Sensitivity and specificity of the neonatal brain-stem auditory evoked potential for hearing and language deficits in survivors of extracorporeal membrane oxygenation

Background— The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. Methods and Results— A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Conclusions— Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

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“…Children who have undergone extracorporeal membrane oxygenation may be at risk for progressive or delayed onset hearing loss. 187,188 …”

Section: Toddlers and Preschoolers: 1 To 5 Years Of Agementioning

confidence: 99%

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Marino¹,

Lipkin²,

Newburger³

et al. 2012

Circulation

1,296

1,156

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“…[4][5][6]9,10 Progressive SNHL in children may also be associated with TORCH infections, meningitis, kernicterus, congenital malformations, and certain genetic disorders. The most recent position statement from the Joint Committee on Infant Hearing identifies family history of hereditary childhood hearing loss, in utero TORCH infection, neurofibromatosis type 2, and neurodegenerative disorders as risk factors associated with delayed-onset SNHL.…”

Section: Commentmentioning

confidence: 99%

“…11 Although the lack of uniform criteria for the diagnosis of PPHN is problematic, worthy of attention is the 50% incidence of SNHL reported in cases of PPHN diagnosed by well-defined criteria 6 together with data linking SNHL to conventional medical treatment of PPHN. 4,9,10 Hyperventilation is a widely used adjunct to treatment of PPHN in which management is aimed at producing pulmonary vascular dilation through the induction of alkalosis. 1 This practice may be associated with decreased cerebral blood flow secondary to cerebrovascular constriction and a correlation between SNHL and the duration of hyperventilation has been demonstrated.…”

Section: Commentmentioning

confidence: 99%

“…9,10 In survivors of ECMO screened with ABR during the first month of life and evaluated audiologically at regular intervals over 4 years, the sensitivity of the ABR for prediction of subsequent hearing loss was determined to be 42% and the specificity was 76% (positive likelihood ratio, 1.75; negative likelihood ratio, 0.76). 10 Consistent with the inability of the ABR newborn screen to predict future hearing loss in ECMO-treated patients are data from several studies reporting progressive SNHL in children with a history of PPHN who had passed their newborn ABR screen. 4,9 The poor predictive value of the neonatal ABR in neonatal intensive care unit patients treated with ECMO illustrates the pitfall encountered when progressive SNHL is evident, and emphasizes the important role of regular audiological monitoring in this group.…”

Section: Commentmentioning

confidence: 99%

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Delayed-Onset Sensorineural Hearing Loss in a 3-Year-Old Survivor of Persistent Pulmonary Hypertension of the Newborn

Hutchin

Gilmer²,

Yarbrough³

2000

Arch Otolaryngol Head Neck Surg

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Persistent pulmonary hypertension of the newborn (PPHN) and its conventional medical treatment are associated with sensorineural hearing loss, yet current recommendations for regular audiological evaluations of PPHN survivors are lacking. We report a case of delayed-onset, progressive sensorineural hearing loss in a 3-year-old patient with a history of PPHN and a normal auditory brainstem evoked response at 6 weeks of age. The relatively late detection of significant sensorineural hearing loss in this otherwise healthy 3-year-old illustrates the need for audiological evaluation at regular intervals in patients with a history of PPHN.

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“…Early identification of HL and appropriate intervention could prevent or minimize adverse effects on these developmental areas (14,15). To our knowledge only one study -by Desai et al -explored the relationship between hearing loss and language development of ECMO survivors; the relationship between neonatal brainstem audiometry results and delayed receptive language ability proved uncertain (16). To shed more light on this issue we tested hearing as well as speech-and language development in survivors of neonatal ECMO-treatment.…”

Section: Introductionmentioning

confidence: 99%

Sensorineural Hearing Loss and Language Development Following Neonatal Extracorporeal Membrane Oxygenation

Hondel

Madderom

Goedegebure

et al. 2013

Pediatric Critical Care Medicine

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OBJECTIVE:To determine the prevalence of hearing loss in school-age children who have undergone neonatal extracorporeal membrane oxygenation (ECMO) treatment and to identify any effects of hearing loss on speech-and language development. DESIGN:Prospective longitudinal follow-up study within the framework of a structured post-ECMO follow-up program.SETTING: Outpatient clinic of a level III university hospital. RESULTS:Tone audiometry was performed by standardized protocol in 136 children aged 5 to 12 years. Hearing loss was considered clinically significant when >20dB. Hearing was normal in 75.7% of children. Five children (3.7%) had bilateral sensorineural or combined hearing loss; 3 of them received special audiological care (2.2% of total sample). Of the 24 children with congenital diaphragmatic hernia, 19 (79.2%) had normal hearing; and only 2 (8.3%) had mild SNHL, unilateral in one of them.Follow-up at 24 months of age had shown normal verbal and non-verbal developmental scores.Language development and intelligence median (range) scores at 5 years of age were also normal: receptive language development 104 (55-133); syntactical development 104 (68-132); and lexical development 101 (50-141) for 89 children; intelligence quotient was 104 (68-132) in 106 children.Scores did not differ between those with normal hearing, and those with mild hearing loss, or those with moderate to severe hearing loss (p=0. 800, p=0.639, p=0.876, and p=0.886, for the respective developmental tests). CONCLUSIONS:We found normal language development and intelligence in a cohort of neonatal ECMO survivors. The prevalence of bilateral sensorineural hearing loss was in accordance with that of larger series in the United States -which exceeds the prevalence in the normal population.3

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Sensitivity and specificity of the neonatal brain-stem auditory evoked potential for hearing and language deficits in survivors of extracorporeal membrane oxygenation

Cited by 26 publications

References 24 publications

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

Delayed-Onset Sensorineural Hearing Loss in a 3-Year-Old Survivor of Persistent Pulmonary Hypertension of the Newborn

Sensorineural Hearing Loss and Language Development Following Neonatal Extracorporeal Membrane Oxygenation

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