Permanent childhood hearing impairment in infants admitted to the neonatal intensive care unit: nested case–control study

Abstract

The prevalence of permanent childhood hearing impairment (PCHI) in infants admitted to a neonatal intensive care unit (NICU) is higher than that in the general population. Our study objective was to identify risk factors associated with PCHI in infants who required admission to the NICU for more than 48 h. We performed a case–control study, including infants of all gestational ages who were admitted to NICU for more than 48 h and who underwent newborn hearing screening between 2005 and 2019. Infants admitted to NICU and diagnosed with PCHI by formal audiology were classified as “cases”. The “controls” were infants who were admitted to NICU and did not have PCHI. Cases and controls (1:4) were matched based on their birth gestation, birthing place, and treating NICU. The prevalence of PCHI in infants admitted to NICU was 6.3% as compared with our general population prevalence of 0.25%. There were 77 cases and 269 controls during the study period. The median age at diagnosis of PCHI in these infants was 132 days (interquartile range 75.5–518.5). Using regression analysis, “any ventilation episodes”, presence of seizures, and major congenital anomalies were significantly associated with PCHI in infants of all gestational ages. There were higher prevalence of PCHI in preterms (<32 weeks) who received furosemide and lower prevalence with antenatal use of magnesium sulphate.

Conclusions: In our study, the prevalence of hearing loss was high in infants admitted to NICU. Gestation-specific risk factors identified in this case–control study would help in counselling of parents.

What is Known:
• In the UK, 1–2/1000 infants are born with hearing loss and infants admitted to the neonatal unit for 48 h or more have increased prevalence of hearing loss (1 in 100 live births).
• Identification of risk factors in infants admitted to neonatal unit would help with risk stratification and further management.
What is New:
• In our study, infants admitted to the neonatal unit had higher prevalence of hearing loss (6.3 in 100 live births).
• In infants across all gestational age “any ventilation episodes”, presence of seizures, and severe congenital anomalies were associated with a statistically significant increase in prevalence of hearing loss. Higher prevalence of hearing loss was noted in preterm infants (<32 weeks) who received furosemide treatment and lower prevalence was noted with antenatal use of magnesium sulphate.

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Data availability

Original data would be available upon request. Please email your request to pkannanloganathan@nhs.net.

Abbreviations

AABR:

Automated auditory brainstem response

AOAE:

Automated otoacoustic emission

BPD:

Bronchopulmonary dysplasia

CMV:

Cytomegalovirus

dBnHL:

Decibel above normal hearing level

HIE:

Hypoxic ischemic encephalopathy

IVH:

Intraventricular hemorrhage

MgSO4 :

Magnesium sulphate

NICU:

Neonatal intensive care unit

PDA:

Patent ductus arteriosus

PCHI:

Permanent childhood hearing impairment

PMA:

Postmenstrual age

ROP:

Retinopathy of prematurity

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Acknowledgements

We would like to thank Kathryn Burn-Thornton, Durham University, for her advice on statistical analysis. We would like to thank Charlotte Kear (paediatric trainee) for her help in data collection. We would like to acknowledge Carol McCormick for her support with manuscript formatting. We would like to acknowledge Professor Win Tin for his support with manuscript appraisal.

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Nair V was responsible for the concept, design, data collection, and interpretation of data, drafted the initial manuscript, and approved the final manuscript. Janakiraman S was responsible for the data collection and interpretation of data and approved the final manuscript. Whittaker S was responsible for the data collection and interpretation of data and approved the final manuscript. Quail J was responsible for the interpretation of data and approved the final manuscript. Foster T was responsible for the interpretation of data and approved the final manuscript. P Loganathan was responsible for the concept, design, data collection, interpretation of data, and data analysis, drafted the initial manuscript, and approved the final manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Prakash Kannan Loganathan.

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Health Research Authority approval (HRA ID): 287027

Communicated by Daniele De Luca

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Nair, V., Janakiraman, S., Whittaker, S. et al. Permanent childhood hearing impairment in infants admitted to the neonatal intensive care unit: nested case–control study. Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-03983-7

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Keywords

  • Permanent childhood hearing impairment
  • Neonatal intensive care unit