Brain-stem auditory evoked response: normative values in children

Click-evoked auditory brainstem responses and autism spectrum disorder: A meta-analytic review

Behavior does not differentiate ASD risk prior to 12 months of age, but biomarkers may inform risk before symptoms emerge. Click-evoked auditory brainstem responses (ABRs) may be worth consideration due to their measurement properties (noninvasiveness; reliability) and conceptual features (well-characterized neural generators), but participant characteristics and assessment protocols vary considerably across studies. Our goal is to perform a meta-analysis of the association between ABRs and ASD. Following an electronic database search (PubMed, Medline, PsycInfo, PsycArticles), we included papers that were written in English, included ASD and typically-developing (TD) groups, and reported the information needed to calculate standardized mean differences (Hedges's g) for at least one ABR latency component (I, III, V, I-III, III-V, I-V). We weighted and averaged effect sizes across conditions and subsets of participants to yield one estimate per component per study. We then performed random-effects regressions to generate component-specific estimates. ASD was associated with longer ABR latencies for Waves III (g = 0.5, 95% CI 0.1, 0.9), V (g = 0.7, 95% CI 0.3, 1.1), I-III (g = 0.7, 95% CI 0.2, 1.2), and I-V (g = 0.6, 95% CI 0.2, 1.0). All components showed significant heterogeneity. Associations were strongest among participants ≤8 years of age and those without middle ear abnormalities or elevated auditory thresholds. In sum, associations between ABRs and ASD are medium-to-large in size, but exhibit heterogeneity. Identifying sources of heterogeneity is challenging, however, due to power limitations and co-occurrence of sample/design characteristics across studies. Research addressing the above limitations is crucial to determining the etiologic and/or prognostic value of ABRs for ASD. Autism Res 2018, 11: 916-927. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Auditory brainstem responses (ABR) may be associated with ASD, but participant characteristics and assessment protocols vary considerably across individual studies. Our goal is to combine the results across these studies to facilitate clarity on the topic. Doing so represents a first step in evaluating whether ABRs yield potential for informing the etiology of ASD risk and/or ASD symptom profiles.

Stability and plasticity of auditory brainstem function across the lifespan

The human auditory brainstem is thought to undergo rapid developmental changes early in life until age ∼2 followed by prolonged stability until aging-related changes emerge. However, earlier work on brainstem development was limited by sparse sampling across the lifespan and/or averaging across children and adults. Using a larger dataset than past investigations, we aimed to trace more subtle variations in auditory brainstem function that occur normally from infancy into the eighth decade of life. To do so, we recorded auditory brainstem responses (ABRs) to a click stimulus and a speech syllable (da) in 586 normal-hearing healthy individuals. Although each set of ABR measures (latency, frequency encoding, response consistency, nonstimulus activity) has a distinct developmental profile, across all measures developmental changes were found to continue well past age 2. In addition to an elongated developmental trajectory and evidence for multiple auditory developmental processes, we revealed a period of overshoot during childhood (5-11 years old) for latency and amplitude measures, when the latencies are earlier and the amplitudes are greater than the adult value. Our data also provide insight into the capacity for experience-dependent auditory plasticity at different stages in life and underscore the importance of using age-specific norms in clinical and experimental applications.

Auditory brainstem responses as a clinical evaluation tool in children after perinatal encephalopathy

Auditory brainstem responses (ABR) reveals the neurophysiological status of the neural axis. In this study we compared the ABR of healthy children, under 1-year-old, with children who suffered from perinatal encephalopathy (PE).

OBJECTIVE

The purpose of this study was to characterize the ABR differences between children with PE and healthy children in order to identify groups with specific neurophysiological profiles, associated with their neurological condition.

METHODS

Thirty-six children with perinatal encephalopathy (PE) and 36 healthy children, ages 1-12 months, were studied. The variables considered were: latencies of waves I, II, N1, III, V, and N2; interpeak latency interval (IPL) of waves I-III, III-V, and I-V; as well as amplitudes of waves I, III, and V. The results were analyzed using ANOVA, as well as Ji(2), and Ward's cluster analysis.

RESULTS

The absolute latencies of the ABR showed an inverse correlation with the children's age. Latencies of waves I, II, N1, V, and N2, IPL III-V, and amplitude of waves III and V show significant differences (p<0.05) between healthy and PE children. Children with PE showed greater absolute latencies and larger wave amplitudes than the control group. Ward's cluster analysis, used to define the groups with similar functional characteristics, revealed three groups: fast, intermediate, and slow-responders, depending on their wave latencies and IPL wave amplitudes. These groups were gender- (p<0.03), age- (p<0.0001), and neurological damage- (p<0.01) related.

CONCLUSIONS

Our data clearly show that the ABR obtained from PE children differ from ABR obtained from healthy children. PE infants showed larger wave latencies, intervals amplitudes than the control group. Three functional profiles resulted from the groups established using the Ward's method, and these indicate their neurological functional condition.

Gender effects in auditory brainstem responses to air- and bone-conducted clicks in neonates

Examinations of gender differences in auditory brainstem response (ABR) wave V latencies and thresholds to air- and bone-conducted clicks were undertaken with neonates. Two hundred and two full-term neonates participated (i.e., 103 males and 99 females). Wave V latency measures for air- and bone-conducted click stimuli of 30, 45, and 60 dB nHL and 15 and 30 dB nHL, respectively, and thresholds to air- and bone-conducted clicks were determined. Female newborns displayed statistically significant shorter wave V latencies than male newborns for air-conducted click stimuli (i.e., approximately 0.2-0.3 ms; P=.0016). There were no significant gender differences in wave V latencies to bone-conducted click stimuli (P=.11). With respect to ABR thresholds, no statistically significant differences were observed for either air-conducted clicks (P=.054) or bone-conducted clicks (P=.18).

EDUCATIONAL OBJECTIVES

As a result of this activity, the participant will be able to (1) describe gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates and (2) summarize possible explanations for observed gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates.

Brain-stem auditory evoked potentials in children with perinatal encephalopathies

OBJECTIVE

We sought to describe if neurological damage, in terms of brain lesions, syndrome and syndrome severity led to abnormalities in the brain-stem auditory evoked potentials (BAEPs) in order to provide a profile of children that could be used as an indicator of subsequent neurological sequelae. We analyzed the BAEPs from a group of children having prior evidence of neurological damage and determined the presence of neurological sequelae when the subjects were 3 years old.

METHODS

Brain-stem auditory evoked potentials (BAEPs) were carried out in a group of 154 children with perinatal neurological damage. The children were classified with neurofunctional (clinical and EEG alterations) or organic and neurofunctional brain disease (clinical, EEG and image alteration) and were all followed from the first month of life and serially for 3 years. We used principal component analysis (PCA), clustered analysis and linear correlation to determine association between BAEPs, risk factors and future sequelae.

RESULTS

Latencies of BAEPs decreased significantly with age, and the time of conduction was modified by the presence of neurological damage. All statistical analyses suggested positive and significant associations between risk factors (trophism and condition at birth), and the latencies of waves I, III and V as well as with IPL III-V (interpeak latency) and I-V. PCA showed that IPL I-III was also positively associated with condition at birth, severity of the neurological syndrome and encephalopathy. In addition, we found that the presence and type of sequela reflected changes in the latencies of the waves, as well as IPLs, primarily those of IPL I-III.

CONCLUSIONS

Our results suggest that statistical methods are often needed to analyze neurological damage. The relation between BAEPs, risk factors and neurological sequelae allowed us to obtain a profile of children, which can be then used as an aid in the prognosis of children having a risk of developing neurological sequelae.

Auditory brainstem responses in children with congenital heart disease

BACKGROUND

Cyanotic congenital heart diseases usually lead to growth and developmental delay in children due to chronic hypoxemia and undernourishment that may affect the central nervous system. The auditory brainstem responses are determined to assess the maturation and function of the brainstem. Therefore, we used the auditory brainstem responses to investigate the effect of cyanotic congenital heart diseases on brainstem maturation.

METHODS

The auditory brainstem responses were investigated in 45 children (23 cyanotic, 22 acyanotic) with congenital heart diseases and compared with the results of 30 healthy counterparts (all children were aged between 2 months and 15 years).

RESULTS

The results of auditory brainstem responses were similar in acyanotic patients and in normal children. The cyanotic patients under 1 year of age had more prolonged I-V interpeak latencies than those of control and acyanotic patients (P < 0.05). There was no difference between all groups older than 1 year of age. In cyanotic children, I-V interpeak latencies showed significant negative correlation with arterial oxygen saturation and partial oxygen pressure (P < 0.05).

CONCLUSIONS

Cyanotic congenital heart diseases may cause significant retardation on brainstem maturation due to chronic hypoxemia, especially in infants under 1 year of age, whereas acyanotic congenital heart diseases have no effect on auditory brainstem responses.

A study of auditory afferent organization in children with dyslalia

The auditory afferent (AA) control is an important feedback mechanism in the speech generation. A different organization of AA pathways in children with speech alterations is suggested. In order to investigate this possibility we recorded the auditory brainstem responses (ABR) and middle latency responses (MLR) on monoaural and binaural click stimulation in a group of 17 normal children with no alteration of the speech (N) and in 16 children with dyslalia (eight with systematic (S) and eight with non-systematic errors of the speech (NS)). All of children were normal hearing, with normal ORL and neurological status, right-handed and with the age approximately 7 years old. A lateralization effect was found in the S group. Normally, it was only found for wave I. The efficiency of both AA pathways was the same in NS group, indicating a more effective right pathway in more rostral areas. A prolonged latency (X = 0.25 ms) of wave III was registered on the right side in the NS group compared to normals, as well for wave V (X = 0.175 ms) with increased sweep rate (21 vs. 51 and 71). The effect of sweep rate augmentation was also studied (21-51-71) on latency values and inter-wave differences in these groups. A successive latency prolongation (X = 2.97 ms) of MLR wave Na was registered between the N-S-NS groups. In the S group a latency binaural interaction (BI) of MLR left wave Na was prolonged for 3.52 ms and in the NS group for a further 1.32 ms compared to normals. Only in the NS group was a prolongation of the BI of the right wave Pa detected (6.76 ms) compared to normals. Results suggest a different AA organization in children with dyslalia. Possible locations of alterations in functioning could be pons, and thalamocortical projections. ABR and MLR could evaluate the auditory-speech capability of children.

Functional auditory development in preterm and full term infants

Bilateral ABRs were recorded from 452 infants 32-45 weeks conceptional age. Differences in laterality, gender and appropriateness for gestational age were investigated in order to increase our understanding of developmental processes in early life. Rate effects were also studied in a subsample of infants (145 ears). All subjects were free of conditions known to affect ABR parameters. Left/right differences were evident for all ABR measures except the amplitude of wave I. Shorter interwave intervals and larger amplitudes were consistently observed on the right. Females exhibited shorter absolute latencies for waves III and V and larger wave I amplitudes than males. Small for gestational age (SGA) infants displayed shorter wave V latencies and interwave intervals relative to AGA infants. These differences, however, disappeared by term age whereas the contrasts in laterality persisted. Increasing the rate of stimulation reduced wave I amplitude irrespective of conceptional age and increased wave V amplitude prior to term. An increase in wave V latency was more pronounced at the higher rate on the left than the right. There was no interaction between rate and appropriateness for gestational age, although SGA infants had shorter wave V and interwave latencies. Our data indicate a slight but significant right ear advantage in the processing of auditory signals. Gender differences were apparent as well. While research on adults and older children have reported similar findings, no other studies to date have observed these results in neonates. The present work also lends support to the view that accelerated neurological development occurs in growth-retarded infants.

Evoked potentials in children with chronic renal failure, treated conservatively or by continuous ambulatory peritoneal dialysis

Children with chronic renal failure (CRF) show developmental, intellectual and motor disturbances. It is questionable if an early start of renal replacement therapy may prevent or delay these disturbances. We studied the neurological and intellectual development of children < 5 years suffering from CRF (creatinine clearance < 20% of normal) prospectively, over a period of 3 years. As part of the neurological study, brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were recorded. Measurements were performed in a group of 22 children every 6 months. In 18 of these children CRF was present from birth. Sufficient data were available for analysis in 19 (BAEP) and 22 (SSEP), respectively. A delay of peak I of BAEP gave indications for peripheral conduction disturbances, possibly due to cochlear dysfunction. Brainstem conduction was normal. There were no differences between the children treated conservatively (n = 9) and those treated with continuous ambulatory peritoneal dialysis (CAPD) (n = 10). In children < 2.5 years SSEP showed a delayed thalamocortical conduction, which was not observed in older children. This might indicate a delayed myelination in young children with CRF. No differences were found between the children treated conservatively (n = 10) and those treated with CAPD (n = 12).

BAEP studies in children with attention deficit disorder

Brainstem auditory evoked potentials (BAEPs) were performed on 114 children with attention deficit disorder (ADD). Prolonged latencies of waves III and V and longer brainstem transmission time interval of waves I-III and I-V were observed in the study group compared with normal controls. A significant asymmetry of wave III latency between the ears was found in children with ADD, but not observed in the control group. The authors conclude that children with ADD have brainstem dysfunction. BAEPs, an objective electrophysiological test, may contribute to the diagnosis of ADD, distinguishing these children from the normal population.

Auditory brainstem responses after ovariectomy and estrogen replacement in rat

Previous work has suggested possible influences of ovarian hormones on evoked potentials in the auditory system. The aim of this project was to study the effects of ovariectomy and subsequent administration of estrogen replacement on the auditory brainstem response and the middle latency response. Groups of 90 day-old Long-Evans hooded rats were anesthetized for bilateral ovariectomies (ovex) and recordings made 3 weeks later. During the week prior to recordings some ovariectomized groups received subcutaneous injections of 10, 100 or 500 micrograms/kg Premarin in peanut oil, and other unoperated animals received vehicle injections. Recordings from vertex/chin using needle electrodes and pure tone stimulus parameters were made under Rompun/Ketamine. The results using 40 kHz tone stimuli showed that mean latencies for ovex animals were longer than animals in the 100 micrograms/kg Premarin group for waves 1a, 1an, 1b, 11, 111, 111n, and 1V/V. Other posthoc comparisons at 40 kHz stimulation revealed differences between control and 100 micrograms/kg Premarin groups for latencies of waves 1b, 1bn, 11 and 111. Latency reduction appeared for waves 1b, 1bn, 11 and 111 for the 10 ovex group, but only at wave 11 for the 500 ovex group, compared to ovex-only animals. Data from 8 kHz stimulation also demonstrated significant differences between the ovex and ovex 100 groups at waves 1bn and Vn. Observations of interpeak latency differences, especially between waves 1a and 11, suggested central as well as cochlear involvement in hormone action.(ABSTRACT TRUNCATED AT 250 WORDS)

Brainstem auditory evoked response during propofol anaesthesia in children

The effect of propofol on the brainstem auditory response was studied in 10 healthy children presenting for elective general surgery. A computer-controlled infusion of propofol was used to induce and maintain anaesthesia. Basal brainstem auditory evoked responses were recorded in the awake child and at different infusion rates of propofol. Significant increases in the latencies of the brainstem waves III and V and the interpeak intervals I-V and III-V were seen and were dose dependent. The changes were small and would not preclude the use of propofol anaesthesia for brainstem auditory evoked response testing in children.

Brain-stem auditory evoked potentials (BAEPs): maturation of interpeak latency I-V (IPL I-V) in the first years of life

BAEPs were recorded from 89 healthy children aged 0.1-52.1 months. The maturation kinetics of interpeak latency I-V can be well approximated by an exponential model with a horizontal asymptote. Adult values are reached by about 3 years of life. Differences between males and females become significant when maturation is completed. A non-fragmented reference range for interpeak latency I-V in the first years of life is provided.