Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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신생아 중환자실에서 난청의 발생빈도 및 위험요소의 중요성

Incidence of hearing loss and importance of risk factors in the neonatal intensive care unit

  • 투고 : 2006.04.12
  • 심사 : 2006.06.21
  • 발행 : 2006.08.15
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초록

목 적 : 선천성 또는 신생아시기에 위험요인을 가진 환아에서 조기 난청의 발생율이 높으며, 지연성 또는 진행성으로 발생하는 난청의 상당 부분도 신생아시기에 위험요인이 있었던 환아에서 발생 한다. 따라서 위험군을 효과적으로 선별하고 관리하는 것은 중요하다. 본 연구는 다양한 위험인자를 발견 할 수 있는 신생아 집중 치료실 입원환자를 대상으로 청력선별검사를 시행하고 난청 발생 빈도와 위험인자들간의 관계 및 상대적인 중요성을 알아보았다. 방 법 : 2003년 5월부터 2005년 12월까지 좋은문화병원 신생아 집중치료실에 입원한 신생아 1,201명을 대상으로 하였다. 검사는 입원원인질환에서 회복되고 교정연령 36주 이상, 체중 2,200 g이상 되었을 때 자동뇌간유발반응검사(AABR. ALGO-3)를 시행하였으며 1차 청력검사에서 통과된 경우 'pass'군 통과하지 못한 경우 'refer'군으로 하였다. 첫 번째 검사에서 'refer'가 나온 경우 1개월 뒤에 재검사를 받도록 하였고 재검사에서 'refer'가 나온 경우 난청 클리닉에 의뢰하여 난청을 확진하였다. 결 과 : 총 1,201명중 1,187명(98.8%)은 청력검사를 통과 하였고 14명(1.2%)이 난청으로 진단되었다. 대상자중 293명(24.4%)이 위험인자를 가지고 있었으며, 이중 282(96.2%)이 통과 하였고, 11명(3.8%)이 난청으로 진단되었다. 위험군에서 난청의 발생빈도가 유의하게 높았다(P<0.001). 각 위험인자들 중에서 난청발생에 유의한 차이를 보인 것은 청력손상을 일으키는 약물의 사용(P<0.001), 출생체중 1,500 g 이하(P<0.001), 안면부 기형(P=0.007) 등이었다. 반면에 위험인자 중 선천성 감염, 고빌리루 빈혈증, 세균성 뇌수막염, 낮은 Apgar점수, 5일 이상의 인공호흡기 사용, 청력 이상을 나타내는 증후군 등은 'pass'군과 'refer'군 사이에 발생 빈도에 있어서 통계적으로 의미가 없었다. 결 론 : 적절한 시기에 난청을 진단하기 위해서 신생아 청력선별검사 뿐만 아니라 난청의 위험요소를 잘 파악하는 것도 중요하다.

Purpose : To assess the incidence of neonatal hearing loss in a neonatal intensive care unit and the relative importance of risk factors for hearing imparement in a neonatal intensive care unit which the Joint Committee on Infant Hearing(JCIH) had recommended. Methods : One thousand, two hundred and one newborns admitted to the Good Moonhwa Intensive Care Unit from May 2003 to December 2005 were assesed using the automated auditory brainstem response(AABR). The screening was performed on those aged more than 36 weeks and weighing more than 2,200 g. We divided the infants into two groups, 'pass' and 'refer'. The 'refer' group were retested one month later, and if classified as 'refer' during the retest, were referred to a hearing impairment clinic. Results : From the 1,201 neonates, 1,187(98.8 percent) passed the test and 14(1.2 percent) failed. 293(24.4 percent) of the 1,201 neonates had a risk factor for hearing impairment; 282(96.2 percent) passed the test and 11(3.8 percent) failed. The group with risk factors were shown to have a higher incidence of hearing loss(P<0.001). The neonates in the refer group were shown to have a higher incidence of ototoxic drugs(P<0.001), low birth weight(<1,500 g)(P<0.001) and craniofacial anomalies(P=0.007). On the other hand, there were no statistical differences between the pass and refer groups in congenital infection, hyperbilirubinemia, bacterial meningitis, low Apgar scores, prolonged mechanical ventilation and syndromes known to include hearing loss. Conclusion : In order to identify hearing-impaired infants within an appropriate period, neonatal hearing screening tests and identification of the risk factors for neonatal hearing loss are important.

키워드

참고문헌

  1. Mason JA, Herrmann KR. Universal infant hearing screening by automated auditory brainstem response measurement. Pediatrics 1998;101:221-8 https://doi.org/10.1542/peds.101.2.221
  2. Mehl AL, Thomson V. Newborn hearing screening : the great omission. Pediatrics 1998;101:1-6 https://doi.org/10.1542/peds.101.1.1
  3. Oghalai JS, Chen L, Brennan ML, Tonini R, Manolidis S. Neonatal hearing loss in the indigent. Laryngoscope 2002; 112:281-6 https://doi.org/10.1097/00005537-200202000-00015
  4. American Academy of Pediatrics. Task Force on Newborn and Infant Hearing. Newborn and infant hearing loss: detection and intervention. Pediatrics 1999;103:527-30 https://doi.org/10.1542/peds.103.2.527
  5. National Institutes of Health. NIH Consensus Statement. Early identification of hearing impairment in infants and young children. Washington, DC : National Institutes of Health;1993;1-24
  6. Moore DR. Postnatal development of the mammalian central auditory system and the neural consequences of auditory deprivation. Acta Otolaryngol Suppl 1985;421:19-30
  7. Brookhouser PE, Worthington DW, Kelly WJ. Unilateral hearing loss in children. Laryngoscope 1990;101:1264-72 https://doi.org/10.1002/lary.5541011202
  8. Yoshinaga-Itano C. Efficacy of early identification and early intervention Semin Hear 1995;16:115-23 https://doi.org/10.1055/s-0028-1083709
  9. Paradise JL, Dollaghan CA, Campbell TF, Feldman HM, Bernard BS, Colbom DK, et al. Language, speech sound production, and cognition in three-year-old children in relation to otitis media with effusion in their first three years of life. Pediatrics 2000;105:1119-30 https://doi.org/10.1542/peds.105.5.1119
  10. Waltzman SB, Cohen NL, Green J. Long-term effects of cochlear implants in children. Otolaryngol Head Neck Surg 2002;126:505-11 https://doi.org/10.1067/mhn.2002.124472
  11. Hassanzadeh S, Farhadi M, Daneshi A. The effects of age on auditory speech perception development in cochlearimplanted prelingually deaf children, Otolaryngol Head Neck Surg 2002;126:524-7 https://doi.org/10.1067/mhn.2002.125110
  12. Joint Committee on Infant Hearing. Year 2000 Position Statement : principles and guidelines for early hearing detection and intervention programs. Pediatrics 2000;106:798- 817 https://doi.org/10.1542/peds.106.4.798
  13. Cunningham M, Cox EO. Hearing Assessment in Infants and Children : recommendations beyond neonatal screening. Pediatrics 2003;111:436-40 https://doi.org/10.1542/peds.111.2.436
  14. Fowler KB, McCollister FP, Dahle AJ, Boppana S, Britt WJ, Pass RF. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997;130:624-30 https://doi.org/10.1016/S0022-3476(97)70248-8
  15. Fowler KB, Dahle AJ, Boppana SB, Pass RF. Newborn hearing screening : will children with hearing loss caused by congenital cytomegalovirus infection be missed? J Pediatr 1999;135:60-4 https://doi.org/10.1016/S0022-3476(99)70328-8
  16. Peltora H, Luhtala K, Valmari P. C-reactive protein as a detection of organic complications during recovery from childhood purulent meningitis. J Pediatr 1984;104:869-72 https://doi.org/10.1016/S0022-3476(84)80483-7
  17. Dias LR, Alves RM, Farhat CK. C-reactive protein follow- up of children with acute bacterial meningitis. Braz J Infect Dis 1999;3:15-22
  18. Yoshikawa S, Ikeda K, Kudo T, Kobayashi T. The effects of hypoxia, premature birth, infection, ototoxic drugs, circulatory system and congenital disease on neonatal hearing loss. Auris Nasus Larynx 2004;31:361-8 https://doi.org/10.1016/S0385-8146(04)00115-4
  19. Shott SR, Joseph A, Heithaus D. Hearing loss in children with Down syndrome. Int J Pediatr Otorhinolaryngol 2001; 61:199-205 https://doi.org/10.1016/S0165-5876(01)00572-9
  20. Barbara CW, Betty RV, Yvonne SS, Judith EW, Richard CF, Michael PG, et al. Identification of neonatal hearing impairment : infants with hearing loss. Ear Hear 2000;21: 488-507 https://doi.org/10.1097/00003446-200010000-00012
  21. Razi MS, Das VK. Effects of adverse perinatal events on hearing. Int J Pediatr Otorhinolaryngol 1994;30:29-40. https://doi.org/10.1016/0165-5876(94)90048-5
  22. Grobler JM, Mercer MJ. Kernicterus associated with elevated predominantly direct-reacting bilirubin. S Afr Med J 1997;87:1146
  23. Vohr BR. New approaches to assessing the risks of hyperbilirubinemia. Clin Perinatol 1990 Jun;17:293-306 https://doi.org/10.1016/S0095-5108(18)30569-4
  24. Gafni M, Sohmer H. Intermediate endocochlear potential levels induced by hypoxia. Acta Otolaryngol 1976;82:354-8 https://doi.org/10.3109/00016487609120919
  25. Nuttall A, Lawrence M. Endocochlear potential and scala media oxygen tension during partial anoxia. Am J Otolaryngol 1980;1:147-53 https://doi.org/10.1016/S0196-0709(80)80008-1
  26. Sohmer H, Freeman S, Malachie S. Multi-modality evoked potentials in hypoxemia. Electroencephalogr Clin Neurophysiol 1989;73:328-33
  27. Hayes D, Northern JL. Infants and Hearing. San Diego: Singular Publishing Group;1996
  28. Petit C. Genes responsible for human hereditary deafness: symphony of a thousand. Nat Genet 1996;14:385-91 https://doi.org/10.1038/ng1296-385