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 the neonatal intensive care unit and explore the scientific and feasible mode of hearing screening and early diagnosis for the high-risk newborns. Methods 673 newborns in NICU received hearing screening test initially with distortion product otoacoustic emission(DPOAE).All babies would received screening again after one month.The infants who failed to pass both tests would performed auditory brainstem response(ABR) test at 3~6 months. Results 164(24.4%) infants didn't pass the initially hearing screening among the 673 newborns.599 infants(89.0%) took part in the second screening test.Thirty-seven(6.2%) infants got positive results.All abnormal infants(37) accepted ABR test at 3~6 months and 18 of them were diagnosed as with hearing impairment.Of them,two infants were auditory neuropathy and four mild hearing loss were associated with otitis media.The incidence of hearing disorder was 2.67%. Conclusions DPOAE combined with automated auditory brainstem response(AABR) is an effective mode for hearing screening among high-risk newborns in NICU.The incidence of auditory neuropathy among these newborns is higher than that of well-born baby,especially hypercholesterolenia is connected with auditory neuropathy.It is necessary for high-risk newborns to trace,revisit and regular audiological testing.