Analysis of first-time hearing screening tests among singlets and twin neonates in neonatal intensive care unit
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摘要: 目的 明确双胎新生儿出现听力障碍的原因和影响因素，为其预防和早期干预提供依据。方法 收集2015年1月—2018年6月在上海交通大学医学院附属上海儿童医学中心重症监护病房(NICU)住院治疗的1452例新生儿，其中130例为双胎新生儿。对其进行自动听性脑干反应(AABR)、畸变产物耳声发射(DPOAE)以及1000 Hz声导抗检查，将检查结果同早产、高胆红素血症、新生儿呼吸窘迫综合征等孕产期常见危险因素进行相关性分析。结果 130例双胎新生儿的剖宫产、早产、新生儿高胆红素血症、低出生体重、极低出生体重、试管婴儿、妊娠期高血压综合征和人工或混合喂养发生率与单胎新生儿相比差异有统计学意义(P < 0.05)，其AABR、DPOAE和声导抗通过率均分别显著低于单胎新生儿。初筛未通过的双胎新生儿复查通过的比例高达72.86%。双胎新生儿AABR初次通过率与先天性心脏病、新生儿呼吸窘迫综合征、剖宫产、低和极低出生体重相关，DPOAE初次通过率与低出生体重和剖宫产相关，声导抗初次单峰率与早产、剖宫产、低出生体重、妊娠期糖尿病和妊娠期高血压综合征等因素呈负相关。诊断性听力筛查结果提示双胎新生儿ABR通过率同妊娠期糖尿病相关，DPOAE通过率与≥40岁高龄产妇相关。结论 NICU中双胎新生儿的听力筛查初次通过率显著低于同期单胎新生儿听力筛查通过率。初次听力筛查未通过的新生儿大部分听力可恢复。其中早产、新生儿呼吸窘迫综合征、低和极低出生体重、先天性心脏病、妊娠糖尿病、妊娠期高血压综合征、≥40岁高龄产妇及剖宫产等危险因素与双胎新生儿初次听力筛查未通过率有显著相关性，需要密切随访。Abstract: Objective To investigate the failure in the hearing screening test among twin neonates in neonatal intensive care unit (NICU) and to further clarify the etiology of neonatal hearing impairment, thus to provide insights into prevention and early intervention.Methods Automated auditory brainstem response(AABR), distortion product otoacoustic emission(DPOAE) and acoustic immittance were performed on 1452 neonates(including 130 twins) admitted in NICU from January 2015 to June 2018 and the risk factors including premature birth, hyperbilirubinemia, neonatal respiratory distress syndrome, etc. were analyzed retrospectively by univariate chi-square test and multivariate logistic regression analysis.Results The incidence of C-section, premature birth, hyperbilirubinemia, low birth weight, very low birth weight, in-vitro fertilization, pregnancy-induced hypertension syndrome and formula or mixed feeding among twin neonates were significantly higher than those of singleton neonates (P < 0.05). The pass rates of the first-time AABR, DPOAE and acoustic immittance were significantly lower than singleton neonates. The proportion of twin neonates who failed the initial screening but recovered in the following test was as high as 72.86%. AABR pass rate was correlated with congenital heart disease, neonatal respiratory distress syndrome, C-section and (very) low birth weight. The pass rate of DPOAE was correlated with low birth weight and C-section. The pass rate of acoustic immittance was correlated with preterm birth, C-section, low birth weight, gestational diabetes and gestational hypertension. The pass rate of diagnostic ABR was associated with gestational diabetes. And the pass rate of diagnostic DPOAE was associated with maternal age ≥40 years old.Conclusion The first-time hearing screening pass rate of twin neonates in NICU is lower than that of neonatal singleton. Most twin neonates who fail in the first screening test will recover. Preterm birth, neonatal respiratory distress syndrome, (very) low birth weight, congenital heart disease, gestational diabetes, pregnancy-induced hypertension syndrome, maternal age ≥ 40 years old and C-section are associated with the first-time failure in hearing screening tests among twin neonates, thus entailing close follow-up.
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表 1 双胎新生儿与单胎新生儿各因素比较
例(%) 项目 总数 双胎 单胎 χ2 P值 人数 1452(100.0) 130(9.0) 1322(91.0) 男性 816(56.2) 64(49.2) 752(56.9) 2.816 0 0.093 剖宫产 806(55.5) 102(78.5) 704(53.3) 30.456 6 < 0.001 早产 693(47.7) 6(4.6) 687(52.0) 106.327 9 < 0.001 新生儿高胆红素血症 416(28.7) 48(36.9) 368(27.8) 4.780 6 0.029 新生儿呼吸窘迫综合征 285(19.6) 24(18.5) 261(19.7) 0.123 2 0.726 先天性心脏病 274(18.9) 30(23.1) 244(18.5) 1.650 2 0.199 低出生体重 605(41.7) 86(66.2) 519(39.3) 35.225 0 < 0.001 极低出生体重 112(7.7) 32(24.6) 80(6.1) 57.300 6 < 0.001 试管婴儿 84(5.8) 46(35.4) 38(2.9) 229.517 0 < 0.001 ≥35岁高龄产妇 231(15.9) 16(12.3) 215(16.3) 1.384 3 0.239 ≥40岁高龄产妇 34(2.3) 2(1.5) 32(2.4) 0.763 0 0.400a) 妊娠期高血压综合征 154(10.6) 24(18.5) 130(9.8) 9.293 1 0.002 妊娠期糖尿病 164(11.3) 10(7.7) 154(11.6) 1.849 5 0.174 人工或混合喂养 1175(80.9) 130(100.0) 1045(79.0) 33.660 5 < 0.001 注：a)Fisher精确检验。 
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表 2 130例双胎新生儿听力筛查初次通过率与各项危险因素的单因素分析
项目 例数(%) AABR DPOAE 声导抗 r P值 95%CI r P值 95%CI r P值 95%CI 男性 64(49.2) 0.42 0.675 -0.144~0.221 0.92 0.358 -0.101~0.278 0.94 0.351 -0.063~0.175 早产 6(4.6) 1.56 0.121 -0.095~0.806 0.31 0.755 -0.394~0.541 1.99 0.049 0.002~0.588 低出生体重 86(66.2) -2.16 0.033 -0.771~-0.034 0.98 0.328 -0.193~0.572 2.16 0.033 0.021~0.501 极低出生体重 32(24.6) 2.57 0.011 0.132~1.017 -0.04 0.968 -0.468~0.450 -0.88 0.379 -0.416~0.160 剖宫产 102(78.5) 2.85 0.005 0.099~0.554 1.68 0.097 -0.036~0.435 2.18 0.032 0.015~0.310 人工或混合喂养 130(100) -1.16 0.248 -0.729~0.190 0.11 0.917 -0.451~0.502 -0.20 0.842 -0.329~0.269 试管婴儿 46(35.4) -0.23 0.817 -0.212~0.168 -0.33 0.744 -0.229~0.164 -1.00 0.319 -0.186~0.061 ≥35岁高龄产妇 16(12.3) -0.10 0.918 -0.308~0.278 -0.92 0.358 -0.446~0.162 1.96 0.052 -0.002~0.379 ≥40岁高龄产妇 2(1.5) 1.28 0.203 -0.311~1.447 1.85 0.067 -0.062~1.761 1.47 0.144 -0.147~0.996 妊娠期糖尿病 10(7.7) 1.17 0.243 -0.132~0.516 0.05 0.961 -0.328~0.344 4.62 < 0.001 0.281~0.703 妊娠高血压综合征 24(18.5) 1.71 0.090 -0.033~0.449 0.54 0.587 -0.181~0.319 -2.86 0.005 -0.383~-0.069 新生儿高胆红素血症 48(36.9) 1.10 0.272 -0.082~0.288 1.54 0.127 -0.043~0.340 -0.08 0.938 -0.125~0.115 新生儿呼吸窘迫综合征 24(18.5) 2.09 0.039 0.013~0.505 0.62 0.539 -0.178~0.334 -0.47 0.638 -0.198~0.122 先天性心脏病 30(23.1) -2.03 0.045 -0.471~-0.006 -0.43 0.670 -0.293~0.189 0.02 0.988 -0.150~0.152
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表 3 双胎新生儿听力诊断性检查未通过率同新生儿各项危险因素的单因素分析
项目 ABR DPOAE 声导抗 r P值 95%CI r P值 95%CI r P值 95%CI 男性 0.91 0.365 -0.070~0.188 1.02 0.308 -0.052~0.164 0.65 0.515 -0.058~0.115 早产 0.46 0.646 -0.245~0.393 1.29 0.201 -0.094~0.441 1.56 0.122 -0.045~0.381 低出生体重 -0.39 0.701 -0.311~0.210 0.40 0.692 -0.175~0.262 1.10 0.274 -0.078~0.271 极低出生体重 0.40 0.690 -0.250~0.376 -0.06 0.953 -0.270~0.254 -0.34 0.732 -0.246~0.173 剖宫产 1.16 0.247 -0.066~0.255 0.15 0.882 -0.124~0.145 1.77 0.079 -0.011~0.204 人工或混合喂养 -0.52 0.606 -0.410~0.240 -0.02 0.988 -0.275~0.270 -0.22 0.824 -0.242~0.193 试管婴儿 -1.01 0.315 -0.203~0.066 -1.11 0.268 -0.176~0.049 -0.62 0.536 -0.118~0.062 ≥35岁高龄产妇 -0.39 0.700 -0.248~0.167 -1.09 0.276 -0.270~0.078 0.85 0.400 -0.080~0.198 ≥40岁高龄产妇 1.32 0.190 -0.207~1.035 2.28 0.025 0.077~1.119 1.51 0.134 -0.099~0.732 妊娠期糖尿病 2.04 0.043 0.007~0.466 1.72 0.088 -0.025~0.359 0.93 0.352 -0.081~0.226 妊娠高血压综合征 0.30 0.764 -0.144~0.196 -0.35 0.728 -0.168~0.118 -1.33 0.185 -0.191~0.037 新生儿高胆红素血症 -1.22 0.225 -0.211~0.050 -0.08 0.935 -0.114~0.105 0.40 0.688 -0.070~0.105 新生儿呼吸窘迫综合征 1.56 0.122 -0.037~0.311 0.70 0.487 -0.094~0.197 0.85 0.397 -0.067~0.166 先天性心脏病 0.22 0.827 -0.146~0.183 1.19 0.236 -0.055~0.221 0.10 0.919 -0.104~0.116
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