The influence of epidural anesthesia on new-born hearing screening: A pilot study

Abstract

Objective:The main aim was to establish if epidural anesthesia had an influence on new-born hearing screening results in newborns born via elective Cesarean section in healthy pregnancies. Specific objectives included determining screening results in a group of newborns born to mothers who had undergone epidural anesthesia during Cesarean section childbirth (experimental group); and comparing the findings with those of a group of newborns born to mothers who had undergone natural delivery without epidural anesthesia (comparison group); while establishing if the time of screening following delivery had any effect on the overall screening results.Materials and Methods:The above objectives were achieved through the use of a prospective quasi-experimental repeated measures design with a comparison group, where 40 newborns (20 in the experimental and 20 in the comparison group) were screened at three different times through transient otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) measures. All participants were screened while resting quietly in open bassinets in an empty new-born nursery. For both test measures, the results were recorded as either pass or refer. Data were analyzed through both descriptive and inferential statistics.Results:Findings indicated that hearing screening earlier than four hours after birth, for both the experimental and comparison groups yielded more false positive findings than testing conducted after 24 hours. An index of suspicion in relation to the influence of epidural anesthesia on Automated Auditory Brainstem Response (AABR), when conducted less than four hours after birth, was raised, as statistically significant findings (P<0.05) were obtained.Conclusions:The findings have implications for timing of screening where universal newborn hearing screening is being implemented.

Association between mode of delivery and failure of neonatal acoustic emission test: A retrospective analysis

“…In our hospital, infants born vaginally are generally discharged 24 to 48 h after birth, whereas those born by CD are discharged on the third day of age. Exclusion criteria were: (1) familial deafness; (2) facial/ear deformities; (3) requirement for intensive care; (4) significant hyperbilirubinemia; (5) OAE performed within 12 h after birth; (6) major congenital malformations or chromosomal aberrations; (7) congenital cytomegalovirus (CMV) infection (congenital CMV test was positive in urine culture); (8) significant congenital hearing losses [abnormal results of OAE and AABR tests found in one or both ears later in life]; (9) mother with histories of influenza infection, diabetes, threatened abortion, smoking, placenta previa, or poison exposure during pregnancy; or (10) infants exposed to risk factors such as hypoxia, asphyxia, amniotic fluid turbidity, and oligohydramnios [6][7][8][9][10]. This study had been approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University, China.…”

“…There are many factors associated with failure of hearing screening in newborn infants. These factors include familial deafness, malformations of face/auricle, secretions in external ear canal [6], middle ear effusion [6], epidural anesthesia in cesarean delivery (CD) births [7], vaginal delivery (VD) [8,9], emergency CD [8], 5-min Apgar score of <5 [8], need for intensive care, significant hyperbilirubinemia [8,9], and OAE performed before 24 h of age [10]. Moreover, OAE test time after delivery also plays an important role in the failure of hearing screening in infants, which actually varies from 12 h to >48 h after live birth of infants.…”

Birth by Cesarean Delivery and Failure on First Otoacoustic Emissions Hearing Test

“…These factors include familial deafness, malformations of face/auricle, secretions in external ear canal, 6 middle ear effusion, 6 epidural anesthesia in CD births, 7 VD, 8,9 emergency CD, 9 5-minute Apgar score ,5, 9 need for intensive care, significant hyperbilirubinemia, 8,9 and OAE before 24 hours of age. 10 In this regard, referral rates for audiological follow-up were 5% to 20% when OAE was conducted ,24 hours and ,3% when OAE was conducted 24 to 48 hours after birth.…”

“…1 Hence, it is vital to isolate and categorize factors that may influence the success or failure of newborn hearing screening programs. 7 The aim of this study was to identify perinatal and neonatal factors that are associated with failure on first OAE in neonatal hearing screening, while focusing on the role of mode of delivery.…”

Impact of Gestational Age on Neonatal Hearing Screening in Vaginally-Born Late-Preterm and Early-Term Infants

“…Known risk factors for failure on hearing screening after birth include family history of hearing loss [8,9], malformations of skull, auricle or face [8,9], secretions in external ear canal [10], epidural anesthesia in cesarean section [11], cesarean section [12,13], 5-min Apgar score <5 [3,14], mechanical ventilation >5 days [13], significant hyperbilirubinemia [13,15], early 1st otoacoustic emissions (OAE) <24 h of age [12,16,17], sepsis and meningitis [8,9], gestational age (GA) <33 weeks [8], congenital cytomegalovirus infection [8], severe asphyxia [8], ototoxic medications [8], male gender [12] and small for gestational age (SGA) status [12]. …”