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Talge NM, Tudor BM, Kileny PR. Click-evoked auditory brainstem responses and autism spectrum disorder: A meta-analytic review. Autism Res 2018; 11:916-927. [PMID: 29603654 DOI: 10.1002/aur.1946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 12/25/2022]
Abstract
Behavior does not differentiate ASD risk prior to 12 months of age, but biomarkers may inform risk before symptoms emerge. Click-evoked auditory brainstem responses (ABRs) may be worth consideration due to their measurement properties (noninvasiveness; reliability) and conceptual features (well-characterized neural generators), but participant characteristics and assessment protocols vary considerably across studies. Our goal is to perform a meta-analysis of the association between ABRs and ASD. Following an electronic database search (PubMed, Medline, PsycInfo, PsycArticles), we included papers that were written in English, included ASD and typically-developing (TD) groups, and reported the information needed to calculate standardized mean differences (Hedges's g) for at least one ABR latency component (I, III, V, I-III, III-V, I-V). We weighted and averaged effect sizes across conditions and subsets of participants to yield one estimate per component per study. We then performed random-effects regressions to generate component-specific estimates. ASD was associated with longer ABR latencies for Waves III (g = 0.5, 95% CI 0.1, 0.9), V (g = 0.7, 95% CI 0.3, 1.1), I-III (g = 0.7, 95% CI 0.2, 1.2), and I-V (g = 0.6, 95% CI 0.2, 1.0). All components showed significant heterogeneity. Associations were strongest among participants ≤8 years of age and those without middle ear abnormalities or elevated auditory thresholds. In sum, associations between ABRs and ASD are medium-to-large in size, but exhibit heterogeneity. Identifying sources of heterogeneity is challenging, however, due to power limitations and co-occurrence of sample/design characteristics across studies. Research addressing the above limitations is crucial to determining the etiologic and/or prognostic value of ABRs for ASD. Autism Res 2018, 11: 916-927. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Auditory brainstem responses (ABR) may be associated with ASD, but participant characteristics and assessment protocols vary considerably across individual studies. Our goal is to combine the results across these studies to facilitate clarity on the topic. Doing so represents a first step in evaluating whether ABRs yield potential for informing the etiology of ASD risk and/or ASD symptom profiles.
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Affiliation(s)
- Nicole M Talge
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, Michigan
| | | | - Paul R Kileny
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
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Jiang ZD, Xu X, Yin R, Shao XM, Wilkinson AR. Differential Changes in Peripheraland Central Components of the Brain Stem Auditory Evoked Potentials during the Neonatal Period Interm Infants after Perinatal Hypoxia-Ischemia. Ann Otol Rhinol Laryngol 2016; 113:571-6. [PMID: 15274419 DOI: 10.1177/000348940411300711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To identify any differences in dynamic changes between peripheral and central hearing after perinatal hypoxia-ischemia, we studied 80 term infants during the neonatal period by serially recording brain stem auditory evoked potentials (BAEPs) at 60 dB normal hearing level. All BAEP wave latencies and the I-V interval increased significantly on day 1 (analysis of variance, all p < .001). Thereafter, the wave I latency decreased gradually with some variation. The wave V latency and the I-V interval increased further on day 3 and then decreased progressively. On day 30, neither the latencies nor the I-V interval differed significantly from those of normal controls, but the wave v latency and the I-V interval still tended to increase slightly. These results suggest that hearing is impaired shortly after hypoxia-ischemia. Peripheral hearing gradually recovers after day 1, whereas central impairment progresses during the first 3 days and then starts to recover. We conclude that peripheral impairment recovers sooner than central impairment after perinatal hypoxia-ischemia.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Fudan University, Shanghai, China
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Revuelta M, Arteaga O, Montalvo H, Alvarez A, Hilario E, Martinez-Ibargüen A. Antioxidant Treatments Recover the Alteration of Auditory-Evoked Potentials and Reduce Morphological Damage in the Inferior Colliculus after Perinatal Asphyxia in Rat. Brain Pathol 2015; 26:186-98. [PMID: 25990815 DOI: 10.1111/bpa.12272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/01/2015] [Indexed: 01/17/2023] Open
Abstract
Maturation of the auditory pathway is dependent on the central nervous system myelination and it can be affected by pathologies such as neonatal hypoxic ischemic (HI) encephalopathy. Our aim was to evaluate the functional integrity of the auditory pathway and to visualize, by histological and cellular methods, the damage to the brainstem using a neonatal rat model of HI brain injury. To carry out this morphofunctional evaluation, we studied the effects of the administration of the antioxidants nicotine, melatonin, resveratrol and docosahexaenoic acid after hypoxia-ischemia on the inferior colliculus and the auditory pathway. We found that the integrity of the auditory pathway in the brainstem was altered as a consequence of the HI insult. Thus, the auditory brainstem response (ABR) showed increased I-V and III-V wave latencies. At a histological level, HI altered the morphology of the inferior colliculus neurons, astrocytes and oligodendricytes, and at a molecular level, the mitochondria membrane potential and integrity was altered during the first hours after the HI and reactive oxygen species (ROS) activity is increased 12 h after the injury in the brainstem. Following antioxidant treatment, ABR interpeak latency intervals were restored and the body and brain weight was recovered as well as the morphology of the inferior colliculus that was similar to the control group. Our results support the hypothesis that antioxidant treatments have a protective effect on the functional changes of the auditory pathway and on the morphological damage which occurs after HI insult.
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Affiliation(s)
- Miren Revuelta
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
| | - Olatz Arteaga
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
| | - Haizea Montalvo
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
| | - Antonia Alvarez
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
| | - Enrique Hilario
- Department of Cell Biology and Histology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
| | - Agustin Martinez-Ibargüen
- Department of Otorhinolaryngology, School of Medicine and Dentistry, University of the Basque Country, Leioa, Spain
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Jiang ZD, Liu TT, Chen C. Brainstem auditory electrophysiology is supressed in term neonates with hyperbilirubinemia. Eur J Paediatr Neurol 2014; 18:193-200. [PMID: 24309481 DOI: 10.1016/j.ejpn.2013.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Whether hyperbilirubinemia suppresses electrophysiological activity of the neonatal auditory brainstem remains to be investigated. AIM To determine whether hyperbilirubinemia suppresses the brainstem auditory electrophysiology in term neonates. METHODS Maximum length sequence brainstem auditory evoked response (MLS BAER) was recorded shortly after confirming hyperbilirubinemia in 58 term neonates. Wave amplitudes of the response were analyzed in detail. RESULTS Compared with age-matched term controls, the neonates with hyperbilirubinemia showed a significant reduction in the amplitudes of MLS BAER waves III and particularly V at all click rates 91-910/s. The reduction tended to be more significant at higher than lower rates. Wave I amplitude was reduced at 910/s. V/I amplitude ratio was decreased at all click rates. Therefore, the amplitudes of MLS BAER, particularly later, waves were all reduced. The amplitudes of all MLS BAER waves tended to be reduced with the increase in total serum bilirubin level. All wave amplitudes were correlated with the level of total serum bilirubin at some or most click rates. CONCLUSIONS Brainstem auditory electrophysiology is suppressed in neonates with hyperbilirubinemia, which related to the severity of hyperbilirubinemia. Wave amplitudes are valuable BAER variables to detect functional impairment of the brainstem and auditory pathway in neonatal hyperbilirubinemia, and are recommended to be used in assessing bilirubin neurotoxicity to the neonatal brain.
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Affiliation(s)
- Ze D Jiang
- Division of Neonatology, Children's Hospital, Fudan University, Shanghai, China.
| | - T T Liu
- Division of Neonatology, Children's Hospital, Fudan University, Shanghai, China
| | - Cao Chen
- Division of Neonatology, Children's Hospital, Fudan University, Shanghai, China
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Suppiej A, Cainelli E, De Benedittis M, Rizzardi E, Bisiacchi PS, Ermani M, Orzan E, Zanardo V. Failure of hearing screening in high-risk neonates does not increase parental anxiety. J Matern Fetal Neonatal Med 2013; 26:932-5. [PMID: 23327442 DOI: 10.3109/14767058.2013.766687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants. METHODS Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents' attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery. RESULTS No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening. CONCLUSIONS Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.
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Affiliation(s)
- A Suppiej
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy.
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Jiang ZD, Zang Z, Wilkinson AR. Cochlear function in 1-year-old term infants born with hypoxia-ischaemia or low Apgar scores. J Paediatr Child Health 2012; 48:160-5. [PMID: 21470333 DOI: 10.1111/j.1440-1754.2011.02066.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the influence of perinatal hypoxia-ischaemia (HI) or low Apgar scores on distortion product otoacoustic emissions (DPOAEs) in infants at 1 year and detect any postnatal changes. METHODS Eighty-eight term infants born with perinatal HI or low Apgar scores alone were recruited at 1 year of age. The ears with type A tympanogram (normal) were studied with DPOAEs at 10 frequencies between 0.5 kHz and 10 kHz. RESULTS DPOAE pass rates were decreased at all frequencies 1-10 kHz, particularly 1 and 2 kHz in both infants born with HI and those with low Apgar scores (χ(2) = 3.80-15.09, P < 0.05-0.01). Overall pass rates in the two groups were also decreased (X(2) = 10.78 and 12.12, P < 0.01 and 0.01). No marked differences were found between infants born with HI and those with low Apgar score. Compared with those recorded at 1 and 6 months, DPOAE pass rates at 1 year were increased slightly in infants born with HI, but showed no marked changes in those born with low Apgar scores. CONCLUSIONS DPOAE pass rates, mainly at 1 and 2 kHz, were decreased at 1 year in infants born with perinatal HI and low Apgar scores, suggesting a relative poor cochlear function. Further studies are needed to ascertain the hearing acuity.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Fudan University, Shanghai, China.
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Jiang ZD, Wilkinson AR. Relationship between brainstem auditory function during the neonatal period and depressed Apgar score. J Matern Fetal Neonatal Med 2010; 23:973-9. [PMID: 19903110 DOI: 10.3109/14767050903410672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To understand whether infants with depressed Apgar scores are at high risk of brainstem auditory impairment, we examined the relationship between brainstem auditory function during the neonatal period and depressed Apgar score. METHODS Brainstem auditory evoked responses (BAERs) were recorded from day 1 to day 30 in 145 term infants with Apgar scores < or = 6. RESULTS For 1-min Apgar score none of BAER response wave latencies and interpeak intervals during the first 15 days correlated significantly with the score. On day 30, all wave latencies but no intervals correlated negatively with the score (all p < 0.05). For 5-min Apgar score, only on day 3 wave V latency and I-V and III-V intervals correlated negatively with the score (all p < 0.05). For 10-min Apgar score, only III-V interval correlated negatively with the score (p < 0.05). No correlation was found between BAER variables on any other days and 5 and 10-min Apgar scores. Wave V latency and I-V and III-V intervals on day 3 were all significantly longer in infants with 5-min Apgar scores < or = 6 than in those with scores > 6. CONCLUSIONS During the neonatal period, only on day 3 after birth a depressed 5-min Apgar score is an indicator associated with central auditory impairment. A depressed 1-min score may be associated with later peripheral auditory impairment.
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Affiliation(s)
- Ze Dong Jiang
- Neonatal Unit, Department of Paediatrics, John Radcliffe Hospital, Headington, University of Oxford, Oxford, UK.
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Jiang ZD, Brosi DM, Chen C, Wilkinson AR. Brainstem response amplitudes in neonatal chronic lung disease and differences from perinatal asphyxia. Clin Neurophysiol 2009; 120:967-73. [DOI: 10.1016/j.clinph.2009.02.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 01/24/2009] [Accepted: 02/16/2009] [Indexed: 11/16/2022]
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Jiang ZD, Liu XY, Shi BP, Lin L, Bu CF, Wilkinson AR. Brainstem auditory outcomes and correlation with neurodevelopment after perinatal asphyxia. Pediatr Neurol 2008; 39:189-95. [PMID: 18725064 DOI: 10.1016/j.pediatrneurol.2008.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 01/24/2008] [Accepted: 06/16/2008] [Indexed: 11/26/2022]
Abstract
We used brainstem auditory-evoked responses and neurodevelopmental assessment to detect abnormalities and correlations between such responses and neurodevelopmental outcomes in 78 children (aged 4-12 years) who survived perinatal asphyxia. Twenty children had brainstem auditory-evoked response abnormalities, including increased threshold, reduced wave V amplitude, decreased V/I amplitude ratio, and prolonged I-V interval. Thirty-seven exhibited neurodevelopmental deficits, including cerebral palsy and developmental delay. The remaining 41 exhibited no deficits. Brainstem auditory-evoked response abnormalities were evident in 15 of 37 (40.5%) children with neurodevelopmental deficits, but in only 5 of 41 (12.2%) with no deficits, which differed significantly (chi(2) = 8.2, P < 0.05). The sensitivity, specificity, positive predictive value, and false-negative rate of brainstem auditory-evoked responses to reflect neurodevelopmental outcomes were 40.5%, 87.8%, 75.0%, and 59.5%, respectively. These findings suggest that in children who survive perinatal asphyxia, brainstem auditory impairment occurs more frequently in those with versus those without neurodevelopmental deficits. Brainstem auditory-evoked responses display a moderate correlation with clinically determined neurodevelopmental outcomes. Despite limitations, brainstem auditory-evoked response is valuable for assessing auditory and neurodevelopmental outcomes after perinatal asphyxia.
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Affiliation(s)
- Ze D Jiang
- Department of Pediatrics, Children's Hospital, Fudan University, Shanghai, China.
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Benito-Orejas JI, Ramírez B, Morais D, Almaraz A, Fernández-Calvo JL. Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs. Int J Pediatr Otorhinolaryngol 2008; 72:1193-201. [PMID: 18550180 DOI: 10.1016/j.ijporl.2008.04.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/20/2008] [Accepted: 04/22/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.
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Jiang ZD, Brosi DM, Shao XM, Wilkinson AR. Sustained depression of brainstem auditory electrophysiology during the first months in term infants after perinatal asphyxia. Clin Neurophysiol 2008; 119:1496-505. [PMID: 18479964 DOI: 10.1016/j.clinph.2008.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 03/10/2008] [Accepted: 03/17/2008] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Fudan University, Shanghai, China.
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Zang Z, Wilkinson AR, Jiang ZD. Distortion product otoacoustic emissions at 6 months in term infants after perinatal hypoxia-ischaemia or with a low Apgar score. Eur J Pediatr 2008; 167:575-8. [PMID: 17541637 DOI: 10.1007/s00431-007-0511-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 04/26/2007] [Indexed: 10/23/2022]
Abstract
Distortion product otoacoustic emissions (DPOAEs) were analyzed at 6 months of age in term infants who had perinatal hypoxia-ischaemia (HI) and those who had a low Agar score alone to detect any abnormalities in cochlear function and any difference between the two groups of infants. The f2 primary tone was presented at ten frequencies (0.5-10 kHz). Both the left and right ears were tested. Compared to normal term controls, both the infants after perinatal HI and those with a low Apgar score alone showed lower DPOAE pass rates, mainly at 1-4 kHz at which the pass rates were decreased significantly (P < 0.05-0.01). The general pattern of DPOAE pass rates at different frequencies was similar in the two groups of infants. The pass rates at 1, 5 and 6 kHz tended to be lower in the infants after perinatal HI than those with a low Apgar score alone, although not statistically significant. Conclusions At 6 months of age, infants after perinatal HI or with a low Apgar score alone had a relatively poor cochlear function, mainly at 1-4 kHz. There are no major differences between the two groups of infants.
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Affiliation(s)
- Zheng Zang
- Department of Paediatrics, Children's Hospital, Fudan University, Shanghai, China
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Jiang ZD, Chen C, Liu TT, Wilkinson AR. Changes in brainstem auditory evoked response latencies in term neonates with hyperbilirubinemia. Pediatr Neurol 2007; 37:35-41. [PMID: 17628220 DOI: 10.1016/j.pediatrneurol.2007.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 02/06/2007] [Accepted: 03/23/2007] [Indexed: 11/27/2022]
Abstract
Ninety term neonates with hyperbilirubinemia were studied with brainstem auditory evoked response to clarify the ototoxic effect of hyperbilirubinemia, and detect any differences in ototoxic effect between different levels of total serum bilirubin. The response threshold in these neonates was significantly elevated (P < 0.001). All wave latencies and I-V interval increased significantly (P < 0.05-0.0001), and correlated weakly with total serum bilirubin (r = 0.24-0.28, all P < 0.05). Twenty-five neonates (28%) had abnormal responses, including 14 (16%) with elevated thresholds or increased wave I latency, suggesting peripheral auditory impairment, and 16 (18%) with increased I-V interval, suggesting central auditory impairment. Wave V latency and I-V interval were longer in neonates with total serum bilirubin of <20 mg/dL than in those with bilirubin 11-15 mg/dL (P < 0.05). However, there were no significant differences in response variables between neonates with total serum bilirubin 11-15 mg/dL and those with bilirubin 16-20 mg/dL, and between neonates with bilirubin 16-20 mg/dL and those with bilirubin >20 mg/dL. Thus, although the acute ototoxic effect of hyperbilirubinemia tends to be more significant at a higher rather than lower level of total serum bilirubin, auditory impairment does not increase closely with the increase in bilirubin.
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Affiliation(s)
- Ze Dong Jiang
- Department of Pediatrics of Children's Hospital, Fudan University, Shanghai, China.
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14
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Suppiej A, Rizzardi E, Zanardo V, Franzoi M, Ermani M, Orzan E. Reliability of hearing screening in high-risk neonates: Comparative study of otoacoustic emission, automated and conventional auditory brainstem response. Clin Neurophysiol 2007; 118:869-76. [PMID: 17317296 DOI: 10.1016/j.clinph.2006.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 12/08/2006] [Accepted: 12/26/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the diagnostic reliability of automated transient evoked otoacoustic emissions (a-TEOAE), automated auditory brainstem response (a-ABR) and conventional brainstem auditory evoked potential (BAEP/ABR) for identification of hearing loss in high-risk neonates. METHODS Two hundred and six neonatal intensive care unit (NICU) admitted neonates were tested pre-discharge. Follow-up included a-TEOAE in all children, repetition of a-ABR or BAEP if failed in NICU. Sensitivity and specificity were compared and correlated with auditory risk factors. RESULTS BAEP had the highest sensitivity (100%) and specificity (90.8%), a-ABR the lowest (88.9% and 70.6%). A statistically significant difference in risk factors for temporary hearing loss was observed between normal and false positive a-TEOAE and BAEP, but not a-ABR outcome. Differences in specificity between a-ABR and a-TEOAE explain the pattern of "absent a-ABR/present a-TEOAE" in 13.8% of ears. CONCLUSIONS The BAEP appears the more reliable test for hearing screening of high-risk neonates because of highest sensitivity and specificity and should be used to confirm the diagnosis of "auditory neuropathy" in high-risk neonates. The reliability of a-ABR devices in critically ill neonates needs further investigation. SIGNIFICANCE This is, to our knowledge, the first attempt to compare the diagnostic reliability of a-TEOAE, a-ABR and BAEP in high-risk neonates.
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Affiliation(s)
- A Suppiej
- Department of Clinical Neurophysiology, Pediatric Hospital, University of Padova, 35100 Padua, Italy.
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Abstract
Over the last three decades, the brainstem auditory evoked response (BAER) has been used to assess functional integrity and development of the auditory system and the brain in conditions that affect the brainstem auditory pathway. As a non-invasive objective test, BAER is particularly suitable in very young or sick infants. It is the major tool to detect hearing impairment in high-risk infants, and a component in universal hearing screening. BAER is also a valuable adjunct to detect neurological impairment in many developmental disorders and functional abnormalities in a range of neurological diseases. The maximum length sequence (MLS) technique has recently been incorporated into neonatal BAER study. Recent results indicate that the MLS has the potential to improve the diagnostic value of BAER in some clinical situations, although the wider utility of this relative new technique remains to be further explored.
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Affiliation(s)
- Andrew R Wilkinson
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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Jiang ZD, Wilkinson AR. Neonatal auditory function and depressed Apgar score: correlation of brainstem auditory response with Apgar score. Acta Paediatr 2006; 95:1556-60. [PMID: 17129961 DOI: 10.1080/08035250600681673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To examine the relationship between neonatal auditory function and Apgar score in term infants with depressed Apgar scores. METHODS Brainstem auditory evoked response (BAER) was recorded on day 3 after birth in term infants who had Apgar scores < or = 7 at 1 and/or 5 min. Half of the infants also had Apgar scores at 10 min, with 17 < or = 7. RESULTS No BAER variables correlated significantly with 1-min Apgar score. However, wave III and V latencies, and I-V, I-III and III-V intervals correlated significantly and negatively with 5-min Apgar score (p < 0.05-0.01). These BAER variables were significantly longer in infants with 5-min Apgar scores < or = 7 than those > 7. Wave V latency and all intervals also correlated negatively with 10-min Apgar score (p < 0.05-0.01). Compared to normal controls, all latencies were prolonged in infants with depressed Apgar scores (all p < 0.05-0.01). All intervals were also prolonged in those with 5-min scores < or = 7 (p<0.05-0.01). Similar results were found when defining the depression of Apgar score as < or = 6. CONCLUSION A depressed 5- and/or 10-min Apgar score is an indicator associated with neonatal auditory, mainly central, impairment. Apgar score < or = 7 or 6 at 1 min alone is unlikely to be associated with central impairment.
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Affiliation(s)
- Ze D Jiang
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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17
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Jiang ZD, Shao XM, Wilkinson AR. Changes in BAER amplitudes after perinatal asphyxia during the neonatal period in term infants. Brain Dev 2006; 28:554-9. [PMID: 16647830 DOI: 10.1016/j.braindev.2006.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 03/14/2006] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
We recorded serially brainstem auditory evoked response (BAER) during the neonatal period in term infants who suffered perinatal asphyxia. The amplitudes of BAER components was analysed at 40 dB above BAER threshold of each subject who had a threshold<or=25 dB nHL. No apparent changes in the amplitudes of waves I and III during the first 5 days after birth. The two wave amplitudes were slightly reduced thereafter. On day 30, the amplitudes were slightly smaller than in normal controls. No statistical significant differences were found in the two amplitudes between the infants after asphyxia and the controls on any days studied. In contrast, wave V amplitude showed a trend of reduction during the whole neonatal period. The amplitude was reduced slightly on the first day after birth, but reduced further on day 3 (ANOVA, P<0.01). Thereafter, the reduction persisted without any significant change. On day 30, wave V amplitude remained significantly smaller than in the controls (P<0.001). Compared to the controls, V/I amplitude ratio was slightly smaller during the neonatal period, but V/III amplitude ratio was significantly smaller on most of the days studied (P<0.05-0.01). The persistent reduction of wave V amplitude suggests a sustained neuronal damage of the auditory brainstem in infants after perinatal asphyxia.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Fudan University, Shanghai, China.
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18
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Stanton SG, Ryerson E, Moore SL, Sullivan-Mahoney M, Couch SC. Hearing screening outcomes in infants of pregestational diabetic mothers. Am J Audiol 2005; 14:86-93. [PMID: 16180972 DOI: 10.1044/1059-0889(2005/008)] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2004] [Accepted: 05/02/2005] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hearing screening results for newborns of diabetic mothers were compared with those of nondiabetic controls. METHOD This study was a retrospective chart review of mothers with pregestational diabetes mellitus and their neonates (n=73) who received newborn hearing screening between January 1, 2000, and May 1, 2002. A group of nondiabetic mothers and their infants (n=73), with birth dates that matched the diabetic group, served as controls. A 2-tiered hearing screening protocol, employing distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (A-ABR) screening techniques, was used. RESULTS The DPOAE screening failure rate was 5.5% (4/73) for babies in the nondiabetic control group and 11.0% (8/73) for infants of diabetic mothers; this difference was not statistically significant. The A-ABR failure rate was 9.1% (1/11) for the diabetic group compared with 0% (0/4) for the controls, but the A-ABR was measured for only a small number of participants in each group. The frequency of premature birth and abnormal birth weight was significantly greater for the infants of diabetic mothers compared with controls. CONCLUSIONS Given the greater frequency of prematurity and abnormal birth weight in the population of neonates born to diabetics, additional research using A-ABR is recommended.
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Affiliation(s)
- Susan G Stanton
- Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267-0379, USA.
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19
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Jiang ZD, Shao XM, Wilkinson AR. Brainstem auditory-evoked responses in full-term newborn infants with temporary low Apgar score. Acta Otolaryngol 2005; 125:163-8. [PMID: 15880947 DOI: 10.1080/00016480410017684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CONCLUSIONS No abnormalities, with the exception of maturational changes, in BAER were found during the neonatal period. The results suggest that a temporary low Apgar score is not accompanied by any significant auditory impairment. OBJECTIVE To examine brainstem auditory function in newborn infants with a temporary low Apgar score but no clinical signs of hypoxic-ischaemic encephalopathy (HIE). MATERIAL AND METHODS The subjects were 36 full-term infants with Apgar scores of < or =7 at 1 and/or 5 min and > or =8 at 10 min but without HIE. The brainstem auditory-evoked response (BAER) was serially recorded at click rates of 21, 51 and 91/s on Days 1, 3, 5, 7 and 30 after birth. RESULTS On Day 1 and Days 3-5, the latencies of waves I, III and V tended to increase slightly at all click rates but did not differ significantly from normal control values. Thereafter, all latencies tended to decrease, reaching control values on Day 30. The I-V interval was similar to the control values at all click rates during the first 5 days, tended to decrease from Day 7 and did not differ from the control values on Day 30. There were no significant changes in BAER wave amplitudes at any of the click rates on any day.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, People's Republic of China.
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20
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Jiang ZD, Yin R, Shao XM, Wilkinson AR. Brain-stem auditory impairment during the neonatal period in term infants after asphyxia: dynamic changes in brain-stem auditory evoked response to clicks of different rates. Clin Neurophysiol 2004; 115:1605-15. [PMID: 15203061 DOI: 10.1016/j.clinph.2004.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2004] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore dynamic changes in brain-stem auditory electrophysiology during the neonatal period in term infants after perinatal asphyxia. METHODS Sixty-eight term newborn infants who suffered asphyxia were studied on days 1, 3, 5, 7, 14 and 30 after birth. Brain-stem auditory evoked response (BAER) was recorded with clicks, delivered at 21, 51 and 91 s(-1) and > or =40 dB above BAER threshold of each subject. RESULTS During the neonatal period wave I latency in the infants after asphyxia increased slightly while later BAER components changed more significantly. On the first day after birth wave III and V latencies and I-V and III-V intervals increased significantly at all rates of clicks (ANOVA P<0.01-0.001). On day 3, the latencies and intervals increased further. III-V/I-III interval ratio increased at 51 and 91 s(-1), suggesting a relatively more significant increase in III-V interval than in I-III interval at higher rates. Thereafter, wave III and V latencies and all intervals decreased progressively, although these BAER variables were still significantly longer than in normal controls on days 5 and 7 (P<0.05-0.001) On day 30, all latencies and intervals approached near normal values, with a slight increase in wave V latency and I-V and III-V intervals at 51 and 91 s(-1). CONCLUSIONS Perinatal asphyxia has a major effect on central auditory function, resulting in acute impairment. The impairment progresses during the first 3 days and then tends towards recovery. By 1 month the impaired auditory function has largely returned to normal. Significant increase in click rates can moderately improve the detection of auditory impairment. SIGNIFICANCE After perinatal asphyxia early detection of hypoxic-ischaemic damage to the central auditory system and initialisation of neuroprotective and therapeutic measures during the first hours after birth are critical to prevent or reduce deterioration of central impairment.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Shanghai Medical University, Shanghai, China.
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21
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Jiang ZD, Brosi DM, Wang J, Xu X, Chen GQ, Shao XM, Wilkinson AR. Time course of brainstem pathophysiology during first month in term infants after perinatal asphyxia, revealed by MLS BAER latencies and intervals. Pediatr Res 2003; 54:680-7. [PMID: 12869665 DOI: 10.1203/01.pdr.0000084084.62571.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic changes in electrophysiology of brainstem auditory neurons during the first month after birth were studied in 51 term infants after perinatal asphyxia using maximum length sequence brainstem auditory evoked responses. The responses were recorded on d 1, 3, 5, 7, 10, 15, and 30 after birth. On d 1, wave III and V latencies and all interpeak intervals increased significantly at all repetition rates of clicks used (91-910/s), especially the higher rates (ANOVA, p < 0.05-0.0001). On d 3, all these latencies and intervals increased further and differed more significantly from the normal control subjects. Thereafter, the latencies and intervals decreased progressively. On d 7, wave V latency and all intervals still differed significantly from the control subjects. These dynamic changes were more significant at higher rates of clicks than at lower rates. On d 10 and 15, all intervals decreased significantly. On d 30, all wave latencies decreased to the values in the normal control subjects on the same day. The intervals also approached normal values, although the III-V and I-V intervals still increased slightly. These results indicate that hypoxic-ischemic brain damage persists during the first week, with a peak on d 3, and recovers progressively thereafter. By 1 mo, the damage has largely returned to normal. Maximum length sequence brainstem auditory evoked responses results correlated well with the stage of hypoxic-ischemic encephalopathy during the first week. The present study revealed a general time course of brainstem pathophysiology after asphyxia, although there were individual variations. Our findings can be used as a reference to monitor cerebral function and help judge the value of neuroprotective or therapeutic interventions. The first week, particularly the first 3 d, is a critical period of hypoxic-ischemic brain damage, and early intervention may prevent or reduce deterioration of the damage.
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Affiliation(s)
- Ze D Jiang
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom.
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Fuess VLR, Bento RF, Alexandre Médicis da Silveira J. Delay in Maturation of the Auditory Pathway and its Relationship to Language Acquisition Disorders. EAR, NOSE & THROAT JOURNAL 2002. [DOI: 10.1177/014556130208101011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied 81 children, mostly boys, who experienced language acquisition delay but whose audiometric thresh olds were normal. We assessed the evolution of children with delayed maturation of auditory pathways by brainstem evoked response audiometry (BERA). We also used a questionnaire administered during diagnostic procedures to determine if there was a probable etiology in each patient. In addition, we further studied language evolution in 29 patients by means of a second questionnaire that was administered approximately 2 years later. Finally, we studied the evolution of the I–V interwave interval and the I/V amplitude ratio in 16 patients by performing a second BERA after a mean interval of 3 years. We ob served improvement in both brainstem transmission time and language acquisition in all 81 patients. However, only a few patients achieved normal range results. Morphologic alterations, which were most common in patients who had had perinatal jaundice, remained un changed. The most common possible risk factors for the delayed maturation pattern observed on BERA were parental consanguinity, prematurity, perinatal anoxia and jaundice, and postnatal seizure and infection. Some patients had more than one of these possible risk factors. We conclude that high-risk newborns and 2-year-old children who have no primitive verbal language skills should undergo BERA as well as investigation of hearing thresholds, interwave intervals, and I/V amplitude ratios. The alteration of these parameters points out the need for early intervention if there is no favorable prognosis.
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Affiliation(s)
| | - Ricardo Ferreira Bento
- Department of Otolaryngology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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Rocinhol LF, Oliveira LM, Colafêmina JF. Malnutrition and environmental stimulation in rats: interpeak intervals of the brainstem auditory evoked potentials. Nutr Neurosci 2002; 4:189-98. [PMID: 11842888 DOI: 10.1080/1028415x.2001.11747362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to investigate the effects of malnutrition, nutritional recovery, environmental stimulation and click intensity on the interpeak intervals of the waves of the Brainstem Auditory Evoked Potentials (BAEPs). The animals were divided into Well-nourished (W) and Malnourished (M) groups. At weaning, half of the M rats were submitted to nutritional recovery (R) until the test day. These groups were further subdivided into Stimulated (S) and Non-stimulated (N) rats. The BAEPs interpeak intervals I-III, I-IV and III-IV were analysed in independent groups of rats on the 18th, 22nd, 32nd and 42nd days of age. During the lactation period, stimulated rats presented shorter I-III, I-IV and III-IV interpeak intervals than Non-stimulated animals. This analysis also indicated a diet x stimulation x age interaction during the lactation period. The WN and MN groups showed a longer I-IV interval than the WS and MS groups, respectively, on the 18th and 22nd day of age, and the MN group also presented a longer I-IV interpeak interval than the WN group on the 22nd day of age. During the post-lactation period, stimulated animals showed shorter I-III and I-IV intervals than non-stimulated rats. Post hoc analysis indicated longer I-III and I-IV interpeak intervals in the MN than in the WN, RN and MS groups. Additionally, malnourished animals showed longer I-III and I-IV intervals than well-nourished and recovered rats when exposed to clicks of 90, 80 or 70 dB intensity. Malnutrition resulted in a delay of normal development of the brainstem auditory pathway indicated by the increases in the interpeak intervals of BAEPs waves, and environmental stimulation reduced these intervals, promoting faster nervous impulse transmission.
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Affiliation(s)
- L F Rocinhol
- Department of the Psychology and Education, FFCLRP, University of the São Paulo, Ribeirão Preto, Brazil.
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Romero G, Mandujano M, Méndez I, Sánchez C. Brain-stem auditory evoked potentials in children with perinatal encephalopathies. Clin Neurophysiol 2000; 111:1901-6. [PMID: 11068221 DOI: 10.1016/s1388-2457(00)00434-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to describe if neurological damage, in terms of brain lesions, syndrome and syndrome severity led to abnormalities in the brain-stem auditory evoked potentials (BAEPs) in order to provide a profile of children that could be used as an indicator of subsequent neurological sequelae. We analyzed the BAEPs from a group of children having prior evidence of neurological damage and determined the presence of neurological sequelae when the subjects were 3 years old. METHODS Brain-stem auditory evoked potentials (BAEPs) were carried out in a group of 154 children with perinatal neurological damage. The children were classified with neurofunctional (clinical and EEG alterations) or organic and neurofunctional brain disease (clinical, EEG and image alteration) and were all followed from the first month of life and serially for 3 years. We used principal component analysis (PCA), clustered analysis and linear correlation to determine association between BAEPs, risk factors and future sequelae. RESULTS Latencies of BAEPs decreased significantly with age, and the time of conduction was modified by the presence of neurological damage. All statistical analyses suggested positive and significant associations between risk factors (trophism and condition at birth), and the latencies of waves I, III and V as well as with IPL III-V (interpeak latency) and I-V. PCA showed that IPL I-III was also positively associated with condition at birth, severity of the neurological syndrome and encephalopathy. In addition, we found that the presence and type of sequela reflected changes in the latencies of the waves, as well as IPLs, primarily those of IPL I-III. CONCLUSIONS Our results suggest that statistical methods are often needed to analyze neurological damage. The relation between BAEPs, risk factors and neurological sequelae allowed us to obtain a profile of children, which can be then used as an aid in the prognosis of children having a risk of developing neurological sequelae.
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Affiliation(s)
- G Romero
- Maestría en Rehabilitación Neurológica, Universidad Autónoma Metropolitana-Xochimilco, Calz del Hueso 1100, Col. Villa Quietud, México D.F. CP 04960, Coyoacan, Mexico
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Jiang ZD, Brosi DM, Shao XM, Wilkinson AR. Maximum length sequence brainstem auditory evoked responses in term neonates who have perinatal hypoxia-ischemia. Pediatr Res 2000; 48:639-45. [PMID: 11044485 DOI: 10.1203/00006450-200011000-00015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Maximum length sequence brainstem auditory evoked response (BAER) was studied within the first week after birth in 28 term neonates who had perinatal hypoxia-ischemia, or asphyxia. In the BAER recorded using conventional averaging techniques (click rate 21/s), the only abnormality was a slight increase in III-V interval, in addition to an increase in wave latencies when including those who had an elevated threshold (t test, all p<0.05). In the maximum length sequence BAER, however, both the III-V and I-V intervals in the asphyxiated infants were significantly increased at all the 91/s, 227/s, 455/s, and particularly 910/s click rates (p<0.05-0.001). The I-III interval was also increased significantly at 455/s and 910/s click rates (both p< 0.05). Wave V amplitude was significantly reduced at all the click rates used (ANOVA, p<0.05-0.001), particularly at 910/s, which sometimes was the only abnormality indicative of brain damage. Both the amplitude ratios V/I and V/III were significantly decreased at 455/s and 910/s click rates (p<0.01 or 0.001). A general trend was that BAER abnormalities after hypoxia-ischemia became more prominent as click rate was increased. Significant abnormalities occurred mainly at very high click rates (455/s and 910/s), which can be achieved using the maximum length sequence technique but not by using conventional averaging techniques. Thus, this technique, which can be used at the cribside, appears to be a better method for the early detection of brain damage after hypoxia-ischemia than using conventional averaging techniques, enhancing the diagnostic value of the BAER.
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Affiliation(s)
- Z D Jiang
- Neonatal Unit, Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Headington, Oxford OX3 9DU, United Kingdom
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26
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Jiang ZD, Brosi DM, Wilkinson AR. Immaturity of electrophysiological response of the neonatal auditory brainstem to high repetition rates of click stimulation. Early Hum Dev 1998; 52:133-43. [PMID: 9783815 DOI: 10.1016/s0378-3782(98)00021-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Changes in brainstem auditory evoked response (BAER) with varying stimulus repetition primarily represent neural processes concerning the efficacy of synaptic transmission in the brainstem auditory pathway. In this study the BAER to different rates of clicks was recorded from 16 term neonates. The results were compared with those from 16 adults to examine whether the degree of maturation of synaptic transmission of the neonatal brainstem auditory pathway parallels that of general function of the pathway. All BAER wave latencies and interpeak intervals increased linearly and wave amplitudes reduced with increasing click rate. The absolute rate-dependent changes in BAER measures were much greater in the neonates than in the adults, reflecting a significant immaturity in the efficacy of synaptic transmission in the neonatal auditory brainstem and in the ability of the neonatal brainstem to process rapid acoustic stimulation. When the data obtained at higher click rates at various age groups were analyzed as percentages, using the BAER measurements at conventionally used slow rate (21/s) of clicks as the denominators, the changing rates (%), or relative changes, of most BAER measures at higher rates in the neonates were still greater than those in the adults. Therefore, the rate-dependent BAER changes in the neonates are relatively less mature than general aspects of the BAER, reflected by the BAER elicited with conventionally used slow rates of clicks. These findings suggest that synaptic efficacy in the neonatal brainstem auditory pathway is relatively less mature than general function of the pathway and thus may be more susceptible to unfavourable perinatal conditions.
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Affiliation(s)
- Z D Jiang
- Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford, UK
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