Prognostic value of newborn hearing screening in patients with myelomeningocele

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Brainstem dysfunction occurs in a minority of patients with myelomeningocele (MMC), most of whom have Chiari Type II malformation. Some surgeons advocate early identification of these patients for craniocervical decompression to avoid significant mortality. The auditory brainstem response has been found to be abnormal in most children with MMC. The present study examines whether failure of routine newborn hearing screening (NHS) predicts brainstem dysfunction in MMC patients.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The charts of 40 newborns with MMC and 50 newborns without MMC who stayed in the neonatal intensive care unit were reviewed. Results of NHS, brainstem symptoms, birth demographics, and surgical history were retrospectively examined. Differences in the presence and onset of brainstem symptoms by NHS result were assessed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Failure of NHS was more common among newborns with MMC who developed brainstem symptoms (31%, 4 of 13 patients) than among newborns without MMC (0%, 0 of 50 patients; p = 0.001). Among the 40 newborns with MMC, brainstem symptoms were more common in those who failed NHS (80%, 4 of 5 patients) than in those who passed (26%, 9 of 35 patients; p = 0.031). Respiratory symptom onset occurred later in patients who failed NHS (median 16 months) than among those who passed (median 0 months; p = 0.022). The positive and negative predictive values of NHS for brainstem dysfunction in MMC were 0.80 and 0.74, respectively.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Results of NHS may help predict future brainstem dysfunction in patients with MMC and may be useful to incorporate into prognostic assessment and surgical decision making.</jats:p></jats:sec>

Alterações auditivas em recém-nascidos e lactentes com mielomeningocele

“…The infants in the Study Groups presented grater absence of TEOAE: two bilateral fails were found in SG1 and two bilateral fails and one unilateral fail were detected in SG2 (Tables 1 and 2). This finding is in agreement with those of a recent study, in which the authors compared the results of NHS in 90 newborns in NICU, 40 with MMC and 50 without the disease, and found greater absence of TEOAE in the first (24) . Cochlear hearing loss was observed in 4.8% of the infants in SG1 and in 5.3% of those in SG2, with no difference between the groups or ears ( Table 5).…”

“…Concerning the type of hearing loss, 31% of the infants in SG1 and 26.3% of those in SG2 presented central auditory disorders. In fact, several studies in the literature have indicated that this population presents higher incidence of this type of impairment (8,24,26) .…”