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Han Y, Li S, Song Y, Sun J, Yan W, Wang J, Gao X, Li X, Ren C, Zhao Q. Risk factors for infant hearing loss: a meta-analysis. Eur J Pediatr 2024; 183:2401-2409. [PMID: 38456989 DOI: 10.1007/s00431-024-05498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Hearing loss is a common disability in infants that significantly impacts their cognitive, language, and literacy development. This study aimed to systematically assess the risk factors for the early identification and intervention in infant hearing loss. Databases were searched for meta-analyses of observational studies until November 2023. The quality assessment was performed using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence. A meta-analysis identified 14 risk factors significantly associated with infant hearing loss. According to the GRADE approach, there were four factors with moderate-certainty evidence (low birth weight(LBW), congenital anomalies, craniofacial anomalies, intracranial hemorrhages), seven factors with low-certainty evidence (ototoxic medications, family history of hearing loss, mechanical ventilation > 5 days, intrauterine infection, admission to neonatal intensive care unit (NICU) > 5 days, mechanical ventilation and asphyxia) and six with extremely-low-certainty evidence (very low birth weight < 1500 g (VLBW), hyperbilirubinemia, sepsis or meningitis, male sex, premature birth, small for gestational age (SGA)). Nevertheless, no significant association was found between infant hearing loss and factors such as small for gestational age (SGA), male sex, and premature birth (P > 0.05). Conclusion: The identification of these 14 interrelated risk factors can prove advantageous in clinical practice, as these findings could guide hearing screening and parental counseling. Furthermore, prospective research could be conducted to develop risk-based scoring systems based on these factors. What is Known: • Infant hearing loss is a worldwide issue. • Risk factors for this condition are debated. What is New: • This is the first meta-analysis to comprehensively evaluate perinatal and postnatal risk factors for hearing loss in infants. • Intracranial hemorrhage, mechanical ventilation, and low birth weight are associated with infant hearing loss. However, no evidence of an association was found between premature birth, being small for gestational age, or male sex and hearing loss.
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Affiliation(s)
- Yiwei Han
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Shangbin Li
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yankun Song
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Jingfei Sun
- Department of Pediatrics, Zhengding People's Hospital, Shijiazhuang, 050000, China
| | - Weichen Yan
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Jie Wang
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiong Gao
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xueying Li
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Changjun Ren
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
| | - Qian Zhao
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
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Gutbir Y, Wainstock T, Sheiner E, Segal I, Sergienko R, Landau D, Walfisch A. Low Apgar score in term newborns and long-term infectious morbidity: a population-based cohort study with up to 18 years of follow-up. Eur J Pediatr 2020; 179:959-971. [PMID: 32016603 DOI: 10.1007/s00431-020-03593-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
Since introduced, the Apgar score has remained the most widespread predictor for neonatal morbidity and mortality. We aimed to investigate the association between low 5-min Apgar score and long-term infectious pediatric morbidity. A population-based cohort analysis was performed comparing total and specific subtypes of infectious morbidity leading to hospitalization among term newborns with normal (≥ 7) and low (< 7) 5-min Apgar scores, born between 1999 and 2014 at a single tertiary regional hospital. Infectious morbidity included hospitalizations involving a pre-defined set of infection-related ICD-9 codes. A Kaplan-Meier survival curve was constructed to compare cumulative infectious morbidity incidence and a Cox proportional hazards model to adjust for confounders. The long-term analysis of 223,335 children (excluding perinatal death cases) yielded 585 (0.3%) infants with low 5-min Apgar scores. The rate of infection-related hospitalizations was 9.8% and 12.4% among newborns with normal and low 5-min Apgar scores, respectively (p = 0.06). Adjusting for maternal age, gestational age, hypertension, diabetes, cesarean delivery, and fertility treatments, the association proved to be statistically significant (adjusted HR = 1.28; 95% CI 1.01-1.61).Conclusion: Term infants with low 5-min Apgar scores may be at an increased risk for long-term pediatric infectious morbidity.What is Known:• Though not meant to be a prognostic tool for long-term morbidity, studies assessing the correlation between low Apgar score and long-term outcomes were and are being performed, reporting significant associations with many outcomes-such as cerebral palsy (CP), ophthalmic disorders, GI disorders, and several types of malignancies.• Yet, an association between low Apgar scores and future health remains a matter of controversy.What is New:• Our work shows that a low 5-min Apgar score is independently associated with long-term pediatric infection-related hospitalizations among term singleton newborns.
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Affiliation(s)
- Yuval Gutbir
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,, Ramat Gan, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ernest E, Wainstock T, Sheiner E, Segal I, Landau D, Walfisch A. Apgar score and long-term respiratory morbidity of the offspring: a population-based cohort study with up to 18 years of follow-up. Eur J Pediatr 2019; 178:403-411. [PMID: 30627856 DOI: 10.1007/s00431-018-03311-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/27/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022]
Abstract
The objective of this study is to investigate whether a significant association exists between low 5-min Apgar scores (< 7) and respiratory morbidity of the offspring. A population-based cohort analysis was performed comparing subtypes of respiratory morbidity leading to hospitalizations among children (up to age 18 years) stratified by their 5 min Apgar scores. Data were collected from two databases of a regional tertiary center. All singleton deliveries occurring between 1991 and 2014 were included in the analysis. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory-related hospitalization incidence and a Cox proportional hazards model to control for confounders. Deliveries (238,622) met the inclusion criteria. Low 5-min Apgar scores were recorded in 742 (0.3%) newborns. Incidence of respiratory hospitalizations was higher among the low 5 min Apgar score group (7.3 vs. 4.8% in the normal [≥ 7] 5 min Apgar score group; OR = 1.5, 95%CI 1.2-2.0, p = 0.003). Association remained significant in the Cox model (aHR = 1.4, 95%CI 1.1-1.9, p = 0.01). Incidence of respiratory-related hospitalizations in preterm born offspring was higher among the low vs. the normal 5 min Apgar score groups (13.4 vs. 7.2%, OR = 2.0, 95%CI 1.2-3.1 , p = 0.008). Association remained significant in the multivariable analysis (aHR = 1.6, 95%CI 1.1-2.5, p = 0.03). The survival curves demonstrated significantly higher cumulative respiratory morbidity in the low Agar score group for the entire cohort and for the preterm born subgroup.Conclusion: Newborns, of any gestational age, with low 5 min Apgar scores appear to be at an increased risk for pediatric respiratory morbidity. What is Known: • Apgar score is a method for assessment of the medical condition of a newborn, and of the need for medical intervention and/or resuscitation. Studies assesing the correlation between low Apgar score and short or long term outcomes report a sgnificant correlation with different outcomes including neurological development and more. As two of its five components (color and respiratory effort) are utilizing the respiratory status, low Apgar scoreis associated with a higher risk for immedisate respiratory morbidity. What is New: • Low Apgar score increases the chances for several long-term respiratory-related morbidities, independent of gestational age and other obstetrical circumstances.
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Affiliation(s)
- Elisha Ernest
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B 653, 8410501, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Leinonen E, Gissler M, Haataja L, Rahkonen P, Andersson S, Metsäranta M, Rahkonen L. Low Apgar scores at both one and five minutes are associated with long-term neurological morbidity. Acta Paediatr 2018; 107:942-951. [PMID: 29359524 DOI: 10.1111/apa.14234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/29/2017] [Accepted: 01/17/2018] [Indexed: 11/27/2022]
Abstract
AIM This study evaluated the associations between low Apgar scores at one and five minutes and long-term neurological impairments. METHODS This study used population-based data on 399,815 singletons born in Finland in 2004-2010 and multivariable logistic regression to examine any associations between low (0-3) and intermediate (4-6) Apgar scores and cerebral palsy, epilepsy, intellectual disability and sensorineural defects by the age of four years. RESULTS The odd ratios (OR) and 95% confidence intervals (95% CI) showed that low Apgar scores were associated with cerebral palsy at one and five minutes (ORs 2.08, 95% CI 1.32-3.26 and 5.19, 95% CI 3.06-8.80), epilepsy (ORs 1.62, 95% CI 1.13-2.33 and 4.79, 95% CI 3.03-7.56), and intellectual disability (ORs 2.46, 95% CI 1.45-4.16 and 6.21, 95% CI 3.33-11.58). Only a low five-minute Apgar score was associated with sensorineural defects (OR 3.13, 95% CI 1.95-5.02). Neurological impairment risks were increased by low Apgar scores at both one and five minutes (OR 11.1, 95% CI 8.6-14.5), but 90.3% of children with persistent low Apgar scores had no impairment. CONCLUSION Low one-minute and five-minute Apgar scores were associated with long-term neurological morbidity, especially when both scores were low.
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Affiliation(s)
- Elina Leinonen
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Mika Gissler
- Information Services Department; National Institute for Health and Welfare; Helsinki Finland
- Division of Family Medicine; Department of Neurobiology, Care Sciences and Society; Karolinska Institute; Stockholm Sweden
| | - Leena Haataja
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Petri Rahkonen
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Sture Andersson
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Marjo Metsäranta
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology; University of Helsinki; Helsinki University Hospital; Helsinki Finland
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Leite JN, Silva VS, Buzo BC. Emissões otoacústicas em recém-nascidos com hipóxia perinatal leve e moderada. Codas 2016; 28:93-8. [DOI: 10.1590/2317-1782/20162015086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/02/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução Atualmente, somente a hipóxia neonatal grave (evidenciada pelo valor do Apgar) é considerada risco para a deficiência auditiva. A hipóxia é uma das causas mais comuns de lesão e morte celular. Nos casos de hipóxia leve ou moderada, embora menor, a privação da oxigenação está presente e, dessa forma, algum dano ao sistema auditivo pode ocorrer. Objetivo Investigar as amplitudes das emissões otoacústicas em recém-nascidos a termo sem risco para deficiência auditiva que apresentaram hipóxia leve ou moderada. Métodos Foram selecionados 37 recém-nascidos de ambos os sexos, divididos em dois grupos: 25 do grupo controle, formado por recém-nascidos sem hipóxia, e 12 do grupo estudo, formado por recém-nascidos com hipóxia leve ou moderada. Resultados Foram pesquisadas as EOAT e EOAPD em ambos os grupos e comparados os seus resultados. Nas EOAPD foram encontradas diferenças estatísticas entre as amplitudes nas frequências 1.000, 2.800, 4.000 e 6.000 Hz. Nas EOAT foram encontradas diferenças estatísticas nas bandas de frequência de 1.000, 1.400, 2.000, 2.800 e 4.000 Hz, sendo as EOA do grupo estudo menores que as do grupo controle. Conclusão Embora a ocorrência de hipóxia neonatal leve e moderada não seja considerada risco para perda auditiva, a mínima privação do oxigênio durante o momento de hipóxia neonatal parece interferir no funcionamento das células ciliadas externas e, consequentemente, no nível de respostas das emissões otoacústicas. Dessa forma, faz-se necessário o acompanhamento longitudinal desses lactentes, a fim de identificar o possível impacto desses resultados na aquisição de linguagem e, futuramente, no desempenho escolar.
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Tweed EJ, Mackay DF, Nelson SM, Cooper SA, Pell JP. Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children. Arch Dis Child Fetal Neonatal Ed 2016; 101:F121-6. [PMID: 26297221 DOI: 10.1136/archdischild-2015-308483] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. METHODS Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. RESULTS Of the 751,369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49,962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0-3, 10.1% had ASN, compared with 9.1% of those scoring 4-7 and 6.6% of those scoring 7-10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. CONCLUSIONS Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level.
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Affiliation(s)
- Emily J Tweed
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Sally-Ann Cooper
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
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Sedation and anesthesia of hatchling leatherback sea turtles (Dermochelys coriacea) for auditory evoked potential measurement in air and in water. J Zoo Wildl Med 2014; 45:86-92. [PMID: 24712166 DOI: 10.1638/2013-0183r.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Sedation or anesthesia of hatchling leatherback sea turtles was employed to acquire auditory evoked potential (AEP) measurements in air and in water to assess their hearing sensitivity in relation to potential consequences from anthropogenic noise. To reduce artifacts in AEP collection caused by muscle movement, hatchlings were sedated with midazolam 2 or 3 mg/kg i.v. for in-air (n = 7) or in-water (n = 11) AEP measurements; hatchlings (n = 5) were anesthetized with ketamine 6 mg/kg and dexmedetomidine 30 microg/kg i.v. reversed with atipamezole 300 microg/kg, half i.m. and half i.v. for in-air AEP measurements. Midazolam-sedated turtles were also physically restrained with a light elastic wrap. For in-water AEP measurements, sedated turtles were brought to the surface every 45-60 sec, or whenever they showed intention signs for breathing, and not submerged again until they took a breath. Postprocedure temperature-corrected venous blood pH, pCO2, pO2, and HCO3- did not differ among groups, although for the midazolam-sedated in-water group, pCO2 trended lower, and in the ketamine-dexmedetomidine anesthetized group there was one turtle considered clinically acidotic (temperature-corrected pH = 7.117). Venous blood lactate was greater for hatchlings recently emerged from the nest than for turtles sedated with midazolam in air, with the other two groups falling intermediate between, but not differing significantly from the high and low lactate groups. Disruptive movements were less frequent with anesthesia than with sedation in the in-air group. Both sedation with midazolam and anesthesia with ketamine-dexmedetomidine were successful for allowing AEP measurements in hatchling leatherback sea turtles. Sedation allowed the turtle to protect its airway voluntarily while limiting flipper movement. Midazolam or ketamine-dexmedetomidine (and reversal with atipamezole) would be useful for other procedures requiring minor or major restraint in leatherback sea turtle hatchlings and other sea turtles, although variable susceptibilities may require dose adjustments.
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