低體重兒的聽力障礙

Hearing Impairment For Very Low Birth Weight Infants:Incidence, Risk Factors Analysis And Follow-up

蘇玄白(Saw Hean-Pat)

指導教授 ： 陳家玉

中山醫學大學/醫學院/醫學研究所/碩士(2006年)

摘要

早產兒特別是低體重兒為聽力障礙的高危險群。對這些嬰兒而言，聽力問題的早期診斷及治療，有助於他們將來的語言發展以及學校和職業上的表現。我們這一個研究的主要目的是評估那一些必須住進我們新生兒加護病房接受治療的低體重兒的聽力障礙發生率，危險因子分析以及 他們在早期診斷後接受治療和後續追踪的結果。
從1998年一月至2003年七月，在中山醫學大學附設醫院新生兒加護病房，一共蒐集215位極低體重兒(男:女=113:102)。那些會導致聽力障礙的危險因子都記錄下來。所有嬰兒都是利用腦幹聽覺反應來檢查聽力。在矯正年齡為六個月時接受第一次的聽力檢查。如果發現任何一耳的聽力檢查有問題 (>40 dB) 時，病人就得在矯正年齡為九、十二、十八、廿四個月時持續追蹤她們的聽力檢查。
在這研究中我們發現極低體重兒的聽力障礙和出生體重、懷孕週數、呼吸器使用天數、住院天數、呼吸窘迫、表面作用劑之治療、慢性肺病變、周腦室白質軟化症、腦性麻痺、壞死性腸炎及敗血症有明顯的統計學上的意義，但是抗生素的使用以及腦室出血則無統計學上的意義。
在這215位極低體重兒當中，其中有208 (96.7%) 位極低體重兒聽力正常，有七位 (3.3%)極低體重兒聽力有異常。在這七位聽力異常的極低體重兒中，其
中一位是混合型聽力障礙，另一位則是雙耳嚴重性週邊型聽力障礙，其他
Ⅱ

則為輕度週邊型聽力障礙。這七位極低體重兒在診斷有聽力障礙後便馬上接受助聽器治療。到目前為止這七位極低體重兒語言發展上並沒有受到影響。.

關鍵字：極低體重兒，早產，聽力障礙

關鍵字

極低體重兒 ； 早產 ； 聽力障礙

並列摘要

Premature infants, especially those with very low birth weights (VLBW), have a high risk of developing hearing impairment. Early diagnosis and treatment of hearing problems plays an important role in speech development and academic and occupational performance later in life. The purpose of this study was to evaluate the incidence and risk factors of hearing impairment in VLBW infants and their associated developmental outcome subsequent to early diagnosis followed by early treatment.
From January 1998 through to July 2003, 215 VLBW infants (M:F=113:102) were enrolled. Potential risk factors for hearing impairment were recorded. All infants underwent assessment of brainstem auditory evoked potential (BAEP) at a corrected age of 6 months. If an abnormal test result (>40 decibels dB) was noted, additional testing was done at the corrected ages of 9, 12, 18, and 24 months.
In this study, we found significant associations between hearing impairment and birth body weight, gestational age, duration of mechanical ventilator usage, duration of hospitalization, respiratory distress syndrome, surfactant treatment, bronchopulmonary dysplasia, periventricular leucomalacia, cerebral palsy, necrotizing enterocolitis and sepsis but there was no significant relationship with Vancomycin and gentamycin use.

Ⅳ
Two hundred and eight (96.7%) of the 215 infants passed the initial auditory test.
Of the seven (3.3%) with abnormal hearing test results, one had a mixed type hearing impairment, one had a severe bilateral peripheral type and the others had mild peripheral type of impairment. All of these infants were provided with hearing aids immediately after diagnosis and no associated speech commencement delay was noted. We conclude that high risk infants must be assessed early for hearing impairment.
Key words: very low birth weight, premature, hearing impairment

並列關鍵字

very low birth weight ； premature ； hearing impairment

參考文獻

1. McGettigan MC, Adolph VR, Ginsberg HG, Goldsmith JP. New ways to ventilate newborns in acute respiratory failure. Pediatr Clin North Am 1998; 45: 475-509.

2. Mazzella M, Bellini C, Calevo MG, et al. A randomized control study comparing the infant flow driver with nasal continuous positive pressure in preterm infants. Arch Dis Childhood Fetal Neonatal Ed 2001; 85: F86-90.

3. Smyth RL. Inhaled nitric oxide treatment for preterm infants with hypoxic respiratory failure. Thorax 2000; 55: 51-5.

4. Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomized trails, 1972-1994. Am J Obstet Gynecol 1995; 173: 322-5.

5. Jiang ZD, Brosi DM, Wilkinson AR. Hearing impairment in preterm very low birthweight babies detected at term by brainstem auditory evoked responses. Acta Paediatr 2001; 90: 1411-5