Neonatal Loss Research Articles

Counseling for personal care options at neonatal end of life: a quantitative and qualitative parent survey.

BackgroundThe death of a newborn is a traumatic life changing event in the lives of parents. We hypothesized that bereaved parents of newborn infants want to have choices in the personal care of their infant at the end of life.MethodsParents who had suffered a perinatal or neonatal loss between 1 and 6 years before the survey in a regional level IV neonatal intensive care unit (NICU) and associated labor and delivery room were invited to participate. Parents chose between an online survey, paper survey or telephone interview. The survey included multiple choice and open ended questions.ResultsParents prefer multiple options for the personal care of their infant at the end of life. Emergent themes were need for guidance by the medical team, memory making, feeling cared for and respected by staff, and regrets related to missed opportunities.ConclusionWhile parents differ in their preferences in utilizing specific personal care options for their infant’s end of life, they share a common preference for being presented with multiple options to choose from and in being guided and supported by healthcare providers, while being afforded the opportunity to make memories with their infant by bonding with and parenting them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0063-6) contains supplementary material, which is available to authorized users.

BREASTFEEDING PROBLEMS AND OTHER FACTORS ASSOCIATED WITH EXCESSIVE NEONATAL WEIGHT LOSS IN A SOCIAL SECURITY HOSPITAL IN LIMA, PERU

during the first days of life the mother is the main source of nutrients for the newborn. However, breastfeeding difficulties are common and may generate excessive neonatal weight loss. estimate the magnitude and association between breastfeeding problems and excessive neonatal weight loss beyond the physiological norm in the neonatology ward in a social security hospital in Lima, Peru. we conducted a cross sectional analysis of the recorded neonatal weight in a routine evaluation (between 24 and 72 hours of life) and compared it against birth weight. Excessive weight loss was defined as a difference greater than or equal to 7 %. Breastfeeding problems (defined as problems with breastfeeding initiation, mouth position, breastfeeding duration, breastfeeding frequency, too much clothing, nipple pain and C form) were investigated using a survey and visual verification. The association between excessive weight loss and breastfeeding problems, adjusted by other factors, was quantified using a multiple generalized linear model. excessive weight loss was present in 18.8% (74/393) of the newborns. Improper positioning of the mouth on the nipple was present in 53.7% (211/393) of neonates while nipple pain was reported by 44.0% (173/393) of mothers. In the adjusted analysis, nipple pain [PR = 1.50 (95% CI: 1.02 to 2.22)] and improper positioning of the mouth [PR = 1.67 (95% CI: 1.09- 2.57)] were associated with an increased occurrence of excessive neonatal weight loss. breastfeeding problems are common. These difficulties are significantly associated with an increased occurrence of excessive neonatal weight loss. Improvements in breastfeeding practices, for example through educational programs, may decrease the occurrence of excessive neonatal weight loss.

Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.

BackgroundUnderstanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.MethodsA literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).ResultsCongenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.ConclusionsWe revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.

Book Review: Coping with infertility, miscarriage, and neonatal loss: Finding perspective and creating meaning

Book Review: Coping with infertility, miscarriage, and neonatal loss: Finding perspective and creating meaning

Factors influencing reproduction in captive-bred cynomolgus monkeys (Macaca fascicularis) from Mauritius.

The cynomolgus monkey is widely used in reproductive research. However, the effects on their reproductive parameters of infant and maternal factors such as birth order, sex of infants, twin births, maternal age and lactation status have not been fully examined. The aim of this retrospective study was to determine how such infant and maternal factors impact on infant birth weight, birth viability, neonatal loss and retained placenta in cynomolgus monkeys. The study was based on birth data from a cohort of 789 females over an eight-year period. Consistent with reports made in other macaque species, female offspring had lower birth weight compared with males. Birth weights of firstborn infants were lower compared with birth weights of higher birth order infants. Results from the logistic regression analysis showed that the risk of non-viable births was increased by advancing maternal age and retained placenta. As in other non-human primates, maternal age had predictive value for non-viable births in cynomolgus monkeys. The risk of neonatal loss decreased with advancing maternal age but was not affected by birth order. Firstborn offspring did not have an increased risk for neonatal loss, possibly from the practice of retaining mothers in their natal groups, which improved maternal skills in primiparous females. However, infant low birth weight and non-lactating females increased the risk of neonatal loss, and the delivery of low birth weight infants was associated with retained placenta. The results from this study can be useful for scientists conducting reproductive studies and for colony managers in maximizing fertility and infant survival of cynomolgus monkeys.

Performing a Perinatal Autopsy

Abstract Intrauterine fetal demise or termination for malformation is adverse obstetric outcomes, agonizing for the parents and frustrating for health care providers. These events are often unpredictable and investigation entails not only the evaluation of the fetus/neonate but also the placenta. Though nothing can compensate the bereavement of families who have encountered fetal or a neonatal loss, a meticulous study of the placental, fetal, and neonatal tissues provides succor and help in the healing process. In recent times, with extensive advances in the pediatric specialty, the significance and requirements for perinatal autopsy have also commensurately heightened. There is an inordinate need for an accurate diagnosis in order to render genetic counseling and ascertain the implications of possible recurrence in future pregnancies. A conscientious perinatal autopsy, supplemented by cytogenetic and metabolic evaluation, followed by dissemination of the information to the parents, clinicians, and public health organizations is of paramount importance. This not only assists in the clinical management and bereavement closure but also helps in the reduction of perinatal mortality and morbidity. An autopsy protocol assists in performing an adequate perinatal dissection, facilitates the recognition and documentation of all relevant information and in addition also provides a format for the collection, recording and presenting of data which facilitates collaborative research. A brief account of the benefits and techniques of perinatal autopsy and the protocol are presented.

Weight loss and low age are associated with intensity of rooting behaviours in newborn infants.

Little is known about the developing breastfeeding behaviour of newborn infants. This study describes infants' prebreastfeeding behaviour during the second day of life and explores possible associations with infant characteristics. We studied 13 mothers and healthy full-term infants after normal births. At 24-48hours of life, the newborns were placed in skin-to-skin contact with their mothers for breastfeeding and were video-filmed. The order, frequency and duration of predefined infant prefeeding behaviours and suckling were coded and analysed using computer-based video software. Prefeeding behaviours occurred in the following order: rooting, hand to mouth movements, licking of the nipple and hand to breast to mouth movements. The infants started to suckle at a median of one to two minutes. Rooting was the most common behaviour, observed in 12 infants. The duration of rooting movements during the last minute before breastfeeding was inversely related to neonatal age (p≤0.001) and positively related to neonatal weight loss (p=0.02) after birth. Infants exhibited a distinct sequence of prefeeding behaviours during the second day of life, and our findings suggest that rooting movements were governed by mechanisms involved in the regulation of food intake and weight gain.

Antenatal factors modulate hearing screen failure risk in preterm infants

ObjectiveThe objective of this study was to characterise the effects of antenatal inflammatory factors and maternal therapies on neonatal hearing screen outcomes in very low birthweight infants.MethodsWe conducted a retrospective...

Kindlin-2 controls TGF-β signalling and Sox9 expression to regulate chondrogenesis.

The signals that control skeletogenesis are incompletely understood. Here we show that deleting Kindlin-2 in Prx1-expressing mesenchymal progenitors in mice causes neonatal lethality, chondrodysplasia and loss of the skull vault. Kindlin-2 ablation reduces chondrocyte density by decreasing cell proliferation and increasing apoptosis, and disrupts column formation, thus impairing the formation of the primary ossification center and causing severe limb shortening. Remarkably, Kindlin-2 localizes to not only focal adhesions, but also to the nuclei of chondrocytes. Loss of Kindlin-2 reduces, while the overexpression of Kindlin-2 increases, Sox9 expression. Furthermore, the overexpression of Sox9 restores the defects in chondrogenic differentiation induced by Kindlin-2 deletion in vitro. In addition, Kindlin-2 ablation inhibits TGF-β1-induced Smad2 phosphorylation and chondrocyte differentiation. Finally, deleting Kindlin-2 in chondrocytes directly impairs chondrocyte functions, resulting in progressive dwarfism and kyphosis in mice. These studies uncover a previously unrecognized function for Kindlin-2 and a mechanism for regulation of the chondrocyte differentiation programme and chondrogenesis.

Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa.

Untreated syphilis in pregnancy is associated with adverse clinical outcomes to the infant. The study aimed to estimate the public health burden resulting from adverse pregnancy outcomes due to syphilis infection among pregnant women not screened for syphilis in 43 countries in sub-Saharan Africa. Estimated country-specific incidence of syphilis was generated from annual number of live births, the proportion of women with at least 1 antenatal care (ANC) visit, the syphilis prevalence rate, and the proportion of women screened for syphilis during ANC.Adverse pregnancy outcome data (stillbirth, neonatal death, low birth weight, and congenital syphilis) were obtained from published sources. Disability-adjusted life-year (DALY) estimates were calculated using undiscounted local life expectancy, the neonatal standard loss function, and relevant disability weights. The model assessed the potential impact of raising ANC coverage to at least 95% and syphilis screening to at least 95% (World Health Organization targets). For all 43 sub-Saharan Africa countries, the estimated incidence of adverse pregnancy outcomes was 205,901 (95% confidence interval [CI], 113,256-383,051) per year, including stillbirth (88,376 [95% CI, 60,854-121,713]), neonatal death (34,959 [95% CI, 23,330-50,076]), low birth weight (22,483 [95% CI, 0-98,847]), and congenital syphilis (60,084 [95% CI, 29,073-112,414]), resulting in approximately 12.5 million DALYs. Countries with the greatest burden are (in DALYs, millions) Democratic Republic of the Congo (1.809), Nigeria (1.598), Ethiopia (1.466), and Tanzania (0.961). Attaining World Health Organization targets could reduce the burden by 8.5 million DALYs. Substantial infant mortality and morbidity results from maternal syphilis infection concentrated in countries with low access to ANC or low rates of syphilis screening.

Evaluation of the Sodium Serum Level in Infants with Jaundice

Background: Inadequate milk intake during the first year of neonate’s life can result in weight loss, severe hyperbilirubinemia, and sometimes hypernatremia. In this study, we aimed to determine the relationship between neonatal weight loss and hypernatremia in term breastfed infants with idiopathic jaundice, as well as the necessity of sodium concentration measurement in newborns with idiopathic jaundice via weight loss measurement. Methods: In this cross-sectional study, we examined 273 infants with jaundice of unknown etiology at Ghaem Hospital, Mashhad, in years 2008-2012. The study sample consisted of 226 infants in the control group (serum sodium concentration

Neonates with Bartter syndrome have enormous fluid and sodium requirements.

Managing neonatal Bartter syndrome by achieving adequate weight gain is challenging. We assessed the correlation between weight gain in neonatal Bartter syndrome and the introduction of fluid and sodium supplementations and indomethacin during the first 4 weeks of life. Daily fluid and electrolytes requirements were analysed using linear regression and Spearman correlation coefficients. The weight gain coefficient was calculated as daily weight gain after physiological neonatal weight loss. We studied seven infants. The highest weight gain coefficients occurred between weeks two and four in the five neonates who either received prompt amounts of fluid (maximum 810 mL/kg/day) and sodium (maximum 70 mmol/kg/day) or were treated with indomethacin. For the two patients with the highest weight gain coefficient, water and sodium supplementations were decreased in weeks two to four leading to a significant negative Spearman correlation between weight gain and fluid supplements (r = -0.55 and -0.68) and weight gain and sodium supplementations (r = -0.96 and -0.72). The two patients with the lowest weight gain coefficient had positive Spearman correlation coefficients between weight gain and fluid and sodium supplementations. Infants with neonatal Bartter syndrome required rapid and enormous fluid and sodium supplementations or the early introduction of indomethacin treatment to achieve adequate weight gain during the early postnatal period.

Hearing Loss by Week of Gestation and Birth Weight in Very Preterm Neonates

To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). We assessed the prevalence of NHL by week of gestation and categories of birth weight in very preterm neonates. Results of the 2-stage Automated Auditory Brainstem Response nationwide Newborn Hearing Screening Program in Dutch Neonatal Intensive Care Units and diagnostic examinations were centrally registered between October 1998 and December 2012 and included in this study. NHL was defined as impaired when the neonate conventional Auditory Brainstem Response level exceeded 35 dB near Hearing Level at diagnostic examination. Birth weight was stratified into <750 g, 750-999 g, 1000-1249 g, 1250-1499 g, and ≥ 1500 g, and by small for gestational age (SGA; <10th percentile) vs appropriate for gestational age. Logistic regression analyses and recursive partitioning were performed. In total, 18,564 very preterm neonates were eligible. The prevalence of NHL consistently increased with decreasing week of gestation (1.2%-7.5% from 31 to 24 weeks) and decreasing birth weight (1.4%-4.8% from ≥ 1500 g to <750 g, all P < .002). Most vulnerable to NHL were girls <28 weeks, boys <30 weeks, and SGA neonates. The SGA effect started at 27 weeks. Gestational age and birth weight quantify the risk of NHL. This information can be used at the individual level for parent counseling and at the population level for medical decision making.

Supporting Families in Neonatal Loss

Around 20,000 neonatal deaths occur each year, many from congenital heart defects such as hypoplastic left heart syndrome. Nurses are on the frontline of caring for families experiencing neonatal loss. Careful spiritual and cultural assessment, attention to beliefs, focusing on relationship, and helping families create legacy can assist with grieving and making meaning out of loss.

Supporting Families in Neonatal Loss

Supporting Families in Neonatal Loss

Screening for Hearing Impairment in High Risk Neonates: A Hospital Based Study.

Hearing loss very early in life can have multiple deleterious effects on the new born most commonly being related to attainment of speech and language. Also, it can affect social, emotional and academic achievement of the child.Early identification of hearing impairment has been shown to improve prognosis and hence screening programs have been widely and strongly advocated. To estimate the incidence of neonatal hearing loss in high risk neonates admitted in tertiary level teaching hospital and to determine the risk factors predictive of hearing impairment in them. It was a prospective study over a period of one year. We screened high risk neonates for hearing impairment admitted to NICU using Brain stem Auditory Evoked Response (BAER).The morphology of the response and wave and interwave latencies was examined in respect to age-appropriate forms. Follow up BAER after one month was performed in cases where initial BAER was abnormal. Babies who tested abnormal on the follow-up were referred for detailed audiology diagnostic work up. A total of 200 cases comprising 118 males (59%) and 82 females (41%) were enrolled. On initial BAER testing, 18 (15.25%) males and 14 (17%) female neonates had hearing loss. Whereas 7 males (70%) and 3 females (30%) had hearing loss out of the total 10 hearing loss cases in the Follow up-BAER testing. Two out of the 6 neonates with birth weight <1500g had hearing loss in the follow up of BAER testing. Use of ototoxic medications, hyperbilirubinemia requiring exchange transfusion, perinatal asphyxia and bacterial meningitis were the major risk factors occurring in 45%, 30% and 26% and 10%. Five neonates had unilateral hearing loss and the rest five (5%) had bilateral impairment.Meningitis was the significant independent clinical risk factors for predicting hearing impairment in high risk neonates.The risk of BAER increased cumulatively with BAER abnormality rate of 4.2%, 22.2% and 33.3% with one two and three risk factors respectively. The overall incidence of hearing loss in initial BERA testing was 16%, in males it was 15.25% in males and in 17% in females,only 62.5% of neonates had a persistent abnormal BAER, with male gender a significant risk factor for this. The incidence of hearing loss increased with number of risk factors. The study highlights that although universal hearing screening programs are warranted; most newborns with a detected hearing loss can be identified based on the risk factors. Thus, a targeted approach for hearing screening may be more feasible in resource limited settings.

Role of Cochlear Microphonic in Newborn Hearing Test

Received September 19, 2014 Revised December 12, 2014 Accepted December 25, 2014 Address for correspondence Seung Hwan Lee, MD Department of OtorhinolaryngologyHead and Neck Surgery, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 133-817, Korea Tel +82-31-560-2363 Fax +82-31-566-4884 E-mail shleemd@hanyang.ac.kr Background and ObjectivesZZCochlear microphonic (CM) is an electrical potential generated by outer hair cells in response to acoustic stimulation. The aim of this study is to evaluate the significance of CM in neonatal hearing loss. Subjects and MethodZZFrom April 2013 to April 2014, 64 neonates hospitalized in neonatal intensive care unit were enrolled. Subjects underwent transient evoked otoacoustic emission (TEOAE), auditory brain stem response (ABR) and CM. We analyzed the results of hearing tests and the correlation between CM and the other test modalities. ResultsZZNinety two ears showed normal ABR waves whereas the other 36 ears had abnormal ABR. There were two neonates who were suspected of auditory neuropathy because of the presence of TEOAE and CM. Among 14 ears who showed abnormal OAE results, 12 ears (86%) were identified as having CM. The amplitudes of CMs were correlated with the reproducibility of TEOAE (p<0.005). Between the ears with positive TEOAE and others with negative TEOAE, the amplitudes of CMs were significantly different (p<0.005). ConclusionZZMany ears were identified with the presence of CM without TEOAE response because of the the vulnerability of OAE from middle ear status and environment. We suppose that CM might provide information on outer hair cell function to complement the OAE in neonatal hearing test. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(6):389-94

Results of the first universal newborn hearing screening in Algeria

Introduction Hearing loss is the most common congenital pathology at birth. Its prevalence increases during the infant period, especially in children at risk. The application of hearing screening in three stages with follow-up of children at risk of developing hearing loss allows to optimize the screening. Goals The aim of this study was to evaluate the prevalence of hearing loss in the neonatal population and identify newborns at risk and to investigate the best way to support infants with such disability from screening to rehabilitation. Materials and methods This prospective study was conducted over a period of 22 months from June 2011 to March 2013, using a systematic screening for deafness in a high-birth-level maternity unit. Results Over a period of 22 months, 17 912 live newborn were born in the maternity ward. The application of screening for deafness at birth allowed us to screen 15 382 newborns, with a coverage rate of 85.9%. We chose a three-stage screening protocol. In the first stage, 15 382 newborns were screened by means of analysis of distortion product of otoacoustic emissions (DPOAE). The screening was negative (presence of DPOAE and absence of hearing loss) in 13 467 newborns, and it was positive (absence of DPOAE and a possibility of hearing loss) for 1915 newborns who were addressed to the second stage of the screening protocol for the analysis of DPOAE again after 1 month of birth. In this second stage of screening, 1516 infants were screened in the ENT Department and 399 infants were lost to follow-up. After the second stage of the screening, 76 infants were addressed to the third stage of the screening protocol, which is also called stage of diagnosis. In this last step, 14 children were lost to follow-up and 62 infants were tested for hearing threshold using analysis of auditory brainstem response. Finally, after verification of the results obtained in the third stage using behavioral audiometry and impedance, 49 children showed hearing loss with a hearing threshold greater than 30 dB. The prevalence of neonatal hearing loss in the maternity unit was 3.2%. There were 27 male and 22 female patients, of whom 29 had bilateral hearing loss and 20 children had unilateral hearing loss. In contrast, the study of the risk factors of hearing loss allowed us to identify those who are present among the detected newborns and to calculate the prevalence of hearing loss among newborns admitted in the neonatal ICU, which was 2.14%. The risk factors most associated with deafness are infections with cytomegalovirus and rubella, damage to the nervous system and craniofacial malformations. The rehabilitation of hearing is based on speech rehabilitation and the use a hearing aid, either conventional prosthesis or cochlear implant. Conclusion Newborn hearing screening using a three-stage protocol is possible. It allows to detect hearing loss earlier to initiate early hearing and language rehabilitation, the only way to guarantee alignment of children born with hearing impairment or with contracted hearing loss during the neonatal period with their peers with normal hearing.

A survey on bacterial involvement in neonatal mortality in dogs.

Bacterial infections represent the second cause of neonatal morbidity and mortality in dogs, so the present study aimed to investigate the bacterial involvement in canine neonatal mortality and to evaluate the antibiotic susceptibility of the isolated bacteria. Fifty-one newborn purebred puppies, born dead or dead within 28 days of age, belonging to 36 different litters, were enrolled and the following procedures were performed on their fresh dead bodies: necropsy, collection of swabs by liver, kidney, lung, small bowel, and possible thoracic and/ or abdominal effusion, for both bacteriological examination and antimicrobial susceptibility testing, and collection of samples by the same organs for histology. About 47% of total swabs were positive at bacteriology (pure bacterial culture or bacterial association). In 65% of the newborn puppies the mortality could be attributed to a bacterial infection. Although the high multidrug resistance, the most effective antimicrobials were third generation cephalosporins and fluorquinolones. In case of neonatal mortality, bacterial culture and antimicrobial susceptibility testing become essential for a targeted therapy in surviving littermates and for the management of following pregnancies in bitches with recurrent neonatal loss.

Assessment of the Ototoxic Effects of Amikacin and Meropenem among Neonates in a Tertiary Government Hospital

Objective: Using pre and post-treatment otoacoustic emission (OAE) tests, this study aimed to assess the ototoxic effect of meropenem, amikacin and meropenem plus amikacin among neonates treated for sepsis neonatorum in a neonatal intensive care unit versus untreated outpatient controls.&#x0D; Methods:&#x0D; Study design: Prospective Quasi-Experimental Controlled Clinical Trial&#x0D; Setting: Tertiary Government Hospital&#x0D; Subjects: Neonates treated for sepsis neonatorum in the Neonatal Intensive Care Unit between August to October 2012 who met inclusion criteria were included in this study. Controls were neonates born in the same institution who were not admitted and did not receive any antibiotic treatment. Excluded were those with APGAR &lt; 5 at first minute, birth weight &lt; 1000 grams, clinically evident congenital anomalies, and initial “refer” results on OAE.&#x0D; Neonates were subjected to OAE testing before and after 7 days treatment with amikacin, meropenem, or a combination of both drugs. Results were analysed using chi-square test. Maternal drug intake, family history of hearing impairment and clinical outcomes (whether expired or discharged improved) were not included in this study. Assessment of ototoxic effects were limited to OAE alone and not confirmed by ABR.&#x0D; &#x0D; Results: OAE “refer” rates were as follows: no amikacin and no meropenem, 0% (0/42); amikacin only, 33.3% (3/9); meropenem only, 25% (2/8) and amikacin and meropenem, 50% (10/20). Statistical analysis showed that hearing loss was dependent on treatment (c2 =23.741, p = &lt; 0.001). Overall, statistical analysis showed that there is an increased risk of hearing loss when treated with amikacin and/or meropenem as compared to no treatment.&#x0D; &#x0D; Conclusion: There is an increased risk of ototoxicity when amikacin, meropenem, or a combination of both drugs is administered to neonates. While the ototoxic effects of amikacin have been elucidated, further studies involving meropenem and its potential ototoxic effect are recommended.&#x0D; &#x0D; Keywords: ototoxicity, amikacin, meropenem, otoacoustic emission testing, neonatal hearing loss&#x0D;