USA Surgery Today

The ill infant, term or preterm, is at risk for damage to the auditory system. Risk factors include congenital infections, shock, hypoxia, hyperbilirubinemia, and the use of ototoxic drugs. Between 2% and 12% of survivors of neonatal intensive care develop moderate to profound hearing loss (81). Preterm infants with birth weights of less than 1,500 g are at highest risk, with 9% to 17% affected (82:Aceon). Early detection of hearing impairment is critical for optimizing speech and language development.

In 1993, the National Institutes of Health Consensus Committee recommended that all infants be screened for hearing impairment prior to hospital discharge because past high-risk criteria identified only between 30% and 50% of the children born with hearing impairment (83:Aceon). Physiologic measures for detecting hearing loss include the otoacoustic emissions (OAEs) and the auditory brainstem response (ABR). The OAEs are sensitive to outer hair cell dysfunction and can be used to detect inner ear hearing loss, but not eighth nerve dysfunction. The ABR can detect auditory nerve and brainstem dysfunction, and is a sensitive method of screening for sensorineural hearing loss. If the OAEs or ABR is abnormal or equivocal, the infant should be referred for otologic, audiologic, and neurodevelopmental follow-up. Preterm infants should be at least 35 weeks postconceptional age before their initial hearing screen.