本文選題：新生兒　切入點(diǎn)：聽力篩查　出處：《重慶醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的:探討新生兒聽力篩查未通過的相關(guān)因素,為開展大規(guī)模的新生兒聽力篩查和聽力損傷高危人群的隨訪提供依據(jù)。 方法:對(duì)重慶醫(yī)科大學(xué)附屬兒童醫(yī)院新生兒病房2009年1月-2009年7月,719例住院患兒的聽力篩查資料進(jìn)行分析。記錄新生兒的性別、胎次、胎齡、分娩方式、出生體重、胎兒窘迫、出生窒息、孕早中期感冒史、母孕期用藥史、臍帶異常、妊娠合并癥、聽力障礙家族史、家居環(huán)境、顱面部畸形、呼吸道分泌物、血糖、黃疸、膽紅素腦病、缺血缺氧性腦病(hypoxic-ischemic encephalopathy,HIE)、肺動(dòng)脈高壓、敗血癥、化膿性腦膜炎、先天性宮內(nèi)感染(TORCHS)、肺炎、新生兒神經(jīng)行為評(píng)分(neonatal behavioral neurological assessment,NBNA)等臨床資料。同時(shí)用單因素χ2檢驗(yàn)和多因素Logistic回歸分析,篩選出新生兒聽力篩查未通過的相關(guān)因素。 結(jié)果: 1.本組719(1438耳)例新生兒中,聽力篩查未通過160例(22.3%),其中,左耳未通過48例(6.7%),右耳未通過28例(3.9%),雙耳未通過84例(11.7%)。 2.聽力初篩未通過的160例中,58例于日齡42天復(fù)查聽力篩查,失訪率達(dá)63.8%。復(fù)查聽力篩查未通過18例(31.0%),一耳未通過13例(22.4%),雙耳未通過5例(8.6%)。 3.719例患兒中血巨細(xì)胞病毒(cytomegalovirus,CMV)抗體陽(yáng)性338例(47.0%),其中IgG陽(yáng)性335例,IgG和IgM同時(shí)陽(yáng)性3例。102例血CMV抗體陽(yáng)性患兒的尿液標(biāo)本中, 2例CMV脫氧核糖核酸(deoxyribonucleic acid,DNA)聚合酶鏈反應(yīng)(polymerase chain reaction,PCR)陽(yáng)性(2.0%)。 4.160例聽力篩查未通過患兒NBNA(36±2)分,明顯低于通過組NBNA(37±1)分(t=3.841,P0.01)。NBNA≤31分,32-35分,≥36分三組的聽力篩查未通過率分別為63.6%,37.2%,19.5%。 5.單因素分析發(fā)現(xiàn),達(dá)到換血標(biāo)準(zhǔn)的高膽紅素血癥、膽紅素腦病、血CMV抗體陽(yáng)性、小于胎齡兒、NBNA≤35分、溶血性黃疸、黃疸起病時(shí)間≤1天、顱面部畸形可能與新生兒聽力篩查未通過有關(guān)(P 0.05)。性別、家居環(huán)境、分娩方式、胎次、胎齡、出生體重、孕早中期感染、母孕期用藥、臍帶異常、妊娠合并癥、胎兒窘迫、出生窒息、HIE、肺動(dòng)脈高壓、低血糖、梅毒、呼吸道分泌物較多、肺炎、敗血癥、細(xì)菌性腦膜炎與新生兒聽力篩查未通過無(wú)明顯相關(guān)關(guān)系(P 0.05)。 6.多因素Logistic回歸分析表明,達(dá)到換血標(biāo)準(zhǔn)的高膽紅素血癥、血CMV抗體陽(yáng)性、NBNA≤35分、顱面部畸形是新生兒聽力篩查未通過的相關(guān)因素(P 0.05,OR值分別為5.913,2.861,0.031,1.623;95%CI分別為1.852-18.87,1.067-7.669,1.037-2.135,1.123-2.34 7)。 結(jié)論: 1.我院住院新生兒聽力初篩未通過率22.3%,復(fù)篩未通過率31.0%。 2.達(dá)到換血標(biāo)準(zhǔn)的高膽紅素血癥、血CMV抗體陽(yáng)性、NBNA≤35分、顱面部畸形是新生兒聽力篩查未通過的相關(guān)因素。性別、家居環(huán)境、分娩方式、胎次、胎齡、出生體重、孕早中期感染、孕期用藥、臍帶異常、妊娠合并癥、胎兒窘迫、出生窒息、HIE、肺動(dòng)脈高壓、低血糖、梅毒、呼吸道分泌物較多、肺炎、敗血癥、細(xì)菌性腦膜炎與聽力篩查未通過無(wú)明顯相關(guān)關(guān)系。 3.NBNA越低,聽力篩查未通過率越高。 4.目前由于人力等醫(yī)療資源有限,開展大規(guī)模的新生兒聽力篩查有一定困難,應(yīng)該對(duì)具有聽力損傷相關(guān)因素的新生兒,即達(dá)到換血標(biāo)準(zhǔn)的高膽紅素血癥、血CMV抗體陽(yáng)性、NBNA≤35分和顱面部畸形等高危兒進(jìn)行重點(diǎn)篩查并加強(qiáng)隨訪。
[Abstract]:Objective: To explore the related factors of neonatal hearing screening, and provide evidence for large-scale neonatal hearing screening and follow-up of high-risk groups.
Methods: the neonatal ward of children's Hospital Affiliated to Medical University Of Chongqing in January 2009 -2009 year in July, 719 Cases of hospitalized children with hearing screening were analyzed retrospectively. Records of neonatal sex, parity, gestational age, mode of delivery, birth weight, fetal distress, birth asphyxia, pregnancy in early stage cold during pregnancy history, medication history, umbilical cord abnormalities, pregnancy disease, family history of hearing impairment, Home Furnishing environment, craniofacial deformities, respiratory secretions, blood glucose, jaundice, bilirubin encephalopathy, hypoxic ischemic encephalopathy (hypoxic-ischemic, encephalopathy, HIE), pulmonary hypertension, sepsis, meningitis, congenital intrauterine infection (TORCHS), pneumonia, neonatal behavioral neurological assessment (neonatal behavioral neurological assessment NBNA), the clinical data. At the same time with the single factor regression analysis Logistic 2 test and multi factors to select related factors of newborn hearing screening did not pass.
Result:
1. of the 719 (1438 ears) cases, hearing screening did not pass through 160 cases (22.3%), including 48 cases (6.7%) of left ear, 28 cases (3.9%) of right ear, and 84 cases of 11.7% ears (11.7%).
2. hearing screening failed in 160 cases, 58 cases on day 42 after hearing screening, the dropout rate of review hearing screening 63.8%. in 18 cases (31%), a failed in 13 cases (22.4% ears), 5 cases (8.6% ears) did not pass.
3.719 cases of CMV (cytomegalovirus, CMV) antibody was positive in 338 cases (47%), 335 cases with positive IgG, IgG and IgM were positive in 3 cases of.102 patients blood CMV antibody positive children urine specimens, 2 cases of CMV DNA (deoxyribonucleic acid DNA) polymerase chain reaction (polymerase chain reaction PCR), positive (2%).
4.160 cases failed in hearing screening in children with NBNA (36 + 2), NBNA group was significantly lower than that by (37 + 1) points (t=3.841, P0.01).NBNA is less than or equal to 31 points, 32-35 points, more than 36 hearing screening in three groups did not pass rate were 63.6%, 37.2%, 19.5%.
5. single factor analysis showed that blood transfusion reached standard hyperbilirubinemia, bilirubin encephalopathy, serum CMV antibody positive, gestational age, NBNA = 35, hemolytic jaundice, jaundice onset time less than 1 days, may be related to craniofacial deformity in newborn hearing screening did not pass on (P 0.05). Home Furnishing gender, environment, mode of delivery, parity, gestational age, birth weight, early and middle pregnancy infection, pregnancy medication, abnormal umbilical cord, pregnancy complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, more respiratory secretions of lung inflammation, sepsis, meningitis and neonatal hearing screening was not correlated (not through P 0.05).
Logistic 6. multi factor regression analysis showed that blood transfusion to standard hyperbilirubinemia, blood CMV antibody positive, NBNA = 35, craniofacial deformity is related to factors of newborn hearing screening failed (P 0.05, OR = 5.913,2.861,0.031,1.623 respectively; 95%CI 1.852-18.87,1.067-7.669,1.037-2.135,1.123-2.34 7).
Conclusion:
1. the rate of inpatient hearing screening in the hospital of our hospital was 22.3%, and the failure rate of rescreening was 31.0%.
2. reach the standard of blood transfusion hyperbilirubinemia, CMV antibody positive, NBNA = 35, craniofacial deformity is related to factors of newborn hearing screening failed. Home Furnishing gender, environment, mode of delivery, parity, gestational age, birth weight, early and middle pregnancy infection, pregnancy medication, umbilical cord abnormalities, pregnancy complications, fetal distress, birth asphyxia, HIE, pulmonary hypertension, hypoglycemia, syphilis, respiratory secretions more, pneumonia, sepsis, meningitis and failed in hearing screening has no significant correlation.
The lower the 3.NBNA, the higher the failure rate of hearing screening.
4. due to manpower limited medical resources, to carry out large-scale newborn hearing screening is difficult, should with related factors of hearing impairment in newborns, which reached the standard of blood transfusion hyperbilirubinemia, CMV antibody positive, NBNA is less than or equal to 35 points and malformation screening in high risk infants and followed up.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R764

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