 10.77 days with a standard deviation of 7.79. The ratio of males to females was almost equal at 1:1.01. For infants who passed hearing screening on at least one ear, 96% (193 infants) correlated with the results of “Baah” testing. For those with bilateral refer results on AABR, 4 out of the 6 correlated with the “Baah” Test.Conclusion. There is potential in using the “Baah” Test as a tool for hearing loss assessment of infants in situations wherein the usual hearing screening tests are inaccessible. It makes use of little resources, and though it does have its limitations in assessing for unilateral hearing loss (as the test cannot test ears in isolation), it would be able to identify infants likely to have bilateral hearing loss.

A Birth Cohort Follow-Up Study on Congenital Zika Virus Infection in Vietnam.

We assessed the development, sensory status, and brain structure of children with congenital Zika virus (ZIKV) infection (CZI) at two years and preschool age. CZI was defined as either ZIKV RNA detection or positive ZIKV IgM and neutralization test in the cord or neonatal blood. Twelve children with CZI born in 2017-2018 in Vietnam, including one with Down syndrome, were assessed at 23-25.5 months of age, using Ages and Stages Questionnaire (ASQ-3), ASQ:Social-Emotional (ASQ:SE-2), Modified Checklist for Autism in Toddlers, automated auditory brainstem response (AABR), and Spot Vision Screener (SVS). They underwent brain CT and MRI. They had detailed ophthalmological examinations, ASQ-3, and ASQ:SE-2 at 51-62 months of age. None had birthweight or head circumference z-score < -3 except for the one with Down syndrome. All tests passed AABR (n = 10). No ophthalmological problems were detected by SVS (n = 10) and detailed examinations (n = 6), except for a girl's astigmatism. Communication and problem-solving domains in a boy at 24 months, gross-motor area in a boy, and gross-motor and fine-motor areas in another boy at 59-61 months were in the referral zone. Brain CT (n = 8) and MRI (n = 6) revealed no abnormalities in the cerebrum, cerebellum, or brainstem other than cerebellar hypoplasia with Down syndrome. The CZI children were almost age-appropriately developed with no brain or eye abnormalities. Careful and longer follow-up is necessary for children with CZI.

Automated ABR screening for hearing loss and its clinical determinants among newborns with hyperbilirubinemia in National Hospital, Abuja, Nigeria.

Severe neonatal hyperbilirubinemia is a known risk factor for sensorineural hearing loss which is usually undiagnosed in our environment until school age due to a lack of routine screening programs. This cross-sectional study conducted between August 2020 and February 2021 employed a universal sampling of consecutive eligible participants after their mothers' consent. Hearing screening was conducted using an automated auditory brainstem response (AABR) device (Otoport OAE + ABR®). The proportion of AABR screening failure was assessed while associated clinical risk factors were determined using logistic regression. Statistical significance was set at 5% for all comparative analyses. One hundred and sixty newborns below 28 days of age, delivered at 34 weeks gestation and above, who had jaundice were recruited. The prevalence of screening AABR failure in at least one ear was 26.2%. Significant risk factors for AABR screening failure in addition to extreme and hazardous hyperbilirubinemia were acute bilirubin encephalopathy (ABE) (Odds Ratio (OR) =4.44, 95% CI = 3.19-6.17), birth weight below 2500 g (OR = 3.16, 95% CI = 1.48-6.77), dull tympanic membrane (TM) (OR = 5.94, 95% CI = 2.36-14.92) and exchange blood transfusion (OR = 4.84, 95% CI = 1.87-12.58). The prevalence of AABR screening failure was high, and a dull TM was its strongest predictor among late preterm and term neonates with hyperbilirubinemia. Otoscopy should be included in the care of newborn with hyperbilirubinemia and screening programs established to mitigate hearing loss among high-risk neonates in Abuja.

Comparative study of Automated Auditory Brainstem Response (AABR) and Brainstem Evoked Response Audiometry (BERA) for Hearing Loss Detection in High Risk Infants delivered in Dhulikhel Hospital

Background &amp; Objective: Brainstem evoked response audiometry (BERA) is most specific and sensitive test for brain stem dysfunction. It is most important objective method for evaluating peripheral auditory system in neonates, infants, sedated and comatose patients and other person who doesn’t understand the language. Objective of the study was to evaluate correlation BERA with other audiological tests in different types of hearing loss. Material and Methods: This was a hospital based retrospective observational analytic study that used a cross-sectional approach. The sampling used was consecutive sampling until the minimum size fulfilled from 1st September 2021 to 30th September 2022. All high-risk infants aged 0–3 months who suffer from asphyxia, sepsis, LBW, premature, and hyperbilirubinemia, the baby was stable and transportable, the patient’s parents were willing to participate were taken. Results: Out of 46 high risk infants of 0 - 3 months, male:female ratio of 1.7:1 with mean age of 31 days, the most common high risk factor was low birth weight and hyperbilirubinemia i.e 23(50%). 64% of infants were pass in AABR 2nd test in comparison to 71% pass in BERA test. Conclusion: There was no difference between AABR and BERA results for HL detection in high-risk infants at NICU.

Short-term outcomes of infants with hyperbilirubinemia-associated auditory neuropathy spectrum disorder in neonatal intensive care unit

Hyperbilirubinemia is a high-risk factor for auditory neuropathy spectrum disorder (ANSD) as well as hearing loss in general. This study described the outcomes of hyperbilirubinemia-associated ANSD infants diagnosed in hearing screening in the neonatal intensive care unit (NICU).A total of 578 children with hyperbilirubinemia admitted to the NICU between October 2020 and October 2021 were included in this study. The distortion product otoacoustic emission (DPOAE) and automatic auditory brainstem response (AABR) were combined for hearing screening, and those who failed the DPOAE or/and AABR underwent an auditory brainstem response (ABR) test. Infants with ANSD were followed up for 12 months.Forty infants (40/578, 6.9%) failed the DPOAE or/and AABR tests, of which, 13 (13/578, 2.2%) were diagnosed as ANSD, and 27 (27/578, 4.7%) were diagnosed as having sensorineural hearing loss (SNHL). Of the 13 ANSD infants followed up for 12 months, 7 recovered, 3 improved, 3 did not recover, and 1 was lost, equating to improved or recovered hearing in 75% (9/12) of ANSD infants at 12 months of age. Moreover, the maximum bilirubin in recovered or improved ANSD infants was 408.6 ± 129.0 μmol/L, while the maximum bilirubin in unrecovered ANSD infants was 749.3 ± 323.0 μmol/L. Furthermore, poorly differentiated and absent ABR waveforms were observed in 6 and 14 ears at 1 month, 2 ears were lost, 6 (6/6, 100.0%) and 6 (6/12, 50.0%) ears were recovered or improved at 12 months of age.s: The incidence of hyperbilirubinemia associated-ANSD was 2.2% of infants screened in the NICU. ANSD caused by hyperbilirubinemia may be transient, with most infants improving or recovering hearing by 12 months of age. Infants with poorly differentiated ABR waveforms and low bilirubin concentration are more likely to recover and hearing aids are not recommended in hyperbilirubinemia-associated ANSD below 12 months of age.

Relationship between Hearing Loss Risk Factors and Hearing Screening Results in Newborns: A Retrospective Cross-Sectional Study

Congenital hearing loss can have a long-term impact on children’s speech and communication abilities. Early detection and intervention of hearing loss are important in newborns. It is well known that there are several risk factors for hearing loss; however, the relationship between these risk factors and hearing screening tests remains uncertain in Iran. Therefore, this study aimed to explore the relationship between hearing loss risk factors and Automated Auditory Brainstem Response (AABR) and Transient-Evoked Otoacoustic Emissions (TEOAEs) within the Iranian context. This retrospective cross-sectional study was conducted on 9622 newborns (4643 females and 4979 males) in Iran. The data related to newborn hearing screening, including gender, the results of initial hearing screening, and hearing loss risk factors, were extracted from newborns’ record files. Data were analyzed using SPSS and a significant level was 0.05%. 190 (3.45%) newborns were referred to the screening. Fourteen newborns were diagnosed with hearing loss (prevalence of hearing loss = 1.45 per 1000) and 9 had one or more risk factors. There was a strong relationship between NICU admission, hyperbilirubinemia, family history of hearing loss, and consanguineous marriage with hearing screening test results (P &lt; 0.05). Among risk factors investigated in this study, hyperbilirubinemia, family history of hearing loss, and intrauterine infections were not significantly correlated with TEOAEs results (P &gt; 0.05). In contrast, they were significantly correlated with AABR results and the lowest OR was for prematurity and the highest for family history of hearing loss. Hyperbilirubinemia, family history of hearing loss, and intrauterine infections were the most significantly correlated risk factors with AABR and family history of hearing loss could be considered as a risk factor that most often leads to AABR failure results in Iran. So, Iranian clinicians, specifically, should ask parents to ask their relatives about any history of hearing loss or other health conditions that may affect their child's health. The findings also provide further evidence supporting the effectiveness of the newborn hearing screening protocols within the Iranian context, which recommend using AABR and TEOAEs tests for infants with risk factors for hearing loss.

Assessment of Hearing Impairment in Sick Newborns: A Prospective Observational Study.

Undiagnosed neonatal hearing loss causes severe language, cognitive, and behavioral problems in children. Sick newborns who spend 48 hours in the neonatal intensive care unit (NICU) have a 10- to 20-fold increased risk of permanent hearing loss.The aim of this study is to identify hearing impairment in high-risk sick newborns who spend at least 48 hours in the NICU. The present prospective observational study was conducted at a single center.All sick neonates admitted to the NICU for a minimum of 48 hours at the JK Lon Hospital, Zanana Hospital, and Mahila Chikitsalaya, Sawai Man Singh (SMS) Medical College, Jaipur,Rajasthan, India, from June 2017 to May 2018 were considered eligible for the study.The primary outcome was the assessment of hearing loss of high-risk newborns using otoacoustic emissions at the time of discharge, six weeks of age, and automated auditory brainstem response (AABR) at three months of chronological age. The secondary outcome was to analyze the association of hearing loss with different risk factors in high-risk neonates. A total of 150 infants who had one or more risk factors were studied, 60 were female and 90 were male. No statistically significant difference in hearing loss was observed based on birth weight, sex, and gestational age.The firstdistortion-product otoacoustic emission(DPOAE) screening was done on infants at the time of discharge from the NICU. Eighty-three infants (55.33%) had "refer" on the first DPOAE and the remaining 67 (44.67%) were passed results at the time of discharge.At six weeks of life, on repeat screening with a second DPOAE test, 36% "refer"on the first screen had a"refer"result on the second DPOAE. However, 4.4% "pass" on the first screen turned out to be"refer"on the second screen. These 33 infants who had"refer"results on the second screen were subjected to testing.At 10 weeks of life, AABR wasperformedon 33 infants. Eleven infants out of 33 had sensorineural hearing loss (SNHL) on AABR. Hearing impairment with the DPOAE test was observed with risk factors neonatal hyperbilirubinemia (NHH), hypoxic ischemic encephalopathy (HIE), and very low birth weight (VLBW) and was statistically significant among all risk factors.But, no such association (between hearing impairment and risk factors) was observed with the AABR test. In our study, we found that the duration of mechanical ventilation in mean days 7.67±6.24 had statistically significant SNHL compared to the lesser duration of mechanical ventilation (p<0.001). Two-stage DPOAEdone prior to AABR is helpful in the early detection of hearing loss.