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【目的】了解先天性听力损失在新生儿重症监护病房(neonatal intensive care unit,NICU)中的发病情况,探讨较为科学而可行的高危新生儿听力筛查及早期诊断模式。【方法】对NICU中673例新生儿进行畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)筛查,所有新生儿于1月后作第2次筛查,2次筛查仍未通过者于3～6月龄进行听性脑干反应(auditory brainstem response,ABR)检查予以诊断。【结果】共筛查673例高危新生儿,初筛结果阳性164例,阳性率为24.4%。复检599例,复检率89.0%,复检阳性37例,阳性率为6.2%。37例患儿于3～6月龄进行ABR检查,确诊有听力障碍18例,其中有2例听神经病患者,5例轻度听力损失患儿与中耳积液有关。673例高危新生儿中听力障碍发病率为2.67%。【结论】NICU中高危新生儿是听力障碍的高发人群,建议DPOAE联合新生儿听力筛查仪(automated auditory brainstem response,AABR)作为该人群的听力筛查模式;NICU新生儿听神经病的发病率比较高,特别是高胆红素血症与听神经病的发生密切相关,所以要做好NICU患者的跟踪随访和定期的听力学评估。
【Objective】 To investigate the incidence of congenital hearing loss in neonatal intensive care unit (NICU) and to explore the more scientific and feasible hearing screening and early diagnosis of high-risk neonates. 【Methods】 Distortion product otoacoustic emission (DPOAE) screening was performed on 673 newborns in the NICU. All newborns were screened for the second time after 1 month and 2 times later 3 ~ 6 months old for auditory brainstem response (auditory brainstem response, ABR) check to be diagnosed. 【Results】 A total of 673 high-risk newborns were screened. The positive results of screening were 164 cases, the positive rate was 24.4%. 599 cases of re-examination, the re-examination rate of 89.0%, 37 cases of re-examination positive, the positive rate was 6.2%. Thirty-seven children underwent ABR at 3 to 6 months of age and 18 were diagnosed with hearing impairment, 2 of whom had auditory neuropathy and 5 of whom had mild hearing loss associated with middle ear effusion. The incidence of hearing impairment in 673 high-risk neonates was 2.67%. 【Conclusions】 High-risk neonates in NICU are high-risk hearing-impaired individuals. We suggest DPOAE combined with AABR as the auditory screening model for this population. The incidence of neonatal auditory neuropathy in NICU High, especially hyperbilirubinemia and the occurrence of auditory neuropathy are closely related, so follow-up of NICU patients and regular audiological assessment should be done.