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Melese M, Adugna DG, Mulat B, Adera A. Hearing loss and its associated factors among metal workshop workers at Gondar city, Northwest Ethiopia. Front Public Health 2022; 10:919239. [PMID: 36003635 PMCID: PMC9393372 DOI: 10.3389/fpubh.2022.919239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionNoise-induced hearing loss is a permanent sensorineural deficiency, which is caused by exposure to excessive noise sound. Although noise-induced hearing loss due to industrialization is a main public health problem in Ethiopia, studies on the prevalence and associated factors of hearing loss are scarce.ObjectivesThis study aimed to assess the prevalence and associated factors of hearing loss among workers at a metal workshop in Gondar city, Northwest Ethiopia.MethodsA cross-sectional study was employed among 300 participants using a stratified sampling technique. Data were collected using an interviewer-administered questionnaire. Bivariable and multivariable logistic regressions were conducted. In the multivariable logistic regression model, adjusted odds ratios (AOR) with a 95% confidence interval (CI) and a p < 0.05 were computed to determine the level of significance.ResultsThe prevalence of hearing loss among metal workshop workers was 30.7% [95% CI: (25.7, 35.7)]. Age between 30 and 44 years [AOR = 2.9; 95% CI: 1.2, 7.1], age between 45 and 65 years [AOR = 3.8; 95% CI (1.5, 9.5)], cigarette smoking [AOR = 2.3; 95% CI: 1.2, 4.5], working area noise level >85 dB [AOR = 2.2; 95% CI: 1.1, 6.5], working experience of 6–10 years [AOR = 1.8; 95% CI: 1.4, 6.0], working experience >10 years [AOR = 3.5; 95% CI: 1.3, 4.3], and using ear protection devices [AOR = 0.3; 95% CI: 0.1, 0.6] were significantly associated with hearing loss.ConclusionThe prevalence of hearing loss was considerably high. This study revealed that advanced age, cigarette smoking, increased working area noise level, and working experiences were found to increase the odds of having hearing loss. Therefore, it is important to emphasize metal workshop workers that are at high risk of hearing loss and develop preventive strategies to reduce the burden of this problem. Besides, minimizing working area noise levels, proper utilization of ear protection devices, and creating awareness about the impact of hearing loss are recommended.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagnew Getnet Adugna
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bezawit Mulat
- Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayechew Adera
- Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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2
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Slagle C, Gist KM, Starr MC, Hemmelgarn TS, Goldstein SL, Kent AL. Fluid Homeostasis and Diuretic Therapy in the Neonate. Neoreviews 2022; 23:e189-e204. [PMID: 35229135 DOI: 10.1542/neo.23-3-e189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
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Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Katja M Gist
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | - Trina S Hemmelgarn
- Division of Pharmacology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Pharmacy, Cincinnati, OH
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Alison L Kent
- Department of Pediatrics, University of Rochester, NY, and Australian National University Medical School, Canberra, ACT, Australia
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3
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Bhatia S, Mehdi MQ, Jain SK. Loop Diuretics in Infants with Heart Failure. Neoreviews 2021; 22:e309-e319. [PMID: 33931476 DOI: 10.1542/neo.22-5-e309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tremendous advances have been made in the last 5 decades in the surgical management of congenital heart disease (CHD). Most infants affected by clinically significant CHD are at risk for developing heart failure (HF). Adult HF management is mostly evidence-based and our knowledge in this field has expanded significantly in the past decade. However, data on management approaches for HF in infants are limited. The indications and implications for various medications and interventions in patients with HF secondary to CHD are an upcoming area of interest. It is critical that we expand our ability to prevent, detect, and manage HF in the pediatric population.
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Affiliation(s)
| | | | - Sunil K Jain
- Departments of *Pediatrics and.,Neonatology, University of Texas Medical Branch, Galveston, TX
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4
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Abdullah A, Dahari KASA, Tamil AM, Rohana J, Razif MYM, Shareena I. The Prevalence of Hearing Loss Among Babies in the Neonatal Intensive Care Unit in a Tertiary Hospital in Malaysia. Medeni Med J 2020; 35:116-120. [PMID: 32733760 PMCID: PMC7384509 DOI: 10.5222/mmj.2020.68466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing HL. Methods This retrospective study was conducted from January 2014-December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of HL, degree of HL and number of risk factors per infant. Results A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required further diagnostic test. Only 105 (49%) babies completed diagnostic tests. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL was in seven babies (17.5%), severe HL in two babies (5%), and profound HL in nine babies (22.5%). The presence of craniofacial anomalies was the only significant independent risk factor for HL with p<0.05 with an odds ratio of 0.105 CI 95% [0.028-0.389]. Of Babies with the presence of three or more risk factors, 100% of them had HL.There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies. Conclusion The prevalence of HL among the NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).
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Affiliation(s)
- Asma Abdullah
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology- Head and Neck Surgery, Kuala Lumpur, Malaysia
| | | | - Azmi Mohd Tamil
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Public Health, Kuala Lumpur, Malaysia
| | - Jaafar Rohana
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pediatric, Kuala Lumpur, Malaysia
| | - Mohamad Yunus Mohd Razif
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology, Kuala Lumpur, Malaysia
| | - Ishak Shareena
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pediatric, Kuala Lumpur, Malaysia
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5
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Bogomilsky MR, Ishanova YS, Rakhmanova IV, Dyakonova IN, Zonenko OG, Shumilov PV. [Screening audiological control in children of different ages after taking ototoxic medications]. Vestn Otorinolaringol 2020; 85:40-44. [PMID: 32241987 DOI: 10.17116/otorino20208501140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To compare auditory function during screening of children of different age groups who received ototoxic therapy. PATIENTS AND METHODS Auditory function was studied in various categories of children receiving ototoxic drugs. Hearing was assessed by the registration of distortion product otoacoustic emission (DPOAE), short-latency evoked potentials (SLEP), tympanometry. Statistical processing was performed using the C program Statgraphics Centurion XV. RESULTS In this study, screening of auditory function in children suffering from cystic fibrosis and receiving ototoxic treatment revealed pathologic conditions of the middle ear according to tympanometry in 15.4% of cases, impaired auditory function in 28.2% of cases according to DPOAE. Early ototoxicosis presented as a decrease in the amplitude of the response at a frequency of 4 kHz, and a change in the structure of the DP-gram in the form of a shift to the low-frequency area. Examination of the auditory function of premature infants receiving potentially ototoxic drugs in the early neonatal period demonstrated that the administration of ototoxic drugs does not affect the maturation of outer hair cells. CONCLUSION Audiological control, such as tympanometry and registration of evoked otoacoustic remission should be included in the outpatient observation of children with a history of ototoxic drugs.
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Affiliation(s)
- M R Bogomilsky
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Otolaryngology of Pediatric Faculty, Moscow, Russia, 117997
| | - Yu S Ishanova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Research Laboratory of Clinical and Experimental Pediatric Otorhinolaryngology, Moscow, Russia, 117997
| | - I V Rakhmanova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Research Laboratory of Clinical and Experimental Pediatric Otorhinolaryngology, Moscow, Russia, 117997
| | - I N Dyakonova
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Department of Physiology, Medical and Biological Faculty, Moscow, Russia, 117997
| | - O G Zonenko
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Academician Tabolin Department of Hospital Pediatrics, Moscow, Russia, 117997
| | - P V Shumilov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Academician Tabolin Department of Hospital Pediatrics, Moscow, Russia, 117997
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Abstract
Pediatric heart failure (PHF) is an important cause of mortality and morbidity. Whereas ischemic heart disease is the most important cause of heart failure in adults, congenital heart diseases (CHD) and cardiomyopathies are important etiologies of PHF. Management of PHF also differs from that of adults. Here authors have reviewed the literature on PHF with respect to etiology, symptoms, investigations and treatment strategies.
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Affiliation(s)
- Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Sudhansu Budakoty
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Sohal K, Moshy J, Owibingire S, Shuaibu I. Hearing loss in children: A review of literature. JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/jmedsci.jmedsci_166_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Analysis of drug-induced hearing loss by using a spontaneous reporting system database. PLoS One 2019; 14:e0217951. [PMID: 31593579 PMCID: PMC6782099 DOI: 10.1371/journal.pone.0217951] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Many drugs can cause hearing loss, leading to sensorineural deafness. The aim of this study was to evaluate the risk of drug-induced hearing loss (DIHL) by using the Japanese Adverse Drug Event Report (JADER) database and to obtain profiles of DIHL onset in clinical settings. We relied on the Medical Dictionary for Regulatory Activities preferred terms and standardized queries, and calculated the reporting odds ratios (RORs). Furthermore, we applied multivariate logistic regression analysis, association rule mining, and time-to-onset analysis using Weibull proportional hazard models. Of 534688 reports recorded in the JADER database from April 2004 to June 2018, adverse event signals were detected for platinum compounds, sulfonamides (plain) (loop diuretics), interferons, ribavirin, other aminoglycosides, papillomavirus vaccines, drugs used in erectile dysfunction, vancomycin, erythromycin, and pancuronium by determining RORs. The RORs of other aminoglycosides, other quaternary ammonium compounds, drugs used in erectile dysfunction, and sulfonamides (plain) were 29.4 (22.4–38.6), 18.5 (11.2–30.6), 15.4 (10.6–22.5), and 12.6 (10.0–16.0), respectively. High lift score was observed for patients with congenital diaphragmatic hernia treated with pancuronium using association rule mining. The median durations (interquartile range) for DIHL due to platinum compounds, sulfonamides (plain), interferons, antivirals for treatment of hepatitis C virus (HCV) infections, other aminoglycosides, carboxamide derivatives, macrolides, and pneumococcal vaccines were 25.5 (7.5–111.3), 80.5 (4.5–143.0), 64.0 (14.0–132.0), 53.0 (9.0–121.0), 11.0 (3.0–26.8), 1.5 (0.3–11.5), 3.5 (1.3–6.8), and 2.0 (1.0–4.5), respectively. Our results demonstrated potential risks associated with several drugs based on their RORs. We recommend to closely monitor patients treated with aminoglycosides for DIHL for at least two weeks. Moreover, individuals receiving platinum compounds, sulfonamides (plain), interferons, and antivirals for HCV infection therapy should be carefully observed for DIHL for at least several months.
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McPherson C. Pharmacotherapy for the Prevention of Bronchopulmonary Dysplasia: Can Anything Compete with Caffeine and Corticosteroids? Neonatal Netw 2019; 38:242-249. [PMID: 31470395 DOI: 10.1891/0730-0832.38.4.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a morbidity of prematurity with implications for respiratory and neurologic health into adulthood. Multiple risk factors contribute to the development of BPD leading to examination of various prevention strategies. The roles of systemic corticosteroids and caffeine have been addressed by the American Academy of Pediatrics. The place in therapy of other agents commonly utilized in clinical practice remains unclear. Inhaled nitric oxide has been the subject of numerous large, randomized controlled trials in preterm infants. Despite sound rationale, these trials have largely failed to document benefit, suggesting a limited role for inhaled nitric oxide therapy in the preterm population. In contrast, intramuscular vitamin A has been documented to reduce the incidence of BPD in randomized trials. However, the invasiveness and the sporadic availability of this therapy have led to decreased utilization. All macrolide antibiotics do not appear to have a similar impact on the incidence of BPD; however, azithromycin administered to infants colonized with Ureaplasma may have impact. Questions remain about the optimal dosing approach and long-term safety of this intervention. Finally, diuretic therapy is widely used in clinical practice despite significant toxicities and limited data supporting a role in BPD prevention. Taken together, available data suggest that caffeine and selective use of corticosteroids remain the mainstays of pharmacologic BPD prevention.
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Abstract
OBJECTIVE To reduce bilateral delayed-onset progressive sensory permanent hearing loss using a systems-wide quality improvement project with adherence to best practice for the administration of furosemide. DESIGN Prospective cohort study with regular audiologic follow-up assessment of survivors both before and after a 2007-2008 quality improvement practice change. SETTING The referral center in Western Canada for complex cardiac surgery, with comprehensive multidisciplinary follow-up by the Complex Pediatric Therapies Follow-up Program. PATIENTS All consecutive patients having single-ventricle palliative cardiac surgery at age 6 weeks old or younger. INTERVENTIONS A 2007-2008 quality improvement practice change consisted of a Parenteral Drug Monograph revision indicating slow IV administration of furosemide, an educational program, and an evaluation. MEASUREMENTS AND MAIN RESULTS The outcome measure was the prevalence of permanent hearing loss by 4 years old. Firth multiple logistic regression compared pre (1996-2008) to post (2008-2012) practice change occurrence of permanent hearing loss, adjusting for confounding variables, including all hospital days, extracorporeal membrane oxygenation, cardiopulmonary bypass time, age at first surgery, dialysis, and sepsis. From 1996 to 2012, 259 infants had single-ventricle palliative surgery at age 6 weeks old or younger, with 173 (64%) surviving to age 4 years. Of survivors, 106 (61%) were male, age at surgery was 11.6 days (9.0 d), and total hospitalization days by age 4 years were 64 (42); 18 (10%) had cardiopulmonary resuscitation and 38 (22%) had sepsis at any time. All 173 (100%) had 4-year follow-up. Pre- to postpractice change permanent hearing loss dropped from 17/100 (17%) to 0/73 (0%) of survivors. On Firth multiple logistic regression, the only variable statistically associated with permanent hearing loss was the pre- to postpractice change time period (odds ratio, 0.03; 95% CI, 0-0.35; p = 0.001). CONCLUSIONS A practice change to ensure slow IV administration of furosemide eliminated permanent hearing loss. Centers caring for critically ill infants, particularly those with single-ventricle anatomy or hypoxia, should review their drug administration guidelines and adhere to best practice for administration of IV furosemide.
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11
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Puia-Dumitrescu M, Bretzius OM, Brown N, Fitz-Henley JA, Ssengonzi R, Wechsler CS, Gray KD, Benjamin DK, Smith PB, Clark RH, Gonzalez D, Hornik CP. Evaluation of Gentamicin Exposure in the Neonatal Intensive Care Unit and Hearing Function at Discharge. J Pediatr 2018; 203:131-136. [PMID: 30244991 PMCID: PMC6361629 DOI: 10.1016/j.jpeds.2018.07.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/25/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the association between gentamicin dosing, duration of treatment, and ototoxicity in hospitalized infants. STUDY DESIGN This retrospective cohort study conducted at 330 neonatal intensive care units (2002-2014) included inborn infants exposed to gentamicin with available hearing screen results, and excluded infants with incomplete dosing data and major congenital anomalies. Our primary outcome was the final hearing screen result performed during hospitalization: abnormal (failed or referred for further testing in one or both ears) or normal (bilateral passed). The 4 measures of gentamicin exposure were highest daily dose, average daily dose, cumulative dose, and cumulative duration of exposure. We fitted separate multivariable logistic regression models adjusted for demographics, comorbidities, and other clinical events. RESULTS A total of 84 808 infants met inclusion/exclusion criteria; median (25th, 75th percentile) gestational age and birth weight were 35 weeks (33, 38) and 2480 g (1890, 3184), respectively. Failed hearing screens occurred in 3238 (3.8%) infants; failed screens were more likely in infants of lower gestational age and birth weight, who had longer hospital lengths of stay, higher rates of morbidities, and were small for gestational age. Median highest daily dose, average daily dose, and cumulative dose were 4.0 mg/kg/day (3.0, 4.0), 3.8 mg/kg/day (3.0, 4.0), and 12.1 mg/kg (9.1, 20.5), respectively. Median cumulative duration of exposure was 3 days (3, 6). In adjusted analysis, gentamicin dose and duration of therapy were not associated with hearing screen failure. CONCLUSIONS Gentamicin dosing and duration of treatment were not associated with increased odds of failed hearing screen at the time of discharge from initial neonatal intensive care unit stay.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Nia Brown
- Duke Clinical Research Institute, Durham, NC
| | | | | | | | - Keyaria D Gray
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | | | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Daniel Gonzalez
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Prevalence of Childhood Permanent Hearing Loss after Early Complex Cardiac Surgery. J Pediatr 2018; 198:104-109. [PMID: 29631768 DOI: 10.1016/j.jpeds.2018.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/20/2018] [Accepted: 02/14/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To estimate the prevalence of childhood permanent hearing loss (PHL) after early cardiac surgery. STUDY DESIGN This prospective observational (1996-2015) study after complex cardiac surgery with cardiopulmonary bypass at ≤6 weeks of life reports audiology follow-up by registered pediatric-experienced audiologists at 6-8 months postsurgery, age 2 years, and as required throughout and thereafter to complete diagnoses. PHL at any frequency (500-4000 Hz) is defined as responses of >25-decibel hearing level in either ear. PHL was evaluated by type (conductive or sensorineural), pattern (flat or sloping), and severity (mild to profound). RESULTS Survival rate was 83.4% (706 of 841 children) with a 97.9% follow-up rate (691 children); 41 children had PHL, 5.9% (95% CI 4.3%, 8.0%). By cardiac defect, prevalence was biventricular, 4.0% (95%CI 2.5%, 6.1%); single ventricle, 10.8% (95%CI 6.8%, 16.1%). Eighty-seven (12.6%) of 691 had syndromes/genetic abnormalities with known association with PHL; of these, 17 (41.5%) had PHL. Of 41 children, 4 had permanent conductive, moderate to severe loss (1 bilateral); 37 had moderate to profound sensorineural loss (29 bilateral with 20 sloping and 9 flat), 6 with cochlear implant done or recommended. CONCLUSIONS Infants surviving complex cardiac surgery are at high risk for PHL. Over 40% with PHL have known syndromes/genetic abnormalities, but others do not have easily identifiable risk indicators. Early cardiac surgery should be considered a risk indicator for PHL.
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Grasty MA, Ittenbach RF, Knightly C, Solot CB, Gerdes M, Bernbaum JC, Wernovsky G, Spray TL, Nicolson SC, Clancy RR, Licht DJ, Zackai E, Gaynor JW, Burnham NB. Hearing Loss after Cardiac Surgery in Infancy: An Unintended Consequence of Life-Saving Care. J Pediatr 2018; 192:144-151.e1. [PMID: 29246336 PMCID: PMC6447030 DOI: 10.1016/j.jpeds.2017.09.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/30/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the prevalence of hearing loss after cardiac surgery in infancy, patient and operative factors associated with hearing loss, and the relationship of hearing loss to neurodevelopmental outcomes. STUDY DESIGN Audiologic and neurodevelopmental evaluations were conducted on 348 children who underwent repair of congenital heart disease at the Children's Hospital of Philadelphia as part of a prospective study evaluating neurodevelopmental outcomes at 4 years of age. A prevalence estimate was calculated based on presence and type of hearing loss. Potential risk factors and the impact of hearing loss on neurodevelopmental outcomes were evaluated. RESULTS The prevalence of hearing loss was 21.6% (95% CI, 17.2-25.9). The prevalence of conductive hearing loss, sensorineural hearing loss, and indeterminate hearing loss were 12.4% (95% CI, 8.8-16.0), 6.9% (95% CI, 4.1-9.7), and 2.3% (95% CI, 0.6-4.0), respectively. Only 18 of 348 subjects (5.2%) had screened positive for hearing loss before this study and 10 used a hearing aid. After adjusting for patient and operative covariates, younger gestational age, longer postoperative duration of stay, and a confirmed genetic anomaly were associated with hearing loss (all P < .01). The presence of hearing loss was associated with worse language, cognition and attention (P <.01). CONCLUSIONS These findings suggest that the prevalence of hearing loss in preschool children after heart surgery in infancy may be 20-fold higher than in the 1% prevalence seen in the general population. Younger gestational age, presence of a genetic anomaly, and longer postoperative duration of stay were associated with hearing loss. Hearing loss was associated with worse neurodevelopmental outcomes.
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Affiliation(s)
- Madison A. Grasty
- Division of Cardiothoracic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
| | - Richard F. Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati
Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Carol Knightly
- Center for Childhood Communication, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia B. Solot
- Center for Childhood Communication, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
| | - Marsha Gerdes
- Center for Psychology, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
| | - Judy C. Bernbaum
- Center for Pediatrics, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
| | - Gil Wernovsky
- Center for Cardiology, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania,Department of Anesthesia and Critical Care Medicine,
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas L. Spray
- Division of Cardiothoracic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
| | - Susan C. Nicolson
- Department of Anesthesia and Critical Care Medicine,
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert R. Clancy
- Department of Pediatrics Division of Neurology, Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J. Licht
- Department of Pediatrics Division of Neurology, Children’s
Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine Zackai
- Center for Pediatrics, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania,Department of Genetics, Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania
| | - J. William Gaynor
- Division of Cardiothoracic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
| | - Nancy B. Burnham
- Division of Cardiothoracic Surgery, Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
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Garinis AC, Kemph A, Tharpe AM, Weitkamp JH, McEvoy C, Steyger PS. Monitoring neonates for ototoxicity. Int J Audiol 2017; 57:S41-S48. [PMID: 28949262 DOI: 10.1080/14992027.2017.1339130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Neonates admitted to the neonatal intensive care unit (NICU) are at greater risk of permanent hearing loss compared to infants in well mother and baby units. Several factors have been associated with this increased prevalence of hearing loss, including congenital infections (e.g. cytomegalovirus or syphilis), ototoxic drugs (such as aminoglycoside or glycopeptide antibiotics), low birth weight, hypoxia and length of stay. The aetiology of this increased prevalence of hearing loss remains poorly understood. DESIGN Here we review current practice and discuss the feasibility of designing improved ototoxicity screening and monitoring protocols to better identify acquired, drug-induced hearing loss in NICU neonates. STUDY SAMPLE A review of published literature. CONCLUSIONS We conclude that current audiological screening or monitoring protocols for neonates are not designed to adequately detect early onset of ototoxicity. This paper offers a detailed review of evidence-based research, and offers recommendations for developing and implementing an ototoxicity monitoring protocol for young infants, before and after discharge from the hospital.
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Affiliation(s)
- Angela C Garinis
- a Oregon Hearing Research Center, Otolaryngology , Oregon Health & Science University , Portland , OR , USA.,b National Center for Rehabilitative Auditory Research , VA Portland Health Care System , Portland , OR , USA
| | - Alison Kemph
- c Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Anne Marie Tharpe
- c Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA
| | | | - Cynthia McEvoy
- e Neonatology, Pediatrics , Oregon Health & Science University , Portland , OR , USA
| | - Peter S Steyger
- a Oregon Hearing Research Center, Otolaryngology , Oregon Health & Science University , Portland , OR , USA.,b National Center for Rehabilitative Auditory Research , VA Portland Health Care System , Portland , OR , USA
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15
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Dumanch KA, Holte L, O'Hollearn T, Walker E, Clark J, Oleson J. High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review. Am J Audiol 2017; 26:129-142. [PMID: 28475714 DOI: 10.1044/2017_aja-16-0116] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/12/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, we examined the association between risk factors for hearing loss and early childhood hearing status (normal hearing, congenital hearing loss, or delayed-onset hearing loss). Follow-up rates of audiologic care following passed or referred birth screens for children with risk factors were also examined. METHOD A retrospective data review was completed on 115,039 children born from 2010 to 2012. Data analyses included prevalence rates, odds ratios, and Fisher exact tests of statistical significance. RESULTS Ninety percent of children were born with no risk factors for hearing loss; of those, 99.9% demonstrated normal hearing by 3 years of age. Of the 10% of children born with risk factors, 96.3% demonstrated normal hearing by age 3, 1.4% presented with congenital hearing loss, and 2.3% demonstrated permanent hearing loss by age 3. Factors that placed children at the highest risk of congenital hearing impairment were neurodegenerative disorders, syndromes, and congenital infections. Factors that placed children at the highest risk of developing permanent postnatal hearing loss were congenital cytomegalovirus, syndromes, and craniofacial anomalies. CONCLUSIONS Certain risk factors place a child at significantly greater risk of congenital hearing impairment or developing permanent hearing loss by age 3. Follow-up diagnostic testing should remain a priority for children with certain risk factors for hearing loss.
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Affiliation(s)
- Kelsey A. Dumanch
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Lenore Holte
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
- Center for Disabilities and Development, University of Iowa, Iowa City
| | | | - Elizabeth Walker
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
| | - Jacob Clark
- College of Public Health, University of Iowa, Iowa City
| | - Jacob Oleson
- College of Public Health, University of Iowa, Iowa City
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Jetton JG, Sorenson M. Pharmacological management of acute kidney injury and chronic kidney disease in neonates. Semin Fetal Neonatal Med 2017; 22:109-115. [PMID: 27720664 DOI: 10.1016/j.siny.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Both acute kidney injury (AKI) and chronic kidney disease (CKD) are seen more frequently in the neonatal intensive care unit (NICU) as advances in supportive care improve the survival of critically ill infants as well as those with severe, congenital kidney and urinary tract anomalies. Many aspects of the infant's care, including fluid balance, electrolyte and mineral homeostasis, acid-base balance, and growth and nutrition require close monitoring by and collaboration among neonatologists, nephrologists, dieticians, and pharmacologists. This educational review summarizes the therapies widely used for neonates with AKI and CKD. Use of these therapies is extrapolated from data in older children and adults or based on clinical experience and case series. There is a critical need for more research on the use of therapies in infants with kidney disease as well as for the development of drug delivery systems and preparations scaled more appropriately for these small patients.
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Affiliation(s)
- Jennifer G Jetton
- Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, USA.
| | - Mark Sorenson
- Department of Pharmaceutical Care, University of Iowa Children's Hospital, Iowa City, IA, USA
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Gentamicin Exposure and Sensorineural Hearing Loss in Preterm Infants. PLoS One 2016; 11:e0158806. [PMID: 27390846 PMCID: PMC4938424 DOI: 10.1371/journal.pone.0158806] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/22/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the impact of gentamicin exposure on sensorineural hearing loss (SNHL) in very low birth weight (VLBW) infants. Methods Exposure to gentamicin was determined in infants born between 1993 and 2010 at a gestational age < 32 weeks and/or with a birthweight < 1500 g, who presented with SNHL during the first 5 years of life. For each case, we selected two controls matched for gender, gestational age, birthweight, and year of birth. Results We identified 25 infants affected by SNHL, leading to an incidence of SNHL of 1.58% in our population of VLBW infants. The proportion of infants treated with gentamicin was 76% in the study group and 70% in controls (p = 0.78). The total cumulated dose of gentamicin administered did not differ between the study group (median 10.2 mg/kg, Q1-Q3 1.6–13.2) and the control group (median 7.9 mg/kg, Q1-Q3 0–12.8, p = 0.47). The median duration of gentamicin treatment was 3 days both in the study group and the control group (p = 0.58). Maximum predicted trough serum levels of gentamicin, cumulative area under the curve and gentamicin clearance were not different between cases and controls. Conclusion The impact of gentamicin on SNHL can be minimized with treatments of short duration, monitoring of blood levels and dose adjustment.
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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Fluid Management. Pediatr Crit Care Med 2016; 17:S35-48. [PMID: 26945328 DOI: 10.1097/pcc.0000000000000633] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In this Consensus Statement, we review the etiology and pathophysiology of fluid disturbances in critically ill children with cardiac disease. Clinical tools used to recognize pathologic fluid states are summarized, as are the mechanisms of action of many drugs aimed at optimal fluid management. DATA SOURCES The expertise of the authors and a review of the medical literature were used as data sources. DATA SYNTHESIS The authors synthesized the data in the literature in order to present clinical tools used to recognize pathologic fluid states. For each drug, the physiologic rationale, mechanism of action, and pharmacokinetics are synthesized, and the evidence in the literature to support the therapy is discussed. CONCLUSIONS Fluid management is challenging in critically ill pediatric cardiac patients. A myriad of causes may be contributory, including intrinsic myocardial dysfunction with its associated neuroendocrine response, renal dysfunction with oliguria, and systemic inflammation with resulting endothelial dysfunction. The development of fluid overload has been associated with adverse outcomes, including acute kidney injury, prolonged mechanical ventilation, increased vasoactive support, prolonged hospital length of stay, and mortality. An in-depth understanding of the many factors that influence volume status is necessary to guide optimal management.
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Poonual W, Navacharoen N, Kangsanarak J, Namwongprom S. Risk factors for hearing loss in infants under universal hearing screening program in Northern Thailand. J Multidiscip Healthc 2015; 9:1-5. [PMID: 26766912 PMCID: PMC4699512 DOI: 10.2147/jmdh.s92818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To define the risk factors for hearing loss in infants (aged 3 months) under universal hearing screening program. MATERIALS AND METHODS A total of 3,120 infants (aged 3 months) who underwent hearing screening using a universal hearing screening program using automated otoacoustic emission test between November 1, 2010 and May 31, 2012 in Uttaradit Hospital, Buddhachinaraj Hospital, and Sawanpracharuk Hospital (tertiary hospitals) located in Northern Thailand were included in this prospective cohort study. RESULTS Of the 3,120 infants, 135 (4.3%) were confirmed to have hearing loss with the conventional otoacoustic emission test. Five of these 135 infants (3.7%) with hearing loss showed test results consistent with auditory brainstem responses. From the univariable analysis, there were eleven potential risk factors associated with hearing deterioration. On multivariable analysis, the risk factors independently associated with hearing loss at 3 months were birth weight 1,500-2,500 g (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1-2.6), APGAR score <6 at 5 minutes (RR 2.2, 95% CI 1.1-4.4), craniofacial anomalies (RR 2.5, 95% CI 1.6-4.2), sepsis (RR 1.8, 95% CI 1.0-3.2), and ototoxic exposure (RR 4.1, 95% CI 1.9-8.6). CONCLUSION This study concluded that low birth weight, APGAR score <6 at 5 minutes, craniofacial anomalies, sepsis, and ototoxic exposure are the risk factors for bilateral hearing loss in infants (aged 3 months) and proper tests should be performed to identify these risk factors. As an outcome, under the present circumstances, it is suggested that infirmary/physicians/general practitioners/health action centers/polyclinics should carry out universal hearing screening in all infants before 36 weeks. The public health policy of Thailand regarding a universal hearing screening program is important for the prevention of disability and to enhance people's quality of life.
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Affiliation(s)
| | | | - Jaran Kangsanarak
- Department of Otolaryngology, Chiang Mai University, Chiang Mai, Thailand
| | - Sirianong Namwongprom
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Vos B, Senterre C, Lagasse R, Levêque A. Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors. BMC Pediatr 2015; 15:160. [PMID: 26475713 PMCID: PMC4609128 DOI: 10.1186/s12887-015-0479-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/08/2015] [Indexed: 01/08/2023] Open
Abstract
Background Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium. Methods A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting). Results Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss. Conclusions We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bénédicte Vos
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium.
| | - Christelle Senterre
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
| | - Raphaël Lagasse
- Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium.
| | | | - Alain Levêque
- Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. .,Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium.
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D'yakonova IN, Kamkina OV, Ishanova YS, Rakhmanova IV, Burmistrova DS. Auditory Function in Immature Animals after Two Consecutive Courses of Ototoxic Antibiotics. Bull Exp Biol Med 2015; 159:415-9. [PMID: 26385408 DOI: 10.1007/s10517-015-2979-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 11/25/2022]
Abstract
In chronic experiments on immature rabbits receiving therapeutic courses of vancomycin, gentamicin, and consecutive administration of vancomicin and gentamicin by the scheme used in neonatology, hearing function was evaluated by the methods of auditory evoked potentials (auditory brainstem response, ABR) and distortion product otoacoustic emission (DPOAE). Comparison with the control group revealed ototoxic effects of all studied antibiotics that manifested in increased sound tolerance and more rapid shortening of latencies in 30-100 dB range. Higher thresholds were found only after gentamicin administration. Vancomycin administration significantly reduced the responses at 4 kHz. Subsequent gentamicin course did not potentiate this effect.
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Affiliation(s)
- I N D'yakonova
- Department of Physiology, Medico-Biological Faculty, Moscow, Russia
| | | | - Yu S Ishanova
- Research Laboratory of Clinical and Experimental Pediatric Otorhinolaryngology, Moscow, Russia.
| | - I V Rakhmanova
- Research Laboratory of Clinical and Experimental Pediatric Otorhinolaryngology, Moscow, Russia
| | - D S Burmistrova
- Department of Pediatric Otorhinolaryngology, N. I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
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El-Barbary MN, Ismail RIH, Ibrahim AAA. Gentamicin extended interval regimen and ototoxicity in neonates. Int J Pediatr Otorhinolaryngol 2015; 79:1294-8. [PMID: 26071016 DOI: 10.1016/j.ijporl.2015.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/27/2015] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the extended interval regimen gentamicin associated ototoxicity in neonatal intensive care unit using hearing tests. METHODS Two hundred and twenty neonates admitted to neonatal intensive care were assessed; 110 neonates who had received gentamicin and 110 neonates who had not received gentamicin served as control group. Gentamicin group were further subdivided according to the duration of treatment into 50 neonates who had received gentamicin for 5 days or less and 60 neonates who had received gentamicin for more than 5 days. TEOAEs were used for hearing screening. Auditory brain response was performed 3 months later for failed cases to confirm the hearing impairment. RESULTS Three neonates failed TEOAEs screening in each group but hearing impairment was confirmed in one neonate only (0.9%) in each group (gentamicin and control groups). Neonates who received gentamicin for more than 5 days showed comparable results as regard TEOAEs or ABR results with those who received gentamicin for 5 days or less, and control group. CONCLUSIONS Extended interval dosing of gentamicin therapy in neonates does not increase the incidence of hearing loss. This suggests that hearing loss in neonatal intensive care unit may be attributed to factors other than gentamicin treatment.
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Affiliation(s)
- Mohamed N El-Barbary
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Ramses Street, Cairo, 11566, Egypt
| | - Rania I H Ismail
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Ramses Street, Cairo, 11566, Egypt.
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Ericson JE, Thaden J, Cross HR, Clark RH, Fowler VG, Benjamin DK, Cohen-Wolkowiez M, Hornik CP, Smith PB. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J 2015; 34:371-5. [PMID: 25760564 PMCID: PMC4357312 DOI: 10.1097/inf.0000000000000573] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coagulase-negative Staphylococcus (CoNS) is the most common cause of bloodstream infections (BSI) in hospitalized infants. CoNS BSI is most reliably treated with vancomycin; however, concerns about side effects and promoting resistance often delay empirical vancomycin therapy until culture results become available. METHODS All infants with CoNS BSI discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group from 1997 to 2012 were identified. Empirical vancomycin therapy was defined as vancomycin exposure on the day of the first positive blood culture. Delayed vancomycin therapy was defined as vancomycin exposure 1-3 days after the first positive blood culture. We used multivariable logistic regression with random effects for site to evaluate the association between the use of empirical vancomycin therapy versus delayed vancomycin therapy and 30-day mortality, controlling for gestational age, small-for-gestational age status, postnatal age on the day of the first positive culture, oxygen requirement, ventilator support and inotropic support on the day the first positive culture was obtained. RESULTS A total of 4364 infants with CoNS BSI were identified; 2848 (65%) were treated with empirical vancomycin. The median postnatal age at first positive culture was 14 days (interquartile range: 9, 21). Unadjusted 30-day mortality was similar for infants treated with empirical vancomycin and infants treated with delayed vancomycin therapy [166/2848 (6%) vs. 69/1516 (4%); P = 0.08]. There was no significant difference in 30-day mortality on multivariable analysis [odds ratio: 1.14 (0.84, 1.56)]. The median duration of bacteremia was 1 day longer for infants with delayed vancomycin therapy [4 days (interquartile range: 2, 6) vs. 3 days (2, 5); P < 0.0001]. CONCLUSIONS The median duration of bacteremia was 1 day longer in infants with CoNS BSI who received delayed vancomycin therapy. Despite this finding, empirical vancomycin therapy for CoNS BSI was not associated with improved mortality.
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Affiliation(s)
- Jessica E. Ericson
- Department of Pediatrics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | | | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | | | - Daniel K. Benjamin
- Department of Pediatrics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Christoph P. Hornik
- Department of Pediatrics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - P. Brian Smith
- Department of Pediatrics, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
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Vasconcellos AP, Kyle ME, Gilani S, Shin JJ. Personally Modifiable Risk Factors Associated with Pediatric Hearing Loss: A Systematic Review. Otolaryngol Head Neck Surg 2014; 151:14-28. [PMID: 24671457 PMCID: PMC4472569 DOI: 10.1177/0194599814526560] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric hearing loss is an increasingly recognized problem with significant implications. Increasing our quantitative understanding of potentially modifiable environmental risk factors for hearing loss may form the foundation for prevention and screening programs. OBJECTIVE To determine whether specific threshold exposure levels of personally modifiable risk factors for hearing loss have been defined, with the overarching goal of providing actionable guidance for the prevention of pediatric hearing loss. DATA SOURCES A systematic review was performed. Computerized searches of PubMed, EMBASE, and the Cochrane Library were completed and supplemented with manual searches. REVIEW METHODS Inclusion/exclusion criteria were designed to determine specific threshold values of personally modifiable risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers. RESULTS There were 38 criterion-meeting studies, including a total of 50,651 subjects. Threshold noise exposures significantly associated with hearing loss in youth included: (1) more than 4 hours per week or more than 5 years of personal headphone usage, (2) more than 4 visits per month to a discotheque, and (3) working on a mechanized farm. Quantified tobacco levels of concern included any level of in utero smoke exposure as well as secondhand exposure sufficient to elevate serum cotinine. CONCLUSIONS Specific thresholds analyses are limited. Future studies would ideally focus on stratifying risk according to clearly defined levels of exposure, in order to provide actionable guidance for children and families.
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Dennett KV, Fligor BJ, Tracy S, Wilson JM, Zurakowski D, Chen C. Sensorineural hearing loss in congenital diaphragmatic hernia survivors is associated with postnatal management and not defect size. J Pediatr Surg 2014; 49:895-9. [PMID: 24888830 DOI: 10.1016/j.jpedsurg.2014.01.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE We determined the incidence of sensorineural hearing loss (SNHL; >20dB at any frequency) in a contemporary cohort of congenital diaphragmatic hernia (CDH) survivors at a single tertiary care center and identified potential risk factors for SNHL. METHODS From 2000 through 2011, clinical and audiologic data were collected on 122 surgically-repaired Bochdalek CDH patients. CDH defect size, duration of ventilation, and cumulative aminoglycoside treatment were used for multivariate logistic regression. RESULTS Incidence of SNHL was 7.4% (9/122). We identified one significant independent predictor of SNHL: cumulative length of aminoglycoside treatment (P<.001; OR 1.44, 95% CI: 1.13-1.83). CONCLUSIONS Over the last decade, the incidence of SNHL in our CDH patients is low compared to previous reports in the literature (7.4%) and is not associated with CDH defect size or the need for extracorporeal membrane oxygenation. Prolonged duration of aminoglycoside treatment increases the risk of SNHL independent of defect size and duration of ventilation.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Brian J Fligor
- Department of Otolaryngology and Communication Enhancement Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sarah Tracy
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Jay M Wilson
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Catherine Chen
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Partridge EA, Bridge C, Donaher JG, Herkert LM, Grill E, Danzer E, Gerdes M, Hoffman CH, D'Agostino JA, Bernbaum JC, Rintoul NE, Peranteau WH, Flake AW, Adzick NS, Hedrick HL. Incidence and factors associated with sensorineural and conductive hearing loss among survivors of congenital diaphragmatic hernia. J Pediatr Surg 2014; 49:890-4; discussion 894. [PMID: 24888829 DOI: 10.1016/j.jpedsurg.2014.01.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution. METHODS We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann-Whitney t-test (p≤0.05). RESULTS A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p=0.0130), prolonged course of hospitalization (p=0.0011), duration of mechanical ventilation (p=0.0046), requirement for tracheostomy (p=0.0013), and duration of loop diuretic (p=0.0005) and aminoglycoside therapy (p=0.0003). CONCLUSIONS We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language.
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Affiliation(s)
- Emily A Partridge
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina Bridge
- The Center for Childhood Communication, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph G Donaher
- The Center for Childhood Communication, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa M Herkert
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elena Grill
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marsha Gerdes
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Casey H Hoffman
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jo Ann D'Agostino
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy C Bernbaum
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie E Rintoul
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William H Peranteau
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alan W Flake
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N Scott Adzick
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Robertson CMT, Tomlinson JT, Wiley MD, Reichert AE. Reducing the prevalence of permanent hearing loss among neonatal intensive care survivors. J Pediatr 2014; 164:1243. [PMID: 24411271 DOI: 10.1016/j.jpeds.2013.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Charlene M T Robertson
- Department of Pediatrics, University of Alberta; Department of Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Jill T Tomlinson
- Health Information Management, Department of Pediatrics, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Michelle D Wiley
- Department of Audiology, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Amber E Reichert
- Department of Pediatrics, University of Alberta; Department of Pediatrics, Glenrose Rehabilitation Hospital; Neonatal Intensive Care Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Topographic and quantitative evaluation of gentamicin-induced damage to peripheral innervation of mouse cochleae. Neurotoxicology 2013; 40:86-96. [PMID: 24308912 DOI: 10.1016/j.neuro.2013.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 11/24/2022]
Abstract
Ototoxicity induced by aminoglycoside antibiotics appears to occur both in hair cells (HCs) and the cochlear nerves that innervate them. Although HC loss can be easily quantified, neuronal lesions are difficult to quantify because two types of afferent dendrites and two types of efferent axons are tangled beneath the hair cells. In the present study, ototoxicity was induced by gentamicin in combination with the diuretic agent furosemide. Neuronal lesions were quantified in cochlear whole-mount preparations combined with microsections across the habenular perforate (HP) openings to achieve a clear picture of the topographic relationship between neuronal damage and HC loss. Multiple immunostaining methods were employed to differentiate the two types of afferent dendrites and two types of efferent axons. The results show that co-administration of gentamicin and furosemide resulted in a typical dynamic pattern of HC loss that spread from the basal turn to the outer hair cells to the apex and inner hair cells, depending on the dose and survival time after drug administration. Lesions of the innervation appeared to occur at two stages. At the early stage (2-4 days), the loss of labeling of the two types of afferent dendrites was more obvious than the loss of labeled efferent axons. At the late stage (2-4 weeks), the loss of labeled efferent axons was more rapid. In the high-dose gentamicin group, the loss of outer HCs was congruent with afferent dendrite loss at the early stage and efferent axon loss at the late stage. In the low-dose gentamicin group, the loss of labeling for cochlear innervation was more severe and widespread. Thus, we hypothesize that the gentamicin-induced damage to cochlear innervation occurs independently of hair cell loss.
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Fjalstad JW, Laukli E, van den Anker JN, Klingenberg C. High-dose gentamicin in newborn infants: is it safe? Eur J Pediatr 2013; 173:489-495. [PMID: 24233331 DOI: 10.1007/s00431-013-2194-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/21/2013] [Indexed: 12/17/2022]
Abstract
Dosing regimens often recommend lower gentamicin doses in neonates (3-5 mg/kg) than in older children (7 mg/kg or more) despite the higher volume of distribution in neonates. We studied an extended-interval high-dose (6 mg/kg) gentamicin regimen in a single tertiary neonatal unit from 2004-2012. During the first week of life, dosing interval was 24 h for term infants, 36 h for preterm infants with gestational age (GA) 29-36 weeks and 48 h for preterm infants with GA <29 weeks. After the first week of life, dosing interval was 24 h if corrected age (GA + postnatal age) ≥29 weeks and 36 h if corrected age <29 weeks. Outcome measures were trough plasma concentration (TPC), ototoxicity and prescription errors. In 546 treatment episodes, TPC was measured prior to the third gentamicin dose. There were 37 episodes (6.7 %) of prescription errors, mainly a too long dosing interval. We included 509 treatment episodes (440 infants) in the final analysis. Mean (standard deviation) gentamicin TPC during the first week of life was 1.1 (0.5) mg/L and after the first week of life 0.8 (0.6) mg/L. In 31 (6 %) episodes, TPC was ≥2.0 mg/L, predominantly among term infants with renal impairment. Thirty-eight patients failed the neonatal hearing screening, but only four of these 38 had permanent hearing loss. All four had a TPC <2.0 mg/L. Conclusions: This extended-interval high-dose gentamicin regimen was associated with low numbers of elevated TPCs, low numbers of prescription errors and no evidence for ototoxicity.
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Affiliation(s)
- Jon Widding Fjalstad
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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30
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Wynn J, Aspelund G, Zygmunt A, Stolar CJH, Mychaliska G, Butcher J, Lim FY, Gratton T, Potoka D, Brennan K, Azarow K, Jackson B, Needelman H, Crombleholme T, Zhang Y, Duong J, Arkovitz MS, Chung WK, Farkouh C. Developmental outcomes of children with congenital diaphragmatic hernia: a multicenter prospective study. J Pediatr Surg 2013; 48:1995-2004. [PMID: 24094947 PMCID: PMC3884579 DOI: 10.1016/j.jpedsurg.2013.02.041] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/08/2013] [Accepted: 02/03/2013] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine developmental outcomes and associated factors in patients with congenital diaphragmatic hernia (CDH) at 2 years of age. METHODS This is a multicenter prospective study of a CDH birth cohort. Clinical and socioeconomic data were collected. Bayley Scales of Infant Development (BSID-III) and Vineland Adaptive Behavior Scales (VABS-II) were performed at 2 years of age. RESULTS BSID-III and VABS-II assessments were completed on 48 and 49 children, respectively. The BSID-III mean cognitive, language, and motor scores were significantly below the norm mean with average scores of 93 ± 15, 95 ± 16, and 95 ± 11. Ten percent (5/47) scored more than 2 standard deviations below the norm on one or more domains. VABS-II scores were similar to BSID-III scores with mean communication, daily living skills, social, motor, adaptive behavior scores of 97 ± 14, 94 ± 16, 93 ± 13, 97 ± 10, and 94 ± 14. For the BSID-III, supplemental oxygen at 28 days, a prenatal diagnosis, need for extracorporeal membrane oxygenation (ECMO) and exclusive tube feeds at time of discharge were associated with lower scores. At 2 years of age, history of hospital readmission and need for tube feeds were associated with lower scores. Lower socioeconomic status correlated with lower developmental scores when adjusted for significant health factors. CONCLUSION CDH patients on average have lower developmental scores at 2 years of age compared to the norm. A need for ECMO, oxygen at 28 days of life, ongoing health issues and lower socioeconomic status are factors associated with developmental delays.
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Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University, NY, NY
| | - Gudrun Aspelund
- Division of Pediatric Surgery, Department of Surgery, Columbia University, NY, NY
| | | | - Charles JH. Stolar
- Division of Pediatric Surgery, Department of Surgery, Columbia University, NY, NY
| | - George Mychaliska
- Division of Pediatric Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI
| | - Jennifer Butcher
- Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI
| | - Foong-Yen Lim
- Division of Pediatric General, Thoracic, and Fetal Surgery, Center for Molecular Fetal Therapy, Cincinnati Children’s Hospital Medical Center, and Cincinnati, OH
| | - Teresa Gratton
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH; Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Neonatology and Pulmonary Biology, Cincinnati, OH
| | - Douglas Potoka
- Division of Pediatric Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kate Brennan
- Department of Instruction and Learning - Early Intervention Program, University of Pittsburgh, Pittsburgh, PA
| | - Ken Azarow
- Division of Pediatric Surgery, Department of Surgery, University of Nebraska College of Medicine/Children’s Hospital and Medical Center, Omaha, NE
| | - Barbara Jackson
- Department of Education, Munroe-Meyer Institute, University of Nebraska Medical Center Omaha, NE
| | - Howard Needelman
- Section of Developmental/Behavioral Pediatrics, Munroe-Meyer Institute, University of Nebraska Medical Center Omaha, NE
| | - Timothy Crombleholme
- Colorado Fetal Care Center, Division of Pediatric General, Thoracic, and Fetal Surgery, Children’s Hospital Colorado and the University of Colorado School of Medicine
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY, NY
| | - Jimmy Duong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, NY, NY
| | - Marc S. Arkovitz
- Department of Pediatric Surgery, Tel Hashomer medical center, Tel Aviv, Israel
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Ruan Q, Ma C, Zhang R, Yu Z. Current status of auditory aging and anti-aging research. Geriatr Gerontol Int 2013; 14:40-53. [PMID: 23992133 DOI: 10.1111/ggi.12124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Qingwei Ruan
- Central Lab; Shanghai Institute of Geriatrics and Gerontology; Huadong Hospital, Shanghai Medical College, Fudan University; Shanghai China
| | - Cheng Ma
- Central Lab; Shanghai Institute of Geriatrics and Gerontology; Huadong Hospital, Shanghai Medical College, Fudan University; Shanghai China
| | - Ruxin Zhang
- Central Lab; Shanghai Institute of Geriatrics and Gerontology; Huadong Hospital, Shanghai Medical College, Fudan University; Shanghai China
| | - Zhuowei Yu
- Central Lab; Shanghai Institute of Geriatrics and Gerontology; Huadong Hospital, Shanghai Medical College, Fudan University; Shanghai China
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Fortenberry JD, Paden ML, Goldstein SL. Acute kidney injury in children: an update on diagnosis and treatment. Pediatr Clin North Am 2013; 60:669-88. [PMID: 23639662 DOI: 10.1016/j.pcl.2013.02.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The concept and definition of acute kidney injury (AKI) in adults and children has undergone significant change in recent years. Biomarker assessment is aiding in description, defining and understanding timing of AKI. AKI demonstrates unique characteristics in association with sepsis and septic shock, organ dysfunction, and fluid overload. Treatment remains problematic, but growing experience with pediatric continuous renal replacement therapies has improved the delivery of care in children. Increasingly, continuous renal replacement therapy is provided in combination with other extracorporeal technologies, and approaches are advancing to improve combined therapy use.
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Affiliation(s)
- James D Fortenberry
- Critical Care Division, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA 30322, USA.
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Wilson MG, Riley P, Hurteau AM, Baird R, Puligandla PS. Hearing loss in congenital diaphragmatic hernia (CDH) survivors: is it as prevalent as we think? J Pediatr Surg 2013; 48:942-5. [PMID: 23701764 DOI: 10.1016/j.jpedsurg.2013.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/03/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE The incidence of sensorineural hearing loss (SNHL;>20 dB loss) in CDH survivors is debated. We evaluated long-term audiological outcomes at a single tertiary care center with ECMO capability and an established neonatal follow-up program. METHODS With REB approval, records of CDH survivors from 2000 to 2010 were retrospectively analyzed. Demographic, postnatal, and audiometric information was gathered. All underwent auditory brainstem response (ABR) or otoacoustic emissions screening before discharge and complete audiological surveillance. Thirty-three patients were evaluated to age 4+ years with others continuing follow-up. RESULTS Forty-three patient records were reviewed with 1 excluded (transferred to another institution). Median GA and BW were 39 weeks (35-41) and 3.1 kg (2-4), respectively. Median ventilation days were 10 (2-189) with 34 infants ventilated 5+ days. Sixteen (36%) received HFOV, 21 (49%) iNO, and 5 (12%) ECMO. The median time to CDH repair was 3 days (1-23), and 11 (26%) required patch repair. Nine infants (21%) received diuretics and oxygen after discharge. Audiological surveillance identified only one patient with SNHL (received HFO, iNO, and patch repair). CONCLUSION Neonatal screening identifies CDH survivors at risk for hearing difficulties but must be followed with comprehensive testing until school age. The incidence of SNHL may be less than previously reported in this population.
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Affiliation(s)
- Marnie Goodwin Wilson
- Division of Pediatric General Surgery, The Montreal Children's Hospital, Montreal, QC, Canada H3H 1P3
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Adatia I, Haworth SG, Wegner M, Barst RJ, Ivy D, Stenmark KR, Karkowsky A, Rosenzweig E, Aguilar C. Clinical trials in neonates and children: Report of the pulmonary hypertension academic research consortium pediatric advisory committee. Pulm Circ 2013; 3:252-66. [PMID: 23662203 PMCID: PMC3641736 DOI: 10.4103/2045-8932.109931] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug trials in neonates and children with pulmonary hypertensive vascular disease pose unique but not insurmountable challenges. Childhood is defined by growth and development. Both may influence disease and outcomes of drug trials. The developing pulmonary vascular bed and airways may be subjected to maldevelopment, maladaptation, growth arrest, or dysregulation that influence the disease phenotype. Drug therapy is influenced by developmental changes in renal and hepatic blood flow, as well as in metabolic systems such as cytochrome P450. Drugs may affect children differently from adults, with different clearance, therapeutic levels and toxicities. Toxicity may not be manifested until the child reaches physical, endocrine and neurodevelopmental maturity. Adverse effects may be revealed in the next generation, should the development of ova or spermatozoa be affected. Consideration of safe, age-appropriate tablets and liquid formulations is an obvious but often neglected prerequisite to any pediatric drug trial. In designing a clinical trial, precise phenotyping and genotyping of disease is required to ensure appropriate and accurate inclusion and exclusion criteria. We need to explore physiologically based pharmacokinetic modeling and simulations together with statistical techniques to reduce sample size requirements. Clinical endpoints such as exercise capacity, using traditional classifications and testing cannot be applied routinely to children. Many lack the necessary neurodevelopmental skills and equipment may not be appropriate for use in children. Selection of endpoints appropriate to encompass the developmental spectrum from neonate to adolescent is particularly challenging. One possible solution is the development of composite outcome scores that include age and a developmentally specific functional classification, growth and development scores, exercise data, biomarkers and hemodynamics with repeated evaluation throughout the period of growth and development. In addition, although potentially costly, we recommend long-term continuation of blinded dose ranging after completion of the short-term, double-blind, placebo-controlled trial for side-effect surveillance, which should include neurodevelopmental and peripubertal monitoring. The search for robust evidence to guide safe therapy of children and neonates with pulmonary hypertensive vascular disease is a crucial and necessary goal.
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Affiliation(s)
- Ian Adatia
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | | | | | | | - Dunbar Ivy
- Children's Hospital of Colorado, University of Colorado, Denver, Colorado, USA
| | - Kurt R. Stenmark
- Children's Hospital of Colorado, University of Colorado, Denver, Colorado, USA
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Martínez-Cruz CF, García Alonso-Themann P, Poblano A, Ochoa-López JM. Hearing loss, auditory neuropathy, and neurological co-morbidity in children with birthweight <750 g. Arch Med Res 2012; 43:457-63. [PMID: 22960856 DOI: 10.1016/j.arcmed.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The current literature considers a birthweight <1,500 g as a risk factor for sensorineural hearing loss (SNHL, hearing threshold >25 decibels), auditory neuropathy (AN), and several neurological sequelae. The aim of the study was to determine the frequency and risk factors associated with SNHL, AN, and neurological morbidity in a group of children with birthweights of <750 g treated at a neonatal care unit and recruited into a long-term follow-up program. METHODS A case-control study was carried out. Inclusion criteria were birthweight <750 g and born between the years 2000 and 2010. We performed brainstem auditory-evoked potentials (BAEP), evoked otoacoustic emissions (EOAE) and free-field audiometry (FFA) in this population. Neonatal variables and procedures were compared between children with SNHL and children with normal bilateral hearing (NBH). RESULTS A total of 93 children with a mean age of 4 years were included in the follow-up. Six children (6.4%) had SNHL and 87 had NBH. We were unable to identify AN in the sample. Mean weight for this sample was 673 ± 68 g and gestational age 27.5 ± 2 weeks. Variables reflecting differences between groups included days under mechanical ventilation, furosemide treatment, and bronchopulmonary dysplasia. In the SNHL group, three patients had periventricular leukomalacia, two had hydrocephalus, and one patient had cerebral palsy. CONCLUSIONS Frequency of SNHL in children with birthweights <750 g was higher than in other premature infants and was related with mechanical ventilation, furosemide application, and bronchopulmonary dysplasia. Association with other neurological morbidities was frequent. Early diagnosis and intervention are required.
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Affiliation(s)
- Carlos F Martínez-Cruz
- Instituto Nacional de Perinatología Dr. Isidro Espinosa de los Reyes (INPer), Mexico, D.F., Mexico.
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Abstract
Diuretics are commonly used to treat infants with oxygen-dependent chronic lung disease. However, there are limited data suggesting a beneficial effect of long-term diuretic therapy on pulmonary function or clinical outcome in this population. Furthermore, data available for review were primarily obtained before the widespread use of antenatal steroids or surfactant replacement therapy, before recognition of the new bronchopulmonary dysplasia. If used in this population, limitations of diuretic therapy as well as significant side effects need to be understood and a rationale approach to clinical use developed on a patient-centered basis.
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Affiliation(s)
- Jeffrey L Segar
- Division of Neonatology, Department of Pediatrics, University of Iowa Children's Hospital, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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38
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Todd NW. Severe diarrhea-dehydration in infancy permanently alters auditory function. Med Hypotheses 2011; 78:239-43. [PMID: 22104193 DOI: 10.1016/j.mehy.2011.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/23/2011] [Indexed: 10/15/2022]
Abstract
Of the myriad etiologies of sensorineural hearing impairment, metabolic stress is rarely considered. I posit that severe dehydration in conjunction with hypoxia, at least during infancy, prompts permanent changes in the cochlea. In a population-based prospective study of otitis media, children without otitis were found to have at age 4-8 years, worse auditory thresholds if as an infant had been hospitalized for diarrhea-dehydration. What is more, stapedius reflex thresholds tended to be lower in children who had been hospitalized for diarrhea-dehydration: that is, less acoustic energy for arousal or to be frightening. The hypothesis that the transient metabolic stress of dehydration with hypoxia prompts permanent sensorineural hearing impairment with reduced uncomfortable loudness thresholds, is both (1) consistent in an evolutionary sense with a subsequent survival advantage, and (2) subject to verification both by descriptive studies of children undergoing ECMO (ExtraCorporeal Membrane Oxygenation) or care for congenital diaphragmatic hernia, and by animal studies.
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Affiliation(s)
- N Wendell Todd
- Department of Otolaryngology, Emory University, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA.
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Robertson CMT, Alton GY, Bork KT, Joffe AR, Tawfik GC, Sauve RS, Moddemann DM, Ross DB, Rebeyka IM. Bilateral sensory permanent hearing loss after palliative hypoplastic left heart syndrome operation. Ann Thorac Surg 2011; 93:1248-53. [PMID: 22105869 DOI: 10.1016/j.athoracsur.2011.08.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/16/2011] [Accepted: 08/18/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bilateral sensory permanent hearing loss (PHL) has been reported after neonatal respiratory failure but has rarely been noted in survivors after cardiac operations. We report the prevalence and severity of PHL after Norwood right ventricular-pulmonary artery shunt for hypoplastic left heart syndrome (HLHS), document progressive loss, and explore markers of acute illness and ototoxic medications for PHL. METHODS This interprovincial longitudinal outcome study after neonatal complex cardiac operations at Stollery Children's Hospital, Edmonton, Alberta, Canada, 2002 to 2007, completed repeated diagnostic audiologic assessments for all survivors by registered pediatric-experienced audiologists. Demographic, surgical, and perisurgical variables, including ototoxic medications, were collected. The association of potentially predictive variables with PHL and its severity were determined by univariate analysis and multiple logistic and linear regression analysis. RESULTS At an age older than 3.5 years, progressive PHL was present in 12 of 42 survivors (28.6%, 95% confidence interval, 16.2% to 44.8%; mortality, 20.9%). Overall lowest partial pressure of arterial oxygen (odds ratio, 1.315; 95% confidence interval, 1.051 to 1.506), and cumulative dose of furosemide given as bolus (odds ratio, 1.062; 95% confidence interval, 1.018 to 1.109) combined to predict PHL and gave 39% of the variance of PHL severity. Antibiotics and neuromuscular blockers were not associated with PHL. CONCLUSIONS Monitoring outcomes of neonates after HLHS surgery revealed unexpected PHL associated with hypoxia and bolus administration of furosemide. As survival improves, close follow-up is necessary to identify outcomes and seek modifiable predictive variables. Changes in the mode of furosemide administration may prevent this complication.
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Affiliation(s)
- Charlene M T Robertson
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada.
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40
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Cooper AC, Commers AR, Finkelstein M, Lipnik PG, Tollefson LM, Wilcox RA, Hoff DS. Otoacoustic Emission Screen Results in Critically Ill Neonates Who Received Gentamicin in the First Week of Life. Pharmacotherapy 2011; 31:649-57. [DOI: 10.1592/phco.31.7.649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vella-Brincat JWA, Begg EJ, Robertshawe BJ, Lynn AM, Borrie TL, Darlow BA. Are gentamicin and/or vancomycin associated with ototoxicity in the neonate? A retrospective audit. Neonatology 2011; 100:186-93. [PMID: 21455009 DOI: 10.1159/000324857] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aminoglycoside-induced ototoxicity has been reported in neonates but its incidence is poorly defined, whereas vancomycin-induced ototoxicity has not been reported in neonates. OBJECTIVE To compare hearing test results in infants in a neonatal intensive care unit (NICU) who were or were not treated with extended interval gentamicin dosing and/or standard vancomycin dosing. METHOD A database of otoacoustic emissions (OAE), over a 5-year period of NICU admissions, was combined with databases of gentamicin and vancomycin dosing to compare patients treated or not treated with these antibiotics. RESULTS A total of 2,347 OAE results was available. OAE failure rates were: no gentamicin and no vancomycin (noGnoV), 7% (85/1,233); gentamicin but no vancomycin (GnoV), 4% (42/949); vancomycin but no gentamicin (VnoG), 22% (9/41) and gentamicin and vancomycin (GandV), 14% (17/124). Compared to noGnoV there was a decreased risk of OAE failure in GnoV (p = 0.022, OR 0.64, 95% CI 0.44-0.94) and an increased risk in VnoG (p = 0.003, OR 3.46, 95% CI 1.54-7.75) and GandV, (p = 0.006, OR 2.20, 95% CI 1.26-3.83). CONCLUSIONS Gentamicin, as used and evaluated in this audit, showed no evidence of an increased risk of ototoxicity; what was observed was a statistically significant decrease in OAE failure rate. Vancomycin, by contrast, was associated with ototoxicity.
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Abstract
Furosemide, a potent loop diuretic, is frequently used in different stages of acute kidney injury, but its clinical roles remain uncertain. This review summarises the pharmacology of furosemide, its potential uses and side effects, and the evidence of its efficacy. Furosemide is actively secreted by the proximal tubules into the urine before reaching its site of action at the ascending limb of loop of Henle. It is the urinary concentrations of furosemide that determine its diuretic effect. The severity of acute kidney injury has a significant effect on the diuretic response to furosemide; a good 'urinary response' may be considered as a 'proxy' for having some residual renal function. The current evidence does not suggest that furosemide can reduce mortality in patients with acute kidney injury. In patients with acute lung injury without haemodynamic instability, furosemide may be useful in achieving fluid balance to facilitate mechanical ventilation according to the lung-protective ventilation strategy.
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Affiliation(s)
- K M Ho
- Royal Perth Hospital and University of Western Australia, Perth, WA, Australia.
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So TY. Use of ototoxic medications in neonates-the need for follow-up hearing test. J Pediatr Pharmacol Ther 2009; 14:200-3. [PMID: 23055904 DOI: 10.5863/1551-6776-14.4.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tsz-Yin So
- Department of Pharmacy, Moses H. Cone Hospital, Greensboro, North Carolina
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Affiliation(s)
- Daphne T. Hsu
- From the Division of Pediatric Cardiology (D.T.H.), Children’s Hospital at Montefiore and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; and Heart Development and Structural Diseases Branch (G.D.P.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
| | - Gail D. Pearson
- From the Division of Pediatric Cardiology (D.T.H.), Children’s Hospital at Montefiore and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; and Heart Development and Structural Diseases Branch (G.D.P.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
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Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am 2009; 56:579-600, Table of Contents. [PMID: 19501693 PMCID: PMC3586568 DOI: 10.1016/j.pcl.2009.04.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rapid evaluation of a neonate who is cyanotic and in respiratory distress is essential for achieving a good outcome. Persistent pulmonary hypertension of the newborn (PPHN) can be a primary cause or a contributing factor to respiratory failure, particularly in neonates born at 34 weeks or more of gestation. PPHN represents a failure of normal postnatal adaptation that occurs at birth in the pulmonary circulation. Rapid advances in therapy in recent years have led to a remarkable decrease in mortality for the affected infants. Infants who survive PPHN are at significant risk for long-term hearing and neurodevelopmental impairments, however. This review focuses on the diagnosis, recent advances in management, and recommendations for the long-term follow-up of infants who have PPHN.
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Robertson CMT, Howarth TM, Bork DLR, Dinu IA. Permanent bilateral sensory and neural hearing loss of children after neonatal intensive care because of extreme prematurity: a thirty-year study. Pediatrics 2009; 123:e797-807. [PMID: 19403472 DOI: 10.1542/peds.2008-2531] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We present population-based, childhood prevalence rates of and neonatal risk factors for permanent hearing loss among extremely premature infants. METHODS By using an inception-cohort, longitudinal study design for 1974-2003, we studied permanent hearing loss among 1279 survivors with gestational age of < or =28 weeks and birth weight of <1250 g (mortality rate: 42.7%; lost to follow-up monitoring: 4.7%) Newborn hearing screening, performed by experienced pediatric audiologists, used click-evoked auditory brainstem response testing after 1975. Survivors underwent repeated behavioral audiologic testing and multidisciplinary follow-up monitoring. Permanent hearing loss was defined as mild/moderate (26-70 dB hearing level), severe/profound (71 to >90 dB hearing level), delayed-onset (diagnosed after previously normal hearing), or progressive (increase in loss of > or =15 dB hearing level). Permanent hearing loss rates were established at 3 years of age, with newborn, infant, and >5-year final hearing outcomes being recorded. Risk factors were compared for children with and without hearing loss, odds ratios were calculated, and prediction performance was determined through area under the curve analysis. RESULTS Forty (3.1%) of 1279 survivors 3 years of age had permanent hearing loss and 24 (1.9%) had severe/profound loss, with no changes over time. Bilateral delayed-onset loss occurred for 4 children (10%) and progressive loss for 11 children (28%). One child had auditory neuropathy, and 29 (73%) had multiple disabilities. Prolonged oxygen use, gastrointestinal surgery, patent ductus arteriosus ligation, and low socioeconomic index yielded good prediction of permanent hearing loss; oxygen use was the most significant predictor of severe/profound loss. CONCLUSIONS Permanent hearing loss remains an adverse outcome of extreme prematurity, complicated by significant delayed-onset and progressive loss. Prolonged supplemental oxygen use is a marker for predicting permanent hearing loss; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of permanent hearing loss.
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Affiliation(s)
- Charlene M T Robertson
- Section of Neurosciences, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Eriksen V, Nielsen LH, Klokker M, Greisen G. Follow-up of 5- to 11-year-old children treated for persistent pulmonary hypertension of the newborn. Acta Paediatr 2009; 98:304-9. [PMID: 18976361 DOI: 10.1111/j.1651-2227.2008.01065.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Determine the prevalence of sensorineural hearing loss (SNHL) and relate this to cumulative exposure to hypoxia, hypocapnia and hypotension. Describe chronic health problems among 5- to 11-year-old children treated for persistent pulmonary hypertension of the newborn (PPHN). METHODS The index group consisted of 85 children and a reference group was matched for age, sex and municipality of current residence. Questionnaires were sent to the families. The families in the index group were asked to participate in an examination of their child's hearing. RESULTS Seven children (11%) had SNHL. SNHL was not associated with hypoxia, hypocapnia or hypotension during treatment for PPHN. In the index group chronic health problems were reported in 42% compared with 17% in the reference group (chi-square test, p = 0.001). Twenty-one percent in the index group were treated with bronchodilator therapy compared with 8% in the reference group (chi-square test, p = 0.028). In the index group five children had cerebral palsy and two had developmental delay. Nineteen percent in the index group and 5% in the reference group had remedial education (chi-square test, p = 0.008). CONCLUSION Children treated for PPHN are at high risk for SNHL. Exposure to hypoxia, hypocapnia or hypotension did not predict SNHL. The incidence of chronic health problems and use of remedial education was high.
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Affiliation(s)
- Vibeke Eriksen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Hosono S, Ohno T, Kimoto H, Shimizu M, Takahashi S, Harada K. Developmental outcomes in persistent pulmonary hypertension treated with nitric oxide therapy. Pediatr Int 2009; 51:79-83. [PMID: 19371283 DOI: 10.1111/j.1442-200x.2008.02664.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to assess 3 year auditory and neurodevelopmental outcomes of persistent pulmonary hypertension of the newborn (PPHN) before and after introducing inhaled nitric oxide (i-NO) therapy, and to detect the clinical factors affecting poor outcome. METHODS A retrospective historical cohort study of 26 survivors with PPHN with oxygenation index (OI) >or=25 (13 infants without i-NO therapy, control group; 13 with i-NO therapy, i-NO group) was performed. Auditory brainstem response (ABR) at 6 and 12 months and neurodevelopmental outcomes at 3 years of age were evaluated. RESULTS ABR abnormalities at 6 months were observed in one infant in the i-NO group and six in the control group (P = 0.04). At 1 year, one infant in the i-NO group and two of six infants in the control group still had ABR abnormality. In the i-NO group, two children had abnormal neurodevelopmental outcomes, as compared with five children in the control group at 3 year follow up. Two children in the control group and no children in the i-NO group had hearing loss at 3 years of age. Hypocapnea (P = 0.04) and elevated creatine phosphokinase (P = 0.04) were found to be most predictive for neurodevelopmental abnormality. CONCLUSION Avoidance of excessive hypocapnea via introduction of i-NO therapy might reduce both ABR and neurodevelopmental abnormalities.
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Affiliation(s)
- Shigeharu Hosono
- Division of Neonatology, Saitama Children's Medical Center, Saitama, Japan.
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Cristobal R, Oghalai JS. Hearing loss in children with very low birth weight: current review of epidemiology and pathophysiology. Arch Dis Child Fetal Neonatal Ed 2008; 93:F462-8. [PMID: 18941031 PMCID: PMC3597102 DOI: 10.1136/adc.2007.124214] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An association between birth weight <1500 g (very low birth weight (VLBW)) and hearing loss has been long recognised. As universal hearing screening programmes have become widely implemented and the survival rate of VLBW babies in modern intensive care units has increased, we have gained a substantially better understanding of the nature of this problem. However, many gaps in our knowledge base exist. This review describes recent data on hearing loss in the VLBW population and explains the current level of understanding about the physiological basis underlying the auditory deficits in these patients. Although VLBW alone may not have a severe impact on hearing, it is commonly associated with multiple other risk factors that can alter hearing in a synergistic fashion. Therefore, the risk of hearing loss is substantially higher than in the general newborn population. Also, it is important to perform a more comprehensive audiometric evaluation than standard otoacoustic emission screening for infants who are in the neonatal intensive care unit in order not to miss hearing loss due to retrocochlear pathology. Furthermore, children with VLBW are also at increased risk of experiencing progressive or delayed-onset hearing loss, and thus should continue to have serial hearing evaluations after discharge from the neonatal intensive care unit.
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Affiliation(s)
- R Cristobal
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - J S Oghalai
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA,The Hearing Center at Texas Children’s Hospital, Houston, Texas, USA,Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA,Department of Bioengineering, Rice University, Houston, Texas, USA
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McGlone A, Cranswick N. Evidence behind the WHO guidelines: Hospital care for children: what is the evidence of safety of gentamicin use in children? J Trop Pediatr 2008; 54:291-3. [PMID: 18710895 DOI: 10.1093/tropej/fmn059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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