Conductive hearing loss in children with bronchopulmonary dysplasia: a longitudinal follow-up study in children aged between 6 and 24 months

Late Onset Hearing Loss in Very Low Birth Weight Infants

Objective

To determine the incidence of late onset hearing loss and associated risk factors in very low birth weight (VLBW) infants.

Study Design

Retrospective study (2003-2015) of post-discharge hearing outcomes and risk factors in the VLBW infant population, before and after the institution of a standardized follow-up program.

Results

Late onset hearing loss increased from 2.9 per 100 VLBW infants to 7.8 per 100 after instituting a monitoring protocol. The follow-up compliance rate nearly doubled. Both infants with late-onset sensorineural hearing loss and those with a conductive component were identified. The rate of conductive loss detection increased seven-fold.

Conclusion

The institution of a standardized hearing follow-up program significantly increased the detection of late onset hearing loss in VLBW infants. A significant proportion of those with late onset hearing loss had a conductive component. Without identification and treatment, even conductive losses may negatively impact speech and language development.

Is chorioamnionitis associated with hearing impairment in preterm infants? A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

It has been reported that chorioamnionitis (CA) could increase the risk of hearing impairment in premature infants, but results are inconsistent. A meta-analysis was performed to systematically evaluate the relationship between CA and hearing impairment in premature infants.

MATERIAL AND METHODS

Search in PubMed, Embase, Cochrane Library from their inception to May 2020. We concluded all cohort and case-control studies which explored the associations between CA and hearing impairment in preterm infants. Pregnant women with other infections besides CA were excluded. PRISMA guidelines were followed. Fixed-and random-effects models were used, depending on heterogeneity. And we performed to calculate odds ratio (ORs), and 95% CIs using fixed-effects models.

RESULTS

Seven studies involving 4134 premature infants were included. There was non-significant association between CA and hearing impairment (adjusted OR 1.43, 95% CI 0.99 to 2.04, P = 0.05; heterogeneity: I² = 13%, P = 0.33).

CONCLUSION

This article concludes that CA is not a risk factor for hearing impairment in premature infants, but most of the current studies are retrospective studies with low intensity and lack of high-quality articles to discuss it.

Continuous positive airway pressure treatment may negatively affect auditory maturation in preterm infants

AIM

Nasal continuous positive airway pressure (CPAP) devices generate loud noise, which might harm auditory function and maturation. The function of auditory pathways can be examined by using brainstem auditory evoked potential (BAEP) and brainstem audiometry (BA) recordings. Our objective was to study whether CPAP treatment during the neonatal period is associated with abnormalities in BAEP and BA recordings.

METHODS

Included in this retrospective study were preterm infants (birth weight ≤1500 g and/or gestational age ≤32 weeks) born between 2002 and 2006 with a comprehensive clinical background and follow-up data, including the duration of CPAP treatment (n = 162). BAEP and BA were recorded near the mean corrected age of one month. The following variables from BAEP and BA examinations were analysed: latencies of BAEP components I, III, V, interpeak intervals (IPI) I-V, I-III, III-V (ms), amplitude I and V (µV), amplitude ratio I/V and BA thresholds.

RESULTS

In the adjusted analysis, a longer CPAP treatment leads to longer latencies of BAEP component III (p = 0.01) and V (p = 0.02) in the right ear.

CONCLUSION

CPAP treatment may impair the auditory maturation and processing mediated via the dominant right ear. The hearing and neurodevelopment of the children who are treated with CPAP should be followed.

Neurodevelopmental outcomes in very preterm infants: The role of severity of Bronchopulmonary Dysplasia

OBJECTIVE

Bronchopulmonary dysplasia is a chronic respiratory disease that still affects preterm neonates; its association with neurodevelopmental (ND) impairment is already known. Different studies investigated neurodevelopmental outcomes in infants with BPD, often using the old dichotomous definition (BPD vs Non-BPD). This retrospective study aims to evaluate the role of different BPD severity grades on ND outcomes at 24 months of corrected age (CA).

METHODS

All preterm infants born between 2011 and 2015 in the study hospital with a gestational age (GA) ≤ 30 weeks and discharged from our NICU were included and were divided in infants with and without BPD. Infants with BPD were divided into three severity groups as defined by NICHD/NHLBI Workshop in 2001, and were compared to their Non-BPD peers, matching them according to the same GA and year of birth. At 24 months postmenstrual age, we assessed general outcomes (growth and hospital readmissions) and neurodevelopmental outcomes (motor, developmental and sensory outcomes) with a standardized assessment.

RESULTS

We enrolled 89 patients affected by BPD of different grades of severity and a control group of 89 preterm infants without BPD. Infants with Moderate and Severe BPD showed a significantly higher corrected odds ratio (OR) for cognitive impairment compared to controls. Within the group of infants without severe disability (regarding Griffiths' scales), infants with Moderate and Severe BPD as well as infants with Mild BPD showed a significantly higher risk of a lower total Developmental Quotient (DQ) score, even after correction for confounding factors.

CONCLUSIONS

Our study evidenced that not only Severe BPD infants, but also Moderate ones showed a higher risk of overall cognitive impairment at 24 months CA. Within the group of infants without severe disability, also those with Mild BPD had lower Griffiths DQ scores than those without. This would suggest that infants with BPD, regardless of severity, warrant neurodevelopmental follow-up.

Effect of bronchopulmonary dysplasia on early intellectual development in preterm infants

BACKGROUND

The aim of this study was to investigate the effect of bronchopulmonary dysplasia (BPD) on the early intellectual development of preterm infants.

METHODS

From 2011 to 2015, 83 preterm infants diagnosed with BPD were recruited to the BPD group, and 89 preterm infants without BPD and 98 healthy term infants were randomly recruited to the non-BPD and term group, respectively. Neural and intellectual development according to the Gesell Development Scale were evaluated and compared between groups at 0-3 months, 3-6 months, 6-9 months, and 9-12 months of adjusted age for preterm infants and real age for term infants. Multivariate logistic regression was used to determine the associations between BPD and adverse neurological outcomes at 9-12 months of adjusted age.

RESULTS

Compared with term infants, preterm infants had significantly lower developmental quotients for adaptability, gross motor, fine motor, language and social skills. At follow up, deficits in one or more neurofunctions related to adaptability, gross motor, fine motor, language and social skills were significantly more frequent in preterm children with BPD than in those with no history of BPD. BPD was independently associated with adverse neurological outcome at 9-12 months of adjusted age in preterm infants.

CONCLUSIONS

Early intelligence disturbances occurred significantly more frequently in BPD infants than in non-BPD infants. Monitoring of the development of the nervous system in BPD infants should be strengthened.

Auditory impairment in infants with neonatal chronic lung disease is alleviated after term

AIM

Very premature infants with neonatal chronic lung disease (CLD) have been reported to have major auditory impairment at term, and we examined the outcomes in 30 infants after term age.

METHODS

Brainstem auditory evoked response (BAER) was recorded at a postconceptional age of 46-61 weeks in 13 CLD cases and 14 controls from China and 17 CLD cases and 22 controls from the UK.

RESULTS

The BAER threshold in the CLD infants was slightly higher. Clicks at the normal hearing level (60 dB) showed no significant differences between the cases and controls in the latencies of BAER waves I, III and V and the I-V interval. However, the CLD infants demonstrated marginal shortening in the I-III interval and a marginal increase in the III-V interval. The amplitudes of BAER waves in the CLD infants were all slightly smaller than the controls. At 70 and 40 dB normal hearing level, the BAER findings were similar to those obtained at 60 dB normal hearing level, with only small variations.

CONCLUSION

There were minor BAER abnormalities in the CLD infants, suggesting minor auditory impairment. The auditory impairment previously detected at the term date was later alleviated.

Sensorineural hearing loss and language development following neonatal extracorporeal membrane oxygenation

OBJECTIVES

To determine the prevalence of hearing loss in school-age children who have undergone neonatal extracorporeal membrane oxygenation treatment and to identify any effects of hearing loss on speech- and language development [corrected] .

DESIGN

Prospective longitudinal follow-up study within the framework of a structured post-extracorporeal membrane oxygenation follow-up program.

SETTING

Outpatient clinic of a level III university hospital.

RESULTS

Tone audiometry was performed by standardized protocol in 136 children aged 5-12 yrs. Hearing loss was considered clinically significant when >20 dB. Hearing was normal in 75.7% of children. Five children (3.7%) had bilateral sensorineural or combined hearing loss; three of them received special audiological care (2.2% of total sample). Of the 24 children with congenital diaphragmatic hernia, 19 (79.2%) had normal hearing and only two (8.3%) had mild sensorineural hearing loss, unilateral in one of them. Follow-up at 24 months of age had shown normal verbal and nonverbal developmental scores. Language development and intelligence median (range) scores at 5 yrs of age were also normal: receptive language development 104 (55-133), syntactical development 104 (68-132), and lexical development 101 (50-141) for 89 children; intelligence quotient 104 (68-132) for 106 children. Scores did not differ among those with normal hearing, mild hearing loss, and moderate-to-severe hearing loss (p = 0.800, p = 0.639, p = 0.876, and p = 0.886, for the respective developmental tests).

CONCLUSIONS

We found normal language development and intelligence in a cohort of neonatal extracorporeal membrane oxygenation survivors. The prevalence of bilateral sensorineural hearing loss was in accordance with that of a larger series in the United States-which exceeds the prevalence in the normal population.

Definition and outpatient management of the very low-birth-weight infant with bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity, is the major cause of pulmonary disease in infants. The pathophysiology and management of BPD have evolved over the past four decades as improved neonatal intensive care unit (NICU) modalities have increased survival rates. The likelihood for developing BPD increases with the degree of prematurity and reaches 25-35% in very low-birth-weight and extremely low-birth-weight infants. BPD affects many organ systems, and infants with BPD are at increased risk for rehospitalization and numerous complications following NICU discharge. The management of BPD and medically related problems, particularly during the first 2 years of life, remains a continuing challenge for parents and healthcare providers. It is important that a multidisciplinary team consisting of the neonatologist/attending physician, primary care physician, and other specialized support staff work in concert and meet regularly to provide continuity of care and accurate patient assessments.