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目的:探讨新生儿不同血清胆红素水平对其听力的影响。方法:本院285例高胆红素血症新生儿,根据血清胆红素水平分为轻、中、重度组。于生后2周及6周采用瞬态耳声发射技术(TEOAE)对其听力进行二次筛查,第二次筛查未通过者3~6月龄进行听觉脑干诱发电位(ABR)检查。结果:二次筛查轻度及中度组TEOAE通过率比较差异无显著性(P>0.05),重度组与轻、中度组比较差异有显著性(P<0.01)。TEOAE通过率与血清胆红素水平呈负相关(P<0.01),第一次筛查已通过,第二次筛查TEOAE通过率轻度组为100%(86/86)、中度组为98.9%(91/92)、重度组为89.6%(26/29)。轻度组及中度组通过率差异无显著性(χ2=0.265,P>0.05),重度组与轻、中度组比较差异有显著性(χ2=10.65,8.23,P<0.01)。ABR检测表明重度组听力障碍发生率明显高于轻、中度组(χ2=5.762,5.23,P<0.05)。结论:轻、中度血清胆红素升高对新生儿听力影响较小,而重度高胆红素血症是造成新生儿听力障碍的高危因素。重度高胆红素血症新生儿应重复筛查听力,避免漏诊。
Objective: To investigate the effect of different serum bilirubin levels on hearing ability of neonates. Methods: 285 newborns with hyperbilirubinemia in our hospital were divided into mild, moderate and severe groups according to serum bilirubin level. At 2 weeks and 6 weeks after birth, transient hearing otoacoustic emission (TEOAE) was used to screen their hearing, and auditory brainstem response (ABR) was performed at 3 to 6 months after the second screening . Results: There was no significant difference in passing rate of TEOAE between mild and moderate groups (P> 0.05). There was significant difference between severe group and mild and moderate groups (P <0.01). The TEOAE passage rate was negatively correlated with serum bilirubin level (P <0.01). The first screening was passed. In the second screening, the TEOAE passage rate was 100% (86/86) in mild group and moderate 98.9% (91/92), severe group was 89.6% (26/29). There was no significant difference in pass rate between mild group and moderate group (χ2 = 0.265, P> 0.05). There was significant difference between severe group and mild and moderate groups (χ2 = 10.65, 8.23, P <0.01). ABR test showed that the incidence of hearing loss in severe group was significantly higher than that in mild and moderate group (χ2 = 5.762,5.23, P <0.05). Conclusion: The mild and moderate serum bilirubin has little effect on newborn hearing, while severe hyperbilirubinemia is the high risk factor of neonatal hearing impairment. Severe hyperbilirubinemia neonates should be repeated screening of hearing, to avoid missed diagnosis.