Abstract
Objective
This study aimed to determine hearing screen outcomes and identify clinical and environmental
risk factors for hearing screen failure in very preterm infants at a level IV single-family
room (SFR) neonatal intensive care unit (NICU).
Study Design
We conducted a retrospective study of infants <33 weeks gestational age admitted to
a level IV SFR NICU who survived to discharge and had automated auditory brainstem
response results available. Demographics, antenatal and postnatal factors, and respiratory
support modes and their duration were collected from the electronic medical record.
Results
Of 425 eligible infants with documented hearing screen results, 353 (83%) passed and
72 (17%) failed the hearing screen (unilateral, N = 44 [61%]; bilateral, N = 28 [39%]). Compared to infants who passed the hearing screen, infants with hearing
screen failure were lower gestational age and birth weight, male sex, were screened
at later postnatal and postmenstrual ages (PMAs), had lower 1- and 5-minute Apgar
scores, longer duration of furosemide therapy, early hypotension, intraventricular
hemorrhage (IVH) ≥Grade 3, and bronchopulmonary dysplasia (BPD) at 36 weeks PMA. Infants
with hearing screen failure experienced longer exposures to invasive and noninvasive
respiratory support. Heated, humidified, high flow nasal cannula >2 liters per minute
exposure was significantly longer in infants with bilateral hearing screen failure
(18.4 ± 18.4 d) compared to duration in infants who passed (7.4 ± 12.8 d) and those
with unilateral failure (9 ± 13 d), (mean ± standard deviation [SD], p < 0.001). In the final logistic model, IVH ≥Grade 3 (odds ratio [OR] = 3.22, 95%
confidence interval [CI]: 1.15–8.98, p = 0.026) and BPD (OR = 2.27, 95% CI: 1.25–4.11, p = 0.007) were the factors with the greatest risk for hearing screen failure.
Conclusion
We speculate that the association of BPD with hearing screen failure may be mediated,
in part, by chronic noise exposure, including from respiratory support devices. Attention
to hearing protection in at-risk infants during respiratory support may mitigate the
risk of hearing loss.
Key Points
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NICU noise often exceeds recommended sound levels.
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Seventeen percent of infants with <33 weeks GA in SFR NICU failed hearing screenings.
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BPD and IVH are risk factors for hearing screen failure.
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Respiratory devices contribute to increased NICU noise.
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hearing protection should be considered during respiratory support.
Keywords
prematurity - hearing screen outcomes - single-family room NICU - sound exposure -
bronchopulmonary dysplasia - intraventricular hemorrhage - heated - humidified high-flow
nasal cannula
