Monitoring neonates for ototoxicity

Abstract

We conclude that current audiological screening or monitoring protocols for neonates are not designed to adequately detect early onset of ototoxicity. This paper offers a detailed review of evidence-based research, and offers recommendations for developing and implementing an ototoxicity monitoring protocol for young infants, before and after discharge from the hospital.

Monitoring Protocols for Cochlear Toxicity

“…18 Untreated hearing loss also can lead to increased hospital readmissions. 20 For pediatric patients, particularly in the first 2 years of life, it is imperative the attending physician and supportive medical personnel understand the many developmental, educational, financial, and, eventually, vocational consequences secondary to developing hearing loss. These include delays in speech and language development, limited educational achievement, and social-emotional development.…”

“…15 Societal costs are estimated at over $1.3 million (in 2015 U.S. dollars after inflation) for each child with severe prelingual hearing loss. 20 Without an audiologist's efforts to educate physicians about the value of a structured, consistent AOMP, it is likely that many patients being treated with ototoxic medications will not receive audiologic care at any point prior to, during, or after treatment. 3,12,19 Scheduling The audiologist should be the team member responsible for defining the timing of audiologic testing and coordinating the scheduling of patients throughout the AOMP.…”

“…Without baseline measures, it is impossible to know if any hearing loss detected during treatment was preexisting or secondary to the ototoxic medication/s. 3,5,6,20 Therefore, the first scheduling goal is to arrange for a baseline test prior to the first treatment or within an acceptable timeframe after the first treatment. The acceptable timeframe is dependent on the prescribed medication.…”

“…For platinum-based drugs, the baseline test should be completed within 24 hours of the first treatment, while a window of 72 hours is acceptable following the first aminoglycoside treatment. 5,20 If possible, the baseline test should be performed in an audiometric test booth to ensure accurate measurements. The results of the baseline test should be as accurate and reliable as possible.…”

“…5 Baseline testing of any kind is almost impossible to perform on neonates since approximately 80% admitted to the NICU are immediately placed on aminoglycoside antibiotics to ward off infection and neonatal sepsis. 20 It is wise to consult with the attending physician to identify patients who are at risk for ototoxicity. 21,22 These include all patients who will be treated with known ototoxic agents paying particular attention to those who have other risk factors that can potentiate ototoxicity.…”