Risk of hearing loss in small for gestational age neonates

Melani Rakhmi Mantu; Lelani Reniarti; Sjarif Hidajat Effendi

doi:10.14238/pi51.1.2011.52-7

Melani Rakhmi Mantu Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin General Hospital, Bandung, West Java
Lelani Reniarti Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin General Hospital, Bandung, West Java
Sjarif Hidajat Effendi Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin General Hospital, Bandung, West Java

DOI: https://doi.org/10.14238/pi51.1.2011.52-7

Keywords: small for gestational age, appropriate for gestational age, hearing loss, otoacoustic emission

Abstract

Background Small for gestational age (SGA) neonates often have intrauterine growth restriction due to placental insufficiency and chronic hypoxia. These conditions may cause developmental impairment, psychosocial disabilities, or metabolic dysfunction in later life. Previous studies have shown greater incidence of speech and language disabilities, learning impairment, and neuromotor dysfunction in term SGA infants compared to term appropriate for gestational age (AGA) infants.

Objective To compare hearing loss in SGA and AGA neonates using otoocoustic emission (OAE) tests and to study correlations between maternal risk factors and hearing loss in SGA neonates.

Methods A cross-sectional study was performed in St. Borromeus Hospital, Limijati Hospital, and Melinda Hospital in Bandung from February to May 2010. Study subjects consisted of full-term neonates born in these three hospitals. A retrospective medical record review was performed for this study. Statistical analysis was done by multivariable logistic-regression.

Results There was a total of 4279 subjects in our study, including 100 SGA neonates and 4179 AGA neonates. We observed a greater percentage of OAE 'refer' (indicating abnormal OAE) results in the SGA group compared to the AGA group (P<0.001, Z=13.247). For suhjects with OAE 'refer' results, we also analyzed the correlation to the following maternal risk factors: smoking, hypertension, diabetes mellitus and asthma. We also found significant differences betweenÂ those with and without each of the four maternal risk factors studied (P< 0.001). By using multivariant analysis to compare SGA and AGA neonates, we found the odds ratio (OR) to he 4.34 (95% CI 2.52 to 7.49, P=0.001), meaning the SGA group had a 4.34 times higher risk of hearing loss than the AGA group.

Conclusion SGA neonates had a higher risk of hearing loss than AGA neonates. In addition, maternal smoking, hypertension, diabetes mellitus and asthma significantly correlated to hearing loss in all newborns. [

References

1. Sataloff RT, Sataloff j. Hearing loss in children. 3rd Ed. New York: Marcel Dekker; 2003. p. 910-6.
2. Hemy K. Audiologic screening of newborn infants who are at risk for hearing impairment. ASHA Guidelines. 1994;18:89-92.
3. Alkalay AL, Graham Jr JM, Pomerance JJ. Evaluation of neonates born with intrauterine growth retardation: review and practice guidelines.J Perinatol.I998;18:142-51.
4. Lee PA, Chernausek SD, Hokken-Koelega ACS, Czernichow P. International small for gestational age advisory board consensus development conference statement: management of short children born small for gestational age, April 24-0ctober 1, 2001. Pediatrics. 2003;111:1253-61.
5. Shalitin S, Lebenthal Y, Philip M. Children born small for gestational age: growth patterns, growth hormone treatment, and long-term sequele. Isr Med Assoc J. 2003;5 :877-82.
6. Hedinger ML, Overpeck MD, Maurer KK, Kuczmarski RJ, McGlynn A. Growth of infants and young children born small or large for gestational age: findings from the third national health and nutrition examination survey. Arch Pediatr Adolesc Med. 1998;152:1225-31.
7. Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med. 2005;353:1802-9.
8. Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev. 2007;28:219-51.
9. Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Consensus statement: management of the child born small for gestational age through to adulthood: a consensus statement of the international societies of pediatric endocrinology and the growth hormone research society. J Clin Endocrinol
Metab.2007;92:804-10.
10. Allen Me. Outcome and follow-up of high risk infant. In: Taeusch HW, Ballard RA, editors. Avery's diseases
of the newborn. 7th ed. Philadelphia: W.B. Saunders; 1998. p. 413-25.
11. Goldenberg RL, Hoffman HJ, Cliver SP. Neurodevelopmental outcome of small-for- gestational-age infants. [cited 27 Nov 2009]. Available from: www.unu. edujunupress.
12. Fried P, Watkinson B. 3 6 and 48 months neurobehavioural follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol. J Dev Behav Pediatr.1990;13:49-58.
13. Schwart R, Teramo K. Effects of diabetic pregnancy on the fetus and newborn. Semin Perinatol. 2000;24:120-
35.
14. Toland AE, Yankowitz J, Winder A, Imagire R, Cox VA, Aylsworth AS, et al. Oculoauriculovertebral abnormalities in children of diabetic mothers. Am J Med Gen. 2000;90:303-9.
15. BecerrajE, Khoury Mj, Cordero jF, EriksonjD. Diabetes mellitus during pregnancy and the risks for specific
birth defects: a population-based-case-control study. Pediatrics. 1990;85:1-9.
16. Wells MD. Pregnancy-induced hypertension and congenital hearing loss. J Ped Otorhinolaringol. 1991;22:39-47.
17. Davel S, Irusen EM, Hall D. Asthma in pregnancy - don't lose control. Curr Allergy Clin Immunol. 2009;22:1-9.
18. Martikainen M. Effects of intrauterine growth retardation and its subtypes on the development of the preterm infant. Early Human Dev. 1992;15:7-17.
19. Todorovich R, Cowell D, Kapuniai L. Auditory responsivity and intrauterine growth retardation in small for gestational age human newborns. Electroencephalogr Clin Neurophysiol. 1987;22:204-12.
20. Carine M. Physiological and pathological response to hypoxia. Am j Pathol. 2004;164:1875-82.
21. Zaputovic S, Stimac T, Propic I, Mahulja-Stamnekovic V, Medica 1. Molecular analysis in diagnostic procedure
of hearing impairment in newborns. J Pediatr. 2005;46:801-7.
22. joint Commitee of Infant Hearing (jCIH). Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120:898-921.
23. Pereira PK, Marins AS, Vieira MR, Azeve do MF. Newborn hearing screening program: association between hearing loss and risk factors. Pro-Fono Revista de Atualizacao Cientifica. 2007;11:267-78. 24. Maurer J. Otoacoustic emissions (OAEs). In: Maurer J, Noel PE, Risey JA. Otoacoustic emissions (OAEs) - SIPAC. 1st Ed. American Academy of OtolaringologyHead and Neck Surgery Foundation, 1997; p. 1-17.
25. HallJW. Assessment of peripheral and central auditory function. In: Bailey BJ, editor. Head and neck surgeryotolaringology. 3rd ed. Philadelphia: LippincottWilliams and Wilkins; 20m.p.I-I?