Comparison of brainstem auditory evoked response at different click rates between preterm babies after neonatal necrotizing enterocolitis and healthy preterm babies

Preterm babies treated with lengthy continuous positive airway pressure are associated with moderate auditory abnormality

AIMS

Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of neonatal respiratory distress for over four decades, but it remains very poorly understood whether there is any brainstem auditory abnormality in babies treated with CPAP. We aimed to detect brainstem auditory abnormality at 34-35 weeks of corrected age in preterm babies treated with CPAP and define any difference between different durations of CPAP treatment.

STUDY DESIGN

Preterm babies were recruited and dichotomized to those with CPAP treatment (CPAP group, n = 67) and those without CPAP treatment (n-CPAP group) (n = 49). Brainstem auditory evoked response (BAER) was studied at 34-35 weeks of corrected age.

RESULTS

Compared with the n-CPAP group, the CPAP group manifested moderately elevated BAER threshold and significantly prolonged latencies of BAER waves III and V and I-V interval. The prolongation was generally more significant in the babies with longer duration of CPAP treatment than those with shorter duration. The I-V interval in the babies with CPAP treatment for >30 days were significantly longer than those with fewer days of CPAP treatment.

CONCLUSION

At 34-35 weeks of corrected age, preterm babies treated with CPAP are associated with moderate auditory abnormality. Further study is warranted to explore more detail of the auditory abnormality in babies treated with CPAP.

Functional status of brainstem auditory pathway in babies born below 30 week gestation with necrotizing enterocolitis

OBJECTIVE

Recent studies showed that neonatal necrotizing enterocolitis (NEC) adversely affects the brainstem auditory pathway in babies born at 30-40 week gestation. We compared the functional status of the pathway between babies born below 30 week gestation with NEC and those without NEC for any differences to understand whether NEC also affects the pathway in babies born at a smaller gestation.

METHOD

Brainstem auditory evoked response was studied at term in NEC babies born below 30 week gestation. The data obtained were compared with age-matched non-NEC babies for any abnormalities, and then compared with previously reported NEC babies born at 30-34 week gestation for any differences.

RESULTS

Although the latencies of waves I and III did not differ significantly between NEC and non-NEC babies, wave V latency in NEC babies was longer than in non-NEC babies at all click rates used. In particular, I-V interpeak interval, reflecting brainstem conduction time, in NEC babies was significant longer than in non-NEC babies. Wave V amplitude and the V/I amplitude ratios in NEC babies was smaller than in non-NEC babies at some click rates. The I-V interval in our NEC babies born below 30 week gestation was longer than in previously reported NEC babies born at 30-34 week gestation at all click rates.

CONCLUSION

NEC babies born below 30 week gestation are associated with delayed brainstem conduction time. Functional status of the brainstem auditory pathway in NEC babies born below 30 week gestation is less favorable than that in those with greater gestation.

Continuous positive airway pressure treatment may negatively affect auditory maturation in preterm infants

AIM

Nasal continuous positive airway pressure (CPAP) devices generate loud noise, which might harm auditory function and maturation. The function of auditory pathways can be examined by using brainstem auditory evoked potential (BAEP) and brainstem audiometry (BA) recordings. Our objective was to study whether CPAP treatment during the neonatal period is associated with abnormalities in BAEP and BA recordings.

METHODS

Included in this retrospective study were preterm infants (birth weight ≤1500 g and/or gestational age ≤32 weeks) born between 2002 and 2006 with a comprehensive clinical background and follow-up data, including the duration of CPAP treatment (n = 162). BAEP and BA were recorded near the mean corrected age of one month. The following variables from BAEP and BA examinations were analysed: latencies of BAEP components I, III, V, interpeak intervals (IPI) I-V, I-III, III-V (ms), amplitude I and V (µV), amplitude ratio I/V and BA thresholds.

RESULTS

In the adjusted analysis, a longer CPAP treatment leads to longer latencies of BAEP component III (p = 0.01) and V (p = 0.02) in the right ear.

CONCLUSION

CPAP treatment may impair the auditory maturation and processing mediated via the dominant right ear. The hearing and neurodevelopment of the children who are treated with CPAP should be followed.

Necrotizing Enterocolitis in Neonates: Has the Brain Taken a Hit 10 Years Later?

Background:

The neonate with necrotizing enterocolitis (NEC) is at risk of developing poor neurodevelopmental outcomes. There is a dearth of long-term follow-up studies in this field, with a majority of studies reporting a follow-up duration of 2 years. The aim of this study was to assess neurodevelopment of babies diagnosed with NEC more than a decade ago. This study was carried out in a tertiary hospital with neonatal surgery and intensive care units.

Materials and Methods:

Retrospective review of notes and telephone interviews with parents of babies diagnosed with NEC between January 2007 and December 2008 was conducted. Evidence of motor, cognitive, and sensory impairment was recorded. Fisher’s exact, χ², and unpaired t-tests were used. P-values <0.05 were considered significant.

Results:

Overall mortality in this cohort was 31%. Eighteen patients were followed up to an average age of 11.2 years. Of the 18 patients, 11 (61%) had a neurological impairment. Of the 15 surgically managed patients, 10 (67%) had an impairment and, of the 3 medically managed patients, 1 (33%) had an impairment. Cognitive impairment was the most common (10/18, 56%), followed by motor (6/18, 33%). Ten of 18 (56%) had special education needs, 9 of 18 (50%) had learning difficulties, 6 of 18 (33%) had speaking difficulties, and 4 of 18 (22%) had cerebral palsy. Patients also had behavioral conditions (3/18, 17%), visual impairment (2/18, 11%), and seizures (2/18, 11%).

Conclusion:

In the field of NEC, there is a hidden neurological burden that neonatal surgeons bequeath to the community. Sixty-one percent of patients are neurologically impaired, affecting the quality of life and function in the long-term. There should be appropriate parent counseling at the point of diagnosis and regular development checks for children with NEC.

Neurodevelopmental impairment in necrotising enterocolitis survivors: systematic review and meta-analysis

AIM

To determine (1) the incidence of neurodevelopmental impairment (NDI) in necrotising enterocolitis (NEC), (2) the impact of NEC severity on NDI in these babies and (3) the cerebral lesions found in babies with NEC.

METHODS

Systematic review: three independent investigators searched for studies reporting infants with NDI and a history of NEC (PubMed, Medline, Cochrane Collaboration, Scopus). Meta-analysis: using RevMan V.5.3, we compared NDI incidence and type of cerebral lesions between NEC infants versus preterm infants and infants with medical vs surgical NEC.

RESULTS

Of 10 674 abstracts screened, 203 full-text articles were examined. In 31 studies (n=2403 infants with NEC), NDI incidence was 40% (IQR 28%-64%) and was higher in infants with surgically treated NEC (43%) compared with medically managed NEC (27%, p<0.00001). The most common NDI in NEC was cerebral palsy (18%). Cerebral lesions: intraventricular haemorrhage (IVH) was more common in NEC babies (26%) compared with preterm infants (18%; p<0.0001). There was no difference in IVH incidence between infants with surgical NEC (25%) and those treated medically (20%; p=0.4). The incidence of periventricular leukomalacia (PVL) was significantly increased in infants with NEC (11%) compared with preterm infants (5%; p<0.00001).

CONCLUSIONS

This study shows that a large proportion of NEC survivors has NDI. NEC babies are at higher risk of developing IVH and/or PVL than babies with prematurity alone. The degree of NDI seems to correlate to the severity of gut damage, with a worse status in infants with surgical NEC compared with those with medical NEC.

TRIAL REGISTRATION NUMBER

CRD42019120522.

Necrotizing Enterocolitis: Long Term Complications

Necrotizing enterocolitis (NEC) remains the most threatening gastrointestinal complication of prematurity leading to high mortality, morbidity and cost. Common complications of NEC include neurodevelopmental delay, failure to thrive, gastrointestinal problems including strictures and adhesions, cholestasis, short bowel syndrome with or without intestinal failure that can be difficult to manage. Infants who develop NEC benefit from close follow-up for early diagnosis and treatment of complications. Those who present with severe complications such as intestinal failure benefit from a multidisciplinary approach involving careful assessment and treatment. Studies done so far are limited in providing a long-term prognosis. Here we review some of these complications. More studies with a longer follow-up period are needed to better understand the later comorbidities that develop in babies with NEC.

Health-related quality of life and neurodevelopmental outcomes among children with intestinal failure

Treatment results of pediatric intestinal failure have improved markedly during the last decades. With improved survival the attention is turning to other essential outcomes including quality of life and neurodevelopment. So far, relatively few studies with limited number of patients and variable methodology have addressed these issues. Based on these studies using generic health related quality of life tools, children with intestinal failure demonstrate decreased physical health, while PN-dependence is also associated with compromised emotional functioning. Impairments of social functioning are frequently observed among older children and parents. Few recent studies on neurodevelopment imply significant impairments in motor and mental skills among children with intestinal failure despite small sample sizes and limited follow-up times. Development of a disease-specific survey designed for the pediatric intestinal failure population could better reveal the health issues with greatest impact on quality of life. Robust studies with appropriate methodology on neurodevelopment in pediatric intestinal failure with extended follow-up times are urgently needed. Quality of life and neurodevelopment requires greater attention from medical professionals managing children with intestinal failure.

Brainstem auditory evoked responses in small-for-gestational age babies born at 30 and less weeks of gestation

Brainstem auditory function in small-for-gestational age (SGA) babies born at 30 and less weeks of gestation is poorly understood. We recorded and analysed brainstem auditory evoked response (BAER) at term in babies born at 26-30 weeks of gestation with a birthweight <3rd centile. Compared with normal term appropriate-for-gestational age (AGA) babies, the preterm SGA babies showed a significant increase in all BAER wave latencies at all click rates of 21-91/s (p < 0.05-0.001). The I-V and III-V interpeak intervals were also increased (p < 0.01-0.001), while the I-III interval was marginally decreased at 91/s (p < 0.05). No significant abnormalities were seen in wave amplitudes. Compared with age-matched preterm AGA babies, the SGA preterm babies showed an increase in wave I latency and a decrease in I-III interval at 51 and 91/s (all p < 0.05). No major and consistent differences were found in the two groups of babies in BAER wave amplitude variables. The increased I-V interval in the preterm SGA babies was correlated inversely with occipito-frontal head circumference at time of testing.

CONCLUSION

Brainstem auditory function is deviant from the normal in SGA babies born at 30 and less weeks of gestation. There is delayed brainstem neural maturation, which is associated with a small head size, and slightly precocial maturation in the more peripheral brainstem auditory regions.

WHAT IS KNOWN

Intrauterine growth retardation has a subtle degree of adverse effect on central brainstem auditory pathway in preterm babies born at 31-36 weeks of gestation.

WHAT IS NEW

Brainstem neural maturation is delayed, with slightly precocial maturation in the more peripheral brainstem auditory regions, in SGA babies born at 30 and less weeks of gestation.

Brainstem auditory response findings in very preterm babies in the intensive care unit

BACKGROUND

There is a need to increase our understanding of whether there is compromised brainstem auditory function in very preterm babies in intensive care.

OBJECTIVES

To evaluate brainstem auditory function in preterm babies born at 32 weeks of gestation or earlier in the intensive care unit to detect any abnormality and the prevalence of the abnormality.

METHODS

We analyzed the brainstem auditory evoked response (BAER) at term in 156 babies born at 32 weeks of gestation or earlier in an intensive care unit. The data were compared to those of normal term babies to detect any differences.

RESULTS

The threshold of BAER was elevated in babies born at 32 weeks of gestation or earlier. All BAER wave latencies were significantly increased. The I-V interpeak interval was also increased. The amplitudes of BAER components tended to be reduced. Twenty-five (16.0%) babies in the intensive care unit had a BAER threshold elevation (>20 dB normal hearing level), suggesting peripheral auditory dysfunction. Thirty-three (21.1%) had an increased I-V interval, and 3 (1.9%) had a decreased V/I amplitude ratio, suggesting central or brainstem auditory dysfunction. Some babies had more than one BAER abnormality. As a whole, 51 (32.7%) babies had BAER abnormalities.

CONCLUSION

Very preterm babies in the intensive care unit are at a high risk for auditory dysfunction. At term, 1 in 3 of these babies has peripheral and/or central auditory dysfunction.