新生儿听力筛查未通过的相关因素分析

发布时间：2018-04-09 15:02

本文选题：新生儿　切入点：听力筛查　出处：《重庆医科大学》2010年硕士论文

【摘要】： 目的:探讨新生儿听力筛查未通过的相关因素,为开展大规模的新生儿听力筛查和听力损伤高危人群的随访提供依据。方法:对重庆医科大学附属儿童医院新生儿病房2009年1月-2009年7月,719例住院患儿的听力筛查资料进行分析。记录新生儿的性别、胎次、胎龄、分娩方式、出生体重、胎儿窘迫、出生窒息、孕早中期感冒史、母孕期用药史、脐带异常、妊娠合并症、听力障碍家族史、家居环境、颅面部畸形、呼吸道分泌物、血糖、黄疸、胆红素脑病、缺血缺氧性脑病(hypoxic-ischemic encephalopathy,HIE)、肺动脉高压、败血症、化脓性脑膜炎、先天性宫内感染(TORCHS)、肺炎、新生儿神经行为评分(neonatal behavioral neurological assessment,NBNA)等临床资料。同时用单因素χ2检验和多因素Logistic回归分析,筛选出新生儿听力筛查未通过的相关因素。结果: 1.本组719(1438耳)例新生儿中,听力筛查未通过160例(22.3%),其中,左耳未通过48例(6.7%),右耳未通过28例(3.9%),双耳未通过84例(11.7%)。 2.听力初筛未通过的160例中,58例于日龄42天复查听力筛查,失访率达63.8%。复查听力筛查未通过18例(31.0%),一耳未通过13例(22.4%),双耳未通过5例(8.6%)。 3.719例患儿中血巨细胞病毒(cytomegalovirus,CMV)抗体阳性338例(47.0%),其中IgG阳性335例,IgG和IgM同时阳性3例。102例血CMV抗体阳性患儿的尿液标本中, 2例CMV脱氧核糖核酸(deoxyribonucleic acid,DNA)聚合酶链反应(polymerase chain reaction,PCR)阳性(2.0%)。 4.160例听力筛查未通过患儿NBNA(36±2)分,明显低于通过组NBNA(37±1)分(t=3.841,P0.01)。NBNA≤31分,32-35分,≥36分三组的听力筛查未通过率分别为63.6%,37.2%,19.5%。 5.单因素分析发现,达到换血标准的高胆红素血症、胆红素脑病、血CMV抗体阳性、小于胎龄儿、NBNA≤35分、溶血性黄疸、黄疸起病时间≤1天、颅面部畸形可能与新生儿听力筛查未通过有关(P 0.05)。性别、家居环境、分娩方式、胎次、胎龄、出生体重、孕早中期感染、母孕期用药、脐带异常、妊娠合并症、胎儿窘迫、出生窒息、HIE、肺动脉高压、低血糖、梅毒、呼吸道分泌物较多、肺炎、败血症、细菌性脑膜炎与新生儿听力筛查未通过无明显相关关系(P 0.05)。 6.多因素Logistic回归分析表明,达到换血标准的高胆红素血症、血CMV抗体阳性、NBNA≤35分、颅面部畸形是新生儿听力筛查未通过的相关因素(P 0.05,OR值分别为5.913,2.861,0.031,1.623;95%CI分别为1.852-18.87,1.067-7.669,1.037-2.135,1.123-2.34 7)。结论: 1.我院住院新生儿听力初筛未通过率22.3%,复筛未通过率31.0%。 2.达到换血标准的高胆红素血症、血CMV抗体阳性、NBNA≤35分、颅面部畸形是新生儿听力筛查未通过的相关因素。性别、家居环境、分娩方式、胎次、胎龄、出生体重、孕早中期感染、孕期用药、脐带异常、妊娠合并症、胎儿窘迫、出生窒息、HIE、肺动脉高压、低血糖、梅毒、呼吸道分泌物较多、肺炎、败血症、细菌性脑膜炎与听力筛查未通过无明显相关关系。 3.NBNA越低,听力筛查未通过率越高。 4.目前由于人力等医疗资源有限,开展大规模的新生儿听力筛查有一定困难,应该对具有听力损伤相关因素的新生儿,即达到换血标准的高胆红素血症、血CMV抗体阳性、NBNA≤35分和颅面部畸形等高危儿进行重点筛查并加强随访。
[Abstract]:Objective: To explore the related factors of neonatal hearing screening, and provide evidence for large-scale neonatal hearing screening and follow-up of high-risk groups.
Methods: the neonatal ward of children's Hospital Affiliated to Medical University Of Chongqing in January 2009 -2009 year in July, 719 Cases of hospitalized children with hearing screening were analyzed retrospectively. Records of neonatal sex, parity, gestational age, mode of delivery, birth weight, fetal distress, birth asphyxia, pregnancy in early stage cold during pregnancy history, medication history, umbilical cord abnormalities, pregnancy disease, family history of hearing impairment, Home Furnishing environment, craniofacial deformities, respiratory secretions, blood glucose, jaundice, bilirubin encephalopathy, hypoxic ischemic encephalopathy (hypoxic-ischemic, encephalopathy, HIE), pulmonary hypertension, sepsis, meningitis, congenital intrauterine infection (TORCHS), pneumonia, neonatal behavioral neurological assessment (neonatal behavioral neurological assessment NBNA), the clinical data. At the same time with the single factor regression analysis Logistic 2 test and multi factors to select related factors of newborn hearing screening did not pass.
Result:
1. of the 719 (1438 ears) cases, hearing screening did not pass through 160 cases (22.3%), including 48 cases (6.7%) of left ear, 28 cases (3.9%) of right ear, and 84 cases of 11.7% ears (11.7%).
2. hearing screening failed in 160 cases, 58 cases on day 42 after hearing screening, the dropout rate of review hearing screening 63.8%. in 18 cases (31%), a failed in 13 cases (22.4% ears), 5 cases (8.6% ears) did not pass.
3.719 cases of CMV (cytomegalovirus, CMV) antibody was positive in 338 cases (47%), 335 cases with positive IgG, IgG and IgM were positive in 3 cases of.102 patients blood CMV antibody positive children urine specimens, 2 cases of CMV DNA (deoxyribonucleic acid DNA) polymerase chain reaction (polymerase chain reaction PCR), positive (2%).
4.160 cases failed in hearing screening in children with NBNA (36 + 2), NBNA group was significantly lower than that by (37 + 1) points (t=3.841, P0.01).NBNA is less than or equal to 31 points, 32-35 points, more than 36 hearing screening in three groups did not pass rate were 63.6%, 37.2%, 19.5%.
5. single factor analysis showed that blood transfusion reached standard hyperbilirubinemia, bilirubin encephalopathy, serum CMV antibody positive, gestational age, NBNA = 35, hemolytic jaundice, jaundice onset time less than 1 days, may be related to craniofacial deformity in newborn hearing screening did not pass on (P 0.05). Home Furnishing gender, environment, mode of delivery, parity, gestational age, birth weight, early and middle pregnancy infection, pregnancy medication, abnormal umbilical cord, pregnancy complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, more respiratory secretions of lung inflammation, sepsis, meningitis and neonatal hearing screening was not correlated (not through P 0.05).
Logistic 6. multi factor regression analysis showed that blood transfusion to standard hyperbilirubinemia, blood CMV antibody positive, NBNA = 35, craniofacial deformity is related to factors of newborn hearing screening failed (P 0.05, OR = 5.913,2.861,0.031,1.623 respectively; 95%CI 1.852-18.87,1.067-7.669,1.037-2.135,1.123-2.34 7).
Conclusion:
1. the rate of inpatient hearing screening in the hospital of our hospital was 22.3%, and the failure rate of rescreening was 31.0%.
2. reach the standard of blood transfusion hyperbilirubinemia, CMV antibody positive, NBNA = 35, craniofacial deformity is related to factors of newborn hearing screening failed. Home Furnishing gender, environment, mode of delivery, parity, gestational age, birth weight, early and middle pregnancy infection, pregnancy medication, umbilical cord abnormalities, pregnancy complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, respiratory secretions more, pneumonia, sepsis, meningitis and failed in hearing screening has no significant correlation.
The lower the 3.NBNA, the higher the failure rate of hearing screening.
4. due to manpower limited medical resources, to carry out large-scale newborn hearing screening is difficult, should with related factors of hearing impairment in newborns, which reached the standard of blood transfusion hyperbilirubinemia, CMV antibody positive, NBNA is less than or equal to 35 points and malformation screening in high risk infants and followed up.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

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