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Am J Perinatol
DOI: 10.1055/a-2483-5788
Original Article

Risk Factors for Hearing Screen Failure in a Single-Family Room Neonatal Intensive Care Unit

Rebecca Suflas   *
1   Department of Pediatrics, Pediatrix Medical Group, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Rebecca Cox   *
2   Department of Family Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
,
Rose M. Viscardi
3   Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
,
Jocelyn C. Leung 
3   Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations Funding None.
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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

  • NICU noise often exceeds recommended sound levels.

  • Seventeen percent of infants with <33 weeks GA in SFR NICU failed hearing screenings.

  • BPD and IVH are risk factors for hearing screen failure.

  • Respiratory devices contribute to increased NICU noise.

  • 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

Authors' Contributions

R.S., R.C., and J.C.L. provided overall conception and design of the study including acquisition and analysis of the data, drafting, and revising content. R.S. and R.C. contributed equally to the work. R.M.V. contributed to the conception and study design, analysis and interpretation of the data, and revision of content. All authors approved the final version of the manuscript.


* These are co-first authors and contributed equally to this work.




Publication History

Received: 30 July 2024

Accepted: 22 November 2024

Accepted Manuscript online:
25 November 2024

Article published online:
21 December 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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