新生儿重症监护病房住院婴儿听力损失相关因素的报告：证据及其局限性的范围综述

文献信息

中文摘要

背景： 听力损失（HL）在新生儿重症监护病房（NICU）出院婴儿中远比在健康婴儿人群中常见。尽管已报告了许多定义宽泛的“危险因素”，但其因果相关性仍不明确。
目的： 我们进行了一项范围综述，以综合NICU和特殊护理 nursery（SCN）婴儿中报告的HL相关因素。随后我们评估了支持证据的强度。
数据来源： 检索了Embase、Medline、APA PsycInfo和Web of Science（2015年1月1日至2025年3月11日）。
研究选择与数据提取： 我们纳入了报告NICU/SCN出院婴儿中与HL相关因素的研究。评论、会议摘要、信件和病例报告/系列被排除。数据由两名评审员使用预先试用的Excel表格独立提取。
综合： 我们遵循PRISMA-ScR指南。报告的因素被分类为类别和广泛领域。我们总结了校正后关联并评价了证据，包括因果支持的指征。
结果： 96项研究符合纳入标准，识别出141个独特因素，这些因素被组织为六个领域和32个类别。没有符合条件的研究专门关注SCN婴儿。最常研究的因素为出生体重（38.5%）、高胆红素血症（25.0%）、Apgar评分（24.0%）、脓毒症（21.9%）和性别（20.8%）。效应估计值报告不频繁，且类别内证据高度异质。在四项研究（4.2%）中识别出对因果解释的支持，包括缺氧-缺血、伴惊厥的脑病、出生后CMV感染以及更高频率的万古霉素给药。证据受到混杂因素校正分析、前瞻性或试验设计以及具有充分随访的研究数量有限的限制。
结论： 关于NICU相关听力损失的文献包括许多反复报告的相关因素，但支持其因果作用的证据仍然有限且异质。因此，许多报告的因素尚不能解释为可信的预防靶点。需要设计更好的研究来估计因果效应，以支持以预防为导向的决策。

英文摘要

BACKGROUND: Hearing loss (HL) is far more common in neonatal intensive care unit (NICU) graduates than in well-baby populations. Although many broadly defined 'risk factors' have been reported, their causal relevance remains unclear.
OBJECTIVES: We conducted a scoping review to synthesise reported factors for HL among NICU and special care nursery (SCN) infants. We then assessed the strength of the supporting evidence.
DATA SOURCES: Embase, Medline, APA PsycInfo, and Web of Science were searched (1 Jan 2015-11 Mar 2025).
STUDY SELECTION AND DATA EXTRACTION: We included studies that reported factors associated with HL among NICU/SCN graduates. Commentaries, conference abstracts, letters, and case reports/series were excluded. Data were extracted independently by two reviewers using a piloted Excel spreadsheet.
SYNTHESIS: We followed PRISMA-ScR guidelines. Reported factors were classified into categories and broad domains. We summarised adjusted associations and appraised the evidence, including indications of causal support.
RESULTS: Ninety-six studies met the inclusion criteria, identifying 141 unique factors which were organised into six domains and 32 categories. No eligible study focused specifically on SCN infants. The most frequently studied factors were birthweight (38.5%), hyperbilirubinemia (25.0%), Apgar score (24.0%), sepsis (21.9%), and sex (20.8%). Effect estimates were infrequently reported, and evidence within categories was highly heterogeneous. Support for causal interpretation was identified in four studies (4.2%), including those of hypoxia-ischemia, encephalopathy with seizures, postnatal CMV infection, and higher frequency of vancomycin dosing. Evidence was limited by the small number of confounder-adjusted analyses, prospective or trial designs, and studies with adequate follow-up.
CONCLUSIONS: The literature on NICU-related hearing loss includes many repeatedly reported associated factors, but the evidence supporting their causal role remains limited and heterogeneous. As a result, many reported factors cannot yet be interpreted as credible prevention targets. Better-designed studies for estimating causal effects are needed to support prevention-oriented decision-making.