No close correlation between brainstem auditory function and peripheral auditory threshold in preterm infants at term age

Brainstem auditory pathway function at four months of corrected postnatal age in preterm infants born below 30 week gestation

OBJECTIVE

Functional status of the brainstem auditory pathway was examined at four months of corrected postnatal age in infants born below 30 week gestation to assess the effect of very or extremely preterm birth on postnatal development of the pathway.

METHODS

Thirty-four preterm infants born at 24-29 week gestation (GA24-29w) were studied at four months of corrected postnatal age. Normal controls were 38 postnatal age-matched term infants. Maximum length sequence brainstem auditory evoked response (MLS BAER) were recorded and analysed with 60 dB nHL clicks.

RESULTS

Compared with term control group, GA24-29w group manifested higher BAER threshold (p < 0.05), longer MLS BAER wave latencies at all click rates 91-910/s (p < 0.01-0.001), and lower wave amplitudes at most click rates (p < 0.05-0.01). No significant differences were found between the two groups in I-V interval at any click rates. I-III interval was shorter while III-V interval was longer in GA24-29w group than in term group at higher rates (all p < 0.05). III-V/I-III interval ratio in GA24-29w group was greater at 455 and 910/s clicks (p < 0.05 and 0.01). These interval variables showed similar changes when 4 GA24-29w infants with threshold elevation were excluded.

CONCLUSIONS

At four months of corrected postnatal age, infants born below 30 week gestation manifested elevated BAER threshold, increased wave latencies, and reduced amplitude. They also manifested a small decrease in I-III interval but a small increase in III-V interval at high rates. Very or extremely preterm birth exerts a mild or moderate effect on postnatal development of the brainstem auditory pathway.

An acoustic gap between the NICU and womb: a potential risk for compromised neuroplasticity of the auditory system in preterm infants

The intrauterine environment allows the fetus to begin hearing low-frequency sounds in a protected fashion, ensuring initial optimal development of the peripheral and central auditory system. However, the auditory nursery provided by the womb vanishes once the preterm newborn enters the high-frequency (HF) noisy environment of the neonatal intensive care unit (NICU). The present article draws a concerning line between auditory system development and HF noise in the NICU, which we argue is not necessarily conducive to fostering this development. Overexposure to HF noise during critical periods disrupts the functional organization of auditory cortical circuits. As a result, we theorize that the ability to tune out noise and extract acoustic information in a noisy environment may be impaired, leading to increased risks for a variety of auditory, language, and attention disorders. Additionally, HF noise in the NICU often masks human speech sounds, further limiting quality exposure to linguistic stimuli. Understanding the impact of the sound environment on the developing auditory system is an important first step in meeting the developmental demands of preterm newborns undergoing intensive care.

Auditory Brainstem Response: reference-values for age

PURPOSE: To study the absolute latencies of waves I , III and V and interpeak I-III , III-V and I-V of Auditory brainstem responses obtained in preterm newborns in relation to post-conceptual age, term newborns and six months of age infants, establishing reference values for each age group. METHODS: Retrospective study realized through the analysis of tests performed on 80 infants divided into four groups, being the group one composed per newborns assessed between 35 and 36 weeks post-conceptual age; group two by newborns assessed between 37 and 38 weeks; group three with newborns reviewed between 39 to 40 weeks; and group four with infants evaluated with six months. RESULTS: The wave I absolute latency in the group one was 1.81 ms, decreasing to 1.79 ms in groups two and three, and to 1.70 ms in group four. The wave III latency in group one was 4.74 ms, decreasing to 4.62 ms in group two, to 4.56 ms in the group three and to 4.37 ms in the group four. The wave V latency in group one was 7.14 ms, in the group two it was 7.05 ms, in the group three 6.90 ms; and in the group four it was 6.50 ms. Interpeak latencies were also decreased in all groups. CONCLUSION: The latencies studied decreased with the increasing age and were similar values with the international literature.

Effects of ventilation on hearing loss in preterm neonates: Nasal continuous positive pressure does not increase the risk of hearing loss in ventilated neonates

INTRODUCTION

There is increased risk of hearing loss in preterm neonates. This risk is further increased by environmental noise exposure especially from life support equipment such as ventilation. Nasal continuous positive airway pressure (NCPAP) used for respiratory support of preterm neonates is known to be associated with prolonged exposure to high levels of noise. However, there is paucity of information on the effect of NCPAP as compared to mechanical ventilation on hearing loss among preterm neonates.

METHODS

A retrospective chart review was performed on neonates with birth weight (BW) <1500g. Association of clinical factors including the use of NCPAP and mechanical ventilation with failure of hearing screen were studied. Those who failed hearing screen were followed for 2 years to observe long term effects of NCPAP on the hearing loss.

RESULTS

Of 344 neonates included in the study, 61 failed hearing screen. Gestational age (p=0.008), BW (p=0.03), ventilation (p=0.02), intrauterine growth retardation (p=0.02), necrotizing enterocolitis (NEC) (p=0.02), apnea (p<0.001), use of vancomycin (p=0.01) and furosemide (p=0.01) were associated with failure of hearing screen. On multivariate analysis, ventilation (OR 4.56, p=0.02), apnea (OR 2.2, p<0.001) and NEC (OR 2.4, p=0.02) were predictors of failed hearing screen. As compared to those not ventilated, the odds of failing hearing screen was 4.53 (p<0.01) and 4.59 (p<0.01) for those treated with NCPAP and mechanical ventilation respectively, with there being no difference between these two ventilatory modalities. Of the 61 neonates, 42 were followed for 2 years, of which 19 had confirmed hearing loss. Among these 19 neonates, there was no difference (p=0.12) between those who were treated with NCPAP or with mechanical ventilation.

CONCLUSION

There is no increase in the hearing loss in preterm neonates treated with NCPAP as compared to mechanical ventilation despite being exposed to higher environmental noise generated by the NCPAP.

Differences in impaired brainstem conduction between neonatal chronic lung disease and perinatal asphyxia

OBJECTIVE

To explore any differences in impaired brainstem function between preterm infants with neonatal chronic lung disease (CLD) and term infants after perinatal asphyxia.

METHODS

Brainstem auditory evoked responses (BAERs) collected using maximum length sequence (MLS) technique were compared at term equivalent age between 43 CLD infants and 117 asphyxiated infants.

RESULTS

In both CLD and asphyxiated infants there was a significant increase in wave V latency and I-V interval in MLS BAER. CLD infants showed a significant increased III-V interval but a normal I-III interval at all click rates. However, asphyxiated infants showed a significant increase in both III-V and I-III intervals. I-III interval was shorter and III-V/I-III interval ratio was greater in CLD infants than in asphyxiated infants. The slope of I-III interval-rate function was steeper in asphyxiated infants than in CLD infants, while the slope of III-V/I-III interval ratio-rate function was the other way around.

CONCLUSIONS

CLD infants had a major increase in more central components of MLS BAER, without appreciable abnormality in more peripheral components. However, asphyxiated infants had a significant increase in both central and peripheral components.

SIGNIFICANCE

Neonatal CLD affects more central regions of the brainstem, whereas perinatal asphyxia affects both peripheral and central regions. This difference, which is likely related to the different nature of hypoxia in CLD and asphyxia, may have some significance for neuroprotective interventions for the two problems.

Sustained depression of brainstem auditory electrophysiology during the first months in term infants after perinatal asphyxia

OBJECTIVE

To gain further insights into the pathophysiological processes of neuronal impairment in neonatal brainstem after perinatal asphyxia.

METHODS

Maximum-length sequence brainstem auditory-evoked response (MLS BAER) was recorded with clicks at 91, 227, 455 and 910/s on days 1, 3, 5, 7, 10, 15 and 30 after birth in 108 term infants who suffered perinatal asphyxia. Wave amplitude variables in the MLS BAER were analysed in detail at 40 dB above BAER threshold in 86 infants who had no peripheral hearing impairment.

RESULTS

On day 1 the amplitudes of MLS BAER waves I, III and V were all reduced significantly at all click rates, especially at higher ones (91-910/s, ANOVA P<0.05-0.001). On day 3 these amplitudes were reduced further. On days 5 and 7, the amplitude reduction persisted and did not show any significant further changes. On days 10 and 15 the reduced amplitudes were increased slightly. On day 30 all amplitudes were still reduced significantly (P<0.05-0.0001). During the first month, the reduction of wave amplitudes was more significant for the later MLS BAER components than for the earlier ones, and occurred most significantly at 455 and 910/s clicks. By comparison, the amplitude reduction in conventional BAER was much less significant.

CONCLUSIONS

During the first month after perinatal asphyxia the amplitudes of MLS BAER waves were reduced significantly and persistently, which was more significant at higher rates of clicks than at lower rates. The reduction is much more persistent than the increase in wave latencies and intervals we previously reported.

SIGNIFICANCE

There is sustained depression of brainstem auditory electrophysiology, indicating neuronal damage of the auditory brainstem, in infants after perinatal asphyxia. This may have important clinical implications.