Objective: The aim of the study was to investigate into the risk factors for failure in the first-time screening test among high-risk neonates in neonatal intensive care unit (NICU) in order to further clarify the etiology of neonatal hearing impairment, thus providing insights into early prevention and intervention. Methods: We performed automated auditory brainstem response (AABR), distortion product otoacoustic emission (DPOAE), and acoustic immittance (AI) on 2,194 high-risk neonates admitted into the NICU of Shanghai Children’s Medical Center from January 2015 to December 2019, and the risk factors, including premature birth, hyperbilirubinemia, and infant respiratory distress syndrome, were analyzed retrospectively by the univariate χ2 test and multivariate stepwise logistic regression analysis. Results: The pass rates of AABR, DPOAE, and AI were 70.21, 78.44, and 93.12%, respectively, in 2,194 cases of high-risk neonates screened, which are significantly lower than those of healthy controls. The most common diagnoses included artificial feeding, preterm birth, C-section, low birth weight (LBW), neonatal hyperbilirubinemia (NHB), neonatal respiratory distress syndrome (NRDS), congenital heart disease (CHD), gestational diabetes mellitus, pregnancy-induced hypertension syndrome, advanced maternal age (AMA), twins, and in vitro fertilization. Stepwise logistic regression analysis indicated that the AABR pass rate was negatively correlated with LBW (p = 0.002), NHB (p < 0.001), NRDS (p = 0.007), artificial or mixed feeding (p = 0.018), and CHD (p = 0.005). The pass rate of DPOAE was negatively correlated with artificial or mixed feeding (p = 0.041), NHB (p < 0.001), LBW (p = 0.007), very LBW (VLBW) (p = 0.008), and C-section (p < 0.001). The pass rate of AI was negatively correlated with revised AMA (≥40 year) (p < 0.001), NHB (p = 0.043), C-section (p = 0.005), and artificial/mixed feeding (p = 0.036). Conclusion: The hearing screening pass rates of high-risk neonates in the NICU were lower than those of normal neonates, among which the rate of AABR was significantly lower than that of DPOAE. NRDS, NHB, LBW, revised AMA, CHD, C-section, and artificial feeding are potential risk factors of hearing impairment. The combination of different hearing screening tests is necessary for accurate diagnosis of congenital hearing disorders.

1.
Aziz
S
,
Soomro
N
.
Twin births and their complications in women of low socioeconomic profile
.
J Pak Med Assoc
.
2012 Nov
;
62
(
11
):
1204
8
..
2.
Boskabadi
H
,
Zakerihamidi
M
,
Moradi
A
,
Bakhshaee
M
.
Risk factors for sensorineural hearing loss in neonatal hyperbilirubinemia
.
Iran J Otorhinolaryngol
.
2018 Jul
;
30
(
99
):
195
202
..
3.
Engdahl
B
,
Eskild
A
.
Birthweight and the risk of childhood sensorineural hearing loss
.
Paediatr Perinat Epidemiol
.
2007 Nov
;
21
(
6
):
495
500
. .
4.
Harlor
AD
 Jr.
,
Bower
C
.
Hearing assessment in infants and children: recommendations beyond neonatal screening
.
Pediatrics
.
2009
;
124
(
4
):
1252
63
. .
5.
Haupt
H
,
Scheibe
F
,
Ludwig
C
.
Changes in cochlear oxygenation, microcirculation and auditory function during prolonged general hypoxia
.
Eur Arch Otorhinolaryngol
.
1993
;
250
(
7
):
396
400
. .
6.
Hille
ET
,
van Straaten
HI
,
Verkerk
PH
.
Prevalence and independent risk factors for hearing loss in NICU infants
.
Acta Paediatr
.
2007 Aug
;
96
(
8
):
1155
8
. .
7.
Hirvonen
M
,
Ojala
R
,
Korhonen
P
,
Haataja
P
,
Eriksson
K
,
Gissler
M
,
Visual and hearing impairments after preterm birth
.
Pediatrics
.
2018 Aug
;
142
(
2
):
e20173888
. .
8.
Johnson
JL
,
White
KR
,
Widen
JE
,
Gravel
JS
,
James
M
,
Kennalley
T
,
Maxon
AB
,
Spivak
L
,
Sullivan-Mahoney
M
,
Vohr
BR
,
Weirather
Y
,
Holstrum
J
.
A multicenter evaluation of how many infants with permanent hearing loss pass a two-stage otoacoustic emissions/automated auditory brainstem response newborn hearing screening protocol
.
Pediatrics
.
2005
;
116
(
3
):
663
72
. .
9.
Khairy
MA
,
Abuelhamed
WA
,
Ahmed
RS
,
El Fouly
HES
,
Elhawary
IM
.
Hearing loss among high-risk newborns admitted to a tertiary Neonatal Intensive Care Unit
.
J Matern Fetal Neonatal Med
.
2018
;
31
(
13
):
1756
61
. .
10.
Litovsky
R
.
Development of the auditory system
.
Handb Clin Neurol
.
2015
;
129
:
55
72
. .
11.
Morton
CC
,
Nance
WE
.
Newborn hearing screening–a silent revolution
.
N Engl J Med
.
2006 May 18
;
354
(
20
):
2151
64
. .
12.
Ogun
B
,
Serbetcioglu
B
,
Duman
N
,
Ozkan
H
,
Kirkim
G
.
Long-term outcome of neonatal hyperbilirubinaemia: subjective and objective audiological measures
.
Clin Otolaryngol
.
2003 Dec
;
28
(
6
):
507
13
. .
13.
Oh
W
,
Tyson
JE
,
Fanaroff
AA
,
Vohr
BR
,
Perritt
R
,
Stoll
BJ
,
Association between peak serum bilirubin and neurodevelopmental outcomes in extremely low birth weight infants
.
Pediatrics
.
2003 Oct
;
112
(
4
):
773
9
. .
14.
Psarommatis
I
,
Florou
V
,
Fragkos
M
,
Douniadakis
E
,
Kontrogiannis
A
.
Reversible auditory brainstem responses screening failures in high risk neonates
.
Eur Arch Otorhinolaryngol
.
2011 Feb
;
268
(
2
):
189
96
. .
15.
Sasireka
BI
,
Jaya
V
,
Vignesh
SS
,
Muthukumar
R
.
Clinical experience on hearing screening in twins and triplets: a retrospective study
.
Indian J Otolaryngol Head Neck Surg
.
2019 Sep
;
71
(
3
):
401
5
. .
16.
Sheen
JJ
,
Wright
JD
,
Goffman
D
,
Kern-Goldberger
AR
,
Booker
W
,
Siddiq
Z
,
Maternal age and risk for adverse outcomes
.
Am J Obstet Gynecol
.
2018 Oct
;
219
(
4
):
390.e1
e15
. .
17.
Thangavelu
K
,
Martakis
K
,
Fabian
S
,
Venkateswaran
M
,
Roth
B
,
Beutner
D
,
Prevalence and risk factors for hearing loss in high-risk neonates in Germany
.
Acta Paediatr
.
2019 Nov
;
108
(
11
):
1972
7
. .
18.
The Joint Committee on Infant Hearing
.
Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs
.
JEHDI
.
2019
;
4
(
2
):
1
44
.
19.
Yoshinaga-Itano
C
,
Sedey
AL
,
Coulter
DK
,
Mehl
AL
.
Language of early- and later-identified children with hearing loss
.
Pediatrics
.
1998
;
102
(
5
):
1161
71
. .
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