The Indian Journal of Pediatrics

, Volume 58, Issue 6, pp 849–855 | Cite as

Evaluation of risk factors for hearing impairment in at risk neonates by brainstem evoked response audiometry (BERA)

  • A. K. Gupta
  • N. K. Anand
  • Hans Raj
Original Articles


Thirteen (19.2%) of 68 at risk neonates in an intensive care nursery with one or more adverse perinatal clinical factors viz; prematurity (<37 wks), low birth weight (<2000 gm), hyperbilirubinemia requiring active intervention, birth anoxia, neonatal seizures, infections, aminoglycoside administration, and craniofacial malformations; were diagnosed to have hearing impairment (elevated auditory threshold) by BERA testing performed within the first six weeks of life at a mean conceptional (gestational age + age after birth) age of 40.2±0.6 wks. As against this, 20 healthy term neonates who were examined at a mean conceptional age of 40.4±0.8 weeks had a normal hearing threshold of 30 db nHL. Elevated auditory threshold was found more frequently in neonates with multiple clinical adverse factors than in those having single risk factor (6/13 Vs 7/55, p<0.001). On multiple logistic regression analysis, however, only 2 factors viz; hyperbilirubinemia at level exceeding indication for exchange transfusion and birth weight <1500 gm, were found to be significantly correlated with the hearing impairment in the affected neonates and in that order of importance. Prematurity, birth asphyxia, neonatal seizures, infections and aminoglycoside administration had no significant correlation with hearing impairment. Since most of the neonates admitted to the neonatal ICU have one or more identified adverse risk factors, their hearing screening by BERA at the time of discharge seems justified.

Key words

Hearing impairment Neonates NICU Risk factors Brainstem evoked response audiometry (BERA) 


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  1. 1.
    Feinmesser M, Tell L, Levi H. Followup of 40,000 infants screened for hearing defect.Audiology 1982; 21: 197–203.PubMedCrossRefGoogle Scholar
  2. 2.
    American Academy of Pediatrics, Joint Committee on Infant Hearing, Position statement.Pediatrics 1982; 70: 496.Google Scholar
  3. 3.
    Konigsmark BW.Genetic and Metabolic Deafness. Philadelphia; W.B. Saunders, 1976: p 419.Google Scholar
  4. 4.
    Hardy JB. Fetal consequences of maternal viral infections in pregnancy.Arch Otolaryngol 1973; 98: 218–227.PubMedGoogle Scholar
  5. 5.
    Crosse VM, Meyer TC, Jerrard JW. Kenicterus & prematurity.Arch Dis Child 1955; 30: 501–508.PubMedGoogle Scholar
  6. 6.
    Fisch L, Osborn DA. Congenital deafness & haemolytic disease of the newborn.Arch Dis Child 1954; 29: 309–316.PubMedCrossRefGoogle Scholar
  7. 7.
    Flottorp G, Morley DE, Skatvedt M. The localization of hearing impairment in athetoids.Acta Otolaryngol 1957; 48: 404–414.PubMedCrossRefGoogle Scholar
  8. 8.
    Schulman-Galambos C, Galambos R. Brainstem evoked response audiometry in newborn hearing screening.Arch Otolaryngol 1979; 105: 86–90.PubMedGoogle Scholar
  9. 9.
    Picton TW, Durieux-Smith A. Auditory evoked potentials in the assessment of hearing.Neurol Clin 1988; 6(4): 791–808.PubMedGoogle Scholar
  10. 10.
    Epstein CM. The use of brainstem auditory evoked potentials in the evaluation of the central nervous system.Neurol Clin 1988; 6(4): 771–789.PubMedGoogle Scholar
  11. 11.
    Despland P, Galambos R. The auditory brainstem response (ABR) is a useful diagnostic tool in intensive care nursery.Pediatr Res 1980; 14: 154–158.PubMedCrossRefGoogle Scholar
  12. 12.
    Picton TW, Taylor MJ, Durieux-Smith A, Edwards CG. Brainstem auditory evoked potentials in pediatrics. In: Aminoff MJ, ed.Electro Diagnosis in Clinical Neurology, 2nd edn, New York: Churchill-Livingstone, 1986: pp 505–534.Google Scholar
  13. 13.
    Kramer SJ, Vertes DR, Condon M. Auditory brainstem responses and clinical followup of high risk infants.Pediatrics 1989; 83(3): 385–392.PubMedGoogle Scholar
  14. 14.
    Dubowitz LMS, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant.J Pediatr 1970; 77: 1–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Shannon DA, Felix JK, Krumholz A et al. Hearing screening of high risk newborn with brainstem auditory evoked potentials. A followup study.Pediatrics 1984; 73(1): 22–26.PubMedGoogle Scholar
  16. 16.
    Alberti PW, Hyde ML, Riko K. An evaluation of BERA for hearing screening in high risk neonates.Laryngoscope 1983; 93: 1115–1121.PubMedCrossRefGoogle Scholar
  17. 17.
    Mjoen S, Langslet A, Tangsrud SE, Sundby A. Auditory brainstem response (ABR) in high risk neonates.Acta Pediatr Scand 1982; 71: 711–715.CrossRefGoogle Scholar
  18. 18.
    Galambos R, Hicks G, Wilson MJ. Hearing loss in graduates of a tertiary intensive care nursery.Ear Hear 1982; 3: 87–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Bernard PA, Pechere JC. Hebert R. Altered objective audiometry in aminoglycosides treated human neonates.Arch Otorhino laryngol 1980; 228: 205–210.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 1991

Authors and Affiliations

  • A. K. Gupta
    • 1
  • N. K. Anand
    • 1
  • Hans Raj
    • 2
  1. 1.Neonatal Division, Department of PediatricsSafdarjang HospitalNew Delhi
  2. 2.Electro Neuro Diagnostic CentreNew Delhi

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