新生儿自动听性脑干反应初筛检测时长和影响因素的分析

Duration of automated auditory brainstem response test for the initial hearing screening and influencing factors for the duration in neonates

摘要:

目的 探讨新生儿自动听性脑干反应（AABR）的初筛检测时长和影响检测时长的因素。方法 选择新生儿重症监护病房（NICU）472例新生儿为研究组，正常新生儿182例为健康对照组，评估两组新生儿首次AABR检测时间对检测结果的影响，并分析影响NICU新生儿AABR检测时长的危险因素。结果 研究组在AABR检测时间180 s、360 s和540 s的人数不通过率分别为41.5%、28.4%、24.4%，健康对照组分别为31.3%、19.8%、15.4%，均随检测时间延长呈下降趋势（P < 0.05）。两组检测时间180 s与360 s、540 s的检测结果一致性一般（Kappa < 0.75，P < 0.05），360 s与540 s的检测结果一致性较好（Kappa > 0.75，P < 0.05）。研究组中位AABR检测时长为108 s（95% CI：97~120 s），长于健康对照组（中位时长75 s，95% CI：65~85 s）（P < 0.05）。Cox回归分析显示，延长AABR检测时长的危险因素包括母亲年龄≥35岁、贫血、电解质紊乱（RR < 1，P < 0.05），持续气道正压通气辅助呼吸时间延长为其保护因素（RR > 1，P < 0.05）。结论 新生儿AABR初筛检测时间延长至360~540 s有助于降低环境因素和危险因素导致的假阳性结果；对存在高危因素的NICU新生儿及时采取干预治疗措施可能有助于减少出院前AABR筛查假阳性结果。

Abstract:

Objective To study the duration of automated auditory brainstem response (AABR) test for initial hearing screening and the factors influencing the duration in neonates. Methods A total of 472 neonates who were admitted to the neonatal intensive care unit (NICU) were enrolled as the study group and 182 healthy neonates were enrolled as the healthy control group. The influence of the duration of AABR test on the initial screening results was observed in the two groups. The influencing factors for the AABR test duration were analyzed. Results In the AABR screening of 180, 360, and 540 seconds, the study group had a failure rate of 41.5%, 28.4%, and 24.4% respectively, while the healthy control group had a failure rate of 31.3%, 19.8%, and 15.4% respectively, showing a decreasing trend with the extension of test time in both groups (P < 0.05). In the two groups, the screening results of 180-second testing were moderately consistent with those of 360- or 540-second testing (Kappa<0.75, P < 0.05), and the screening results of 360-second testing were highly consistent with those of 540-second testing (Kappa>0.75, P < 0.05). In the study group, the median duration of AABR test was 108 seconds (95%CI:97-120 seconds), which was significantly longer than the duration of 75 seconds (95%CI:65-85 seconds) in the healthy control group (P < 0.05). The Cox regression analysis showed that maternal age ≥ 35 years, anemia, and electrolyte disturbance (RR < 1, P < 0.05) were independent risk factors for prolonged AABR test duration, while the prolonged continuous positive airway pressure-assisted ventilation was a protective factor (RR > 1, P < 0.05). Conclusions The AABR test time of 360-540 seconds for initial hearing screening helps to reduce false positive results due to environmental and risk factors in neonates. It may be useful to reduce the false positive results of AABR screening before discharge by taking corresponding intervention measures for NICU neonates with high risk factors.