肯尼亚内罗毕早产儿新生儿听力筛查未通过的患病率及危险因素：一项前瞻性队列研究

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中文摘要

背景： 尽管全球儿童听力损失的疾病负担沉重，但在包括肯尼亚在内的许多低收入和中等收入国家，对普遍新生儿听力筛查（UNHS）指南的依从性仍然很低。由于相关的围产期和新生儿疾病，早产儿尤其容易面临听力损失风险增加。本研究旨在调查早产新生儿听力筛查未通过的患病率及危险因素。
方法： 我们在肯尼亚内罗毕的肯雅塔国家医院（KNH）和姆巴加蒂县转诊医院新生儿病房（NBUs）开展了一项基于医院的前瞻性队列研究。纳入胎龄≤34周出生的婴儿，并在出院前接受自动听性脑干反应（AABR）筛查。记录了婴儿特征、母亲人口学资料、妊娠并发症和新生儿疾病。采用logistic回归评估危险因素与听力筛查未通过之间的关联。
结果： 共对376名婴儿进行了筛查。平均胎龄为30.8周，半数以上为女性（54.5%）。其中，27名婴儿被转诊（单耳或双耳听力筛查未通过），患病率为7.2%。与任何母亲特征（如年龄、产前保健就诊和妊娠并发症）均无显著相关性。然而，在多变量校正后，克拉霉素仍独立相关（p=0.01），而窒息则呈边缘性关联（p=0.05）。
结论： 我们报告了早产儿中AABR新生儿听力筛查未通过的患病率为7.2%，显著高于一般新生儿人群的全球基线估计值。克拉霉素和出生窒息是唯一与听力筛查未通过相关的因素。这些发现强调了在肯尼亚和撒哈拉以南非洲实施并加强UNHS项目的重要性，并对早产儿和高危婴儿进行针对性随访，以实现早期发现和干预。

英文摘要

BACKGROUND: Despite the high burden of global childhood hearing loss, compliance with universal newborn hearing screening (UNHS) guidelines is low in many low- and middle-income countries, including Kenya. Preterm infants are especially prone to an increased risk of hearing loss due to the associated perinatal and neonatal morbidities. The objectives of this study were to investigate the prevalence and risk factors of failed hearing screening in preterm newborns.
METHODS: We conducted a hospital-based prospective cohort study of preterm infants at the Kenyatta National Hospital (KNH) and the Mbagathi County Referral Hospital newborn units (NBUs) in Nairobi, Kenya. Those born at ≤34 weeks' gestational age were recruited and underwent Automated Auditory Brainstem Response (AABR) screening before their discharge. Infant characteristics, maternal demographics, pregnancy complications and neonatal illnesses were documented. Logistic regression was used to assess associations between risk factors and failed hearing screening.
RESULTS: Screening was done on 376 infants. The average gestational age was 30.8 weeks and more than half were female (54.5%). Among these, 27 infants were referred (failed hearing screening either in one or both ears), a prevalence of 7.2%. There was no significant correlation with any maternal characteristics like age, attendance of antenatal care and pregnancy complications. However, after multivariable adjustment, clarithromycin remained independently associated (p=0.01) while asphyxia had a borderline association (p=0.05).
CONCLUSION: We report a prevalence of failed newborn hearing screening by AABR of 7.2% among preterm infants, substantially higher than the global baseline estimates for the general newborn population. Clarithromycin and birth asphyxia were the only factors associated with a failed hearing screening. These findings underscore the importance of implementing and strengthening UNHS programmes in Kenya and sub-Saharan Africa, with targeted follow-up of preterm and high-risk infants to enable early detection and intervention.