《Brainstem auditory evoked potential for neonatal jaundice the clinical significance of hearing test.pdf》由会员分享，可在线阅读，更多相关《Brainstem auditory evoked potential for neonatal jaundice the clinical significance of hearing test.pdf（12页珍藏版）》请在得力文库 - 分享文档赚钱的网站上搜索。
1、-最新资料推荐最新资料推荐-Brainstem auditory evoked potential forBrainstem auditory evoked potential forneonatal jaundice the clinical significance ofneonatal jaundice the clinical significance ofhearing testhearing test Brainstem auditory evoked potential for neonatal jaundicethe clinical significance of heari
2、ng test Brainstem auditoryevokedpotentialforneonataljaundicetheclinicalsignificance of hearing testAbstract Objective Toinvestigate brain stem auditory evoked potentials(BrainstemAuditory Evoked Potential,BAEP)on neonatal jaundice in earlydiagnosis of hearing impairment and followed up for clinicals
3、ignificance.Methods Dundee company Keypoint EMG evokedpotential of 258 BAEP in children with neonatal jaundice weredetected,of which children with abnormal hearing tests werecarried out in 3,6-month-old BAEP re-examination.BAEP inchildren with abnormal results of 258 cases was 81.01%,abnormal mainly
4、 as,latencies were prolonged,waveprolongation,poorlydifferentiatedwaveformorwaveformdisappeared.BAEP detection of 60 newborns participated in theBAEP in children with abnormal hearing review,the 60 cases ofneonatal jaundice V wave average age of 3 months threshold forthe(70+-14.6)dBnHL,6 months of a
5、ge the average hearing1 1/1212threshold of wave V(42+-12.6)dBnHL,the difference wassignificant(P lt;0.001).abnormal rate increased with theincreased levels of UCB,BAEP abnormal rate B,C,D group andA group,the difference was statistically significant(Plt;0.05).Conclusion jaundice and BAEP abnormaliti
6、es aredirectly related to the severity and prognosis of children withabnormal neonatal BAEP testing at 6 months old BAEP afterreferralofchildrenwithhearingimpairmentswhichrecommendedinterventionsareeconomicallyfeasible.Keywords:bilirubininneonataljaundiceofbrainstemauditoryevokedpotentialhearingtest
7、Abstract:Objective To explore the value of early diagnosis and clinicsignificance of following up on the brainstem auditory evokedpotential(BAEP)in neonates with jaundice.Methods BAEP wasdetected in 258 neonates with jaundice by the myoelectricityevoked potential machine(DANTEC,Denmark).60 cases neo
8、natalpatients with hearing loss after birth of 3 month and 6 monthunderwent BAEP test respectively.Results The abnormality rateof BAEP in 258 caseswas 81.01%.The abnormal findings in BAEPincluded prolongation of PL and IPL of the wave,and,andundifferentiationordisappearanceofthewaveshape.60infants w
9、ho had abnormal BAEPs received following up BAEP test.-最新资料推荐最新资料推荐-Average hear threshold of the neonates after birth of 3 monthand 6 month were(70+-14.6)dBnHL and(42+-12.6)dBnHLrespectively(P lt;0.001).Conclusion The jaundice can causedamage to peripheral auditory nerve and brainstem function ofth
10、e neonate.There are directly relations between jaundicedegreeandabnormaldegreeofBAEP,prognosis.Itiseconomically practicable that the technique of BAEP was usedto examine the neonatal patients with hearing loss after birthof six month and early intervention was performed in patientswith hearing loss.
11、Keywords:bilirubinemia,brainstemauditory evoked potential;neonate;jaundice;hearing examineJaundice is the most common symptoms of early neonatal,neonatal jaundice may be physiological,it can be pathological,which is also known as neonatal hyperbilirubinemia(Neonatalhyperbilirubinemia).Jaundice bilir
12、ubin can occur in severecasesencephalopathy(kernicterus),therebyenablingtheconduction system involvement in brain stem auditory brainstemauditoryevokedpotential.brainstemauditoryevokedpotentials(BAEP)detection of jaundice in children may providea non-invasive,objective assessment of peripheral audit
13、orysystem and brain stem effective way of activities.In recent3 3/1212years,newborn hearingtest,especially the newborn intensivecare unit hearing test has attracted academic attention.Atpresent,the few reports of neonatal hearing impairment.nowin October 2004 to 2006 in our hospital in May of 258 ho
14、spitalneonatal jaundice neonatal BAEP testing and hearing follow-upresults are analyzed as follows.1 Data and methods1.1 Clinical data 258 cases of neonatal patients are fromhospital,172 cases of male and female 86 cases,the averagegestational age of 37 to 41 weeks,mean birth weight 3247g(26003950g)
15、,nopregnancy andchildbirthcomplications andcongenital nervous system and ear disorders,is not usedototoxic drugs,no special family history.jaundice after birthtime is 1 5d,the duration of jaundice was 23 30d,testingdays for the 5 30d.According to the serum indirect bilirubin(unconjugated hyperbiliru
16、bin,UCB)were divided into 4 groups,A group for the control group,normal full-term newborns,UCBlt;220mol/L,a total of 28 cases,B group of children withUCB 220 308mol/L,65,C group children UCB308 342mol/L,91,D group of children with UCBgt;342mol/L,102 cases.hearing on the detection of abnormal neonata
17、l BAEP 209 casesof children,respectively,in 3,6 months after BAEP testing.1.2 BAEP detection Dundee Corporation by Keypoint EMG-最新资料推荐最新资料推荐-evoked potential,in a quiet room temperature 20 25,thenatural sleep state testing of children,crying,to use 10%chloral hydrate solution(0.4 0.5mL/kg)orally to
18、inducesleep.supine patients,the use of disposable paste electrode,recording electrode placed on top of the head(CZ),referenceelectrode placed on the same side of the test ear mastoid behindthe ear,ear white noise on the shield,short subjects ear soundstimulation,stimulus intensity used sensory level
19、,maximum ofnot more than 110dB,frequency 10Hz,superposition of 1024,left ear and repeat were examined to ensure their accuracy,latency of each BAEP were measured(PL),peak interval(IPL),amplitude and waveform differentiation.on each test inchildren with both serum total bilirubin and indirect bilirub
20、inconcentrations.1.3BAEPabnormalitiescriteriamain wave,disappear or poorly differentiated waveform,poor reproducibility,wave PL and IPL is greater than thenormal value of the room,the PL side of the difference wave(ILD)gt;0.4ms,the same test wave amplitude and wave andlt;0.5,which exceptions shall b
21、e guilty of any of the abnormalcases.the V wave threshold togt;30dBnHL as 2 4kHz rangeof indicators of hearing loss,hearing loss degree standard 1:5 5/1212mild(hearingthreshold3650dBnHL),moderate(hearingthreshold of 51 70dBnHL),severe(hearing threshold of 71 90dBnHL),very severe(hearing thresholdgt;
22、90dBnHL).BAEPabnormalities isrecommended 3monthsreview.1.4Statistical Methods Using SPSS 13.0 statistical software,with a+-s measurement data,said single-factor analysis ofvariance,homogeneityofvariancewiththeLSDmethod,non-homogeneity of variance with Dunnetts T3 method,P lt;0.05was considered stati
23、stically significant.2 Results2.1 BAEP test results The group of 258 cases of neonataljaundice detect abnormal BAEP 209 cases,abnormal rate of81.01%,was diagnosed with varying degrees of hearing loss.Anomalies mainly as,wave latencies were prolonged,between waves prolonged,poorly differentiated wave
24、form orwaveformdisappeared.abnormalrateincreasedwiththeincreased levels of UCB,BAEP abnormality rate of B,C,D groupand A group,the difference was statistically significant (Plt;0.05),and any two of four groups comparison,B and C group,C group and D group was significantly(P lt;0.05).Table 1.Table 1
25、BAEP abnormality groups compared with UCB(abbreviated)2.2 The hearing-impaired children of hearing loss ears BAEPthreshold case review 258 cases of 116 cases of jaundice-最新资料推荐最新资料推荐-in children 3 months old when BAEP in the referral,abnormalrate of 27.59%,V wave average hearing threshold for the(70
26、+-14.6)dBnHL,116 cases with 60 patients at 6 months of agefor the first 2 BAEP referral,abnormal rate of 15%reviewaverage hearing threshold of wave V(42+-12.6)dBnHL,theevaluation of children with hearing threshold increased morethan 3 months old,the difference was statistically significant(P lt;0.00
27、1).Table 2 Table 2.review hearing children ofhearing loss ears BAEP threshold(omitted Links to freepaper download 3 Discussion BAEP can record the soundproduced by stimulation of the auditory system after a seriesofpotential responses,acomprehensiveresponse tothephysiological process of the auditory
28、 nerve and pathologicalphenomena,neonatal jaundice can be an early and sensitivereaction of bilirubin neurotoxicity.BAEP stability there iswave,representingdifferentpartsoftheresultingpotential.its specific neural generators 2 are:waveExtracranial auditory nerve,wave cochlear nucleus,wave onthe oliv
29、e,wave lateral lemniscus,brain wave inferiorcolliculus.,wave in the whole range of stimulus intensityis relatively stable,so often,wave PL,#8203;#8203;,7 7/1212,wave IPL to represent the extent of damage the nervoussystem.gestation of 28 weeks to 30 weeks the fetus can berecorded BAEP.BAEP waveform
30、shape is changing with the growthand development and mature,and with age,BAEP of the PLshortened and the amplitudes increase,wave most significant2.60%of the full-term children,80%of the pretermchildren in the jaundice after birth are currently thought tohave some indirect bilirubin toxicity,and the
31、 blood-brainbarrier through the biofilm,especially in newborn immatureblood-brain barrier generally believed that the indirectbilirubin over 324mol/L,through the blood-brain barrier intothe brain tissue and poison the brain cells,so when the lackof timely diagnosis and treatment,severe cases can cau
32、sekernicterus,leading to central nervous system damage 3-4.BAEP in bilirubin cause brain damage can occur very earlychanges in the development of sensitive monitoring of thedisease is one of the indicators 5-6.Recent studies havefound around the auditory pathway to follow after the first hubAfter th
33、e first under-development rule of the upper brain stem,on behalf of the cochleaand auditory nervedistalwavesmainly in the potential development before birth,so a varietyofperinatalfactors,especiallyjaundicefactors,more-最新资料推荐最新资料推荐-peripheral hearing loss caused by,resulting in varying degreesof hea
34、ring loss,on behalf of central conduction function,major wave of IPL 1 month before birth and during the first 2years of maturity can also be influenced by the jaundice.Therefore,abnormal BAEP many forms,both PL,IPL extendedanother wave disappeared.clinically disappeared under the Vwaveform to deter
35、mine whether the severity of hearing loss.Jaundice in children in this group was 81.01%abnormal BAEP(209/258).Mainly as,latency were prolonged or disappeared,wave prolongation,poorly differentiated waveform orwaveform disappeared,suggesting jaundice on auditory pathwayin children is very damaging.In
36、 the study,we found the highestproportion of involvement wave,indicating the increase ofbilirubin in the first invasion and the surrounding auditorynerve,thereby involving the central nervous system,which isoftenneonataljaundicemainlyassociatedwithhearingimpairment.The mechanism of bilirubin neuroto
37、xicity hasnot yet entirely clear,most scholars believed that the mainimpact of synaptic transmission in neurons 4.Immature brainbarrier neonatal period,when the bilirubin concentrationexceeds a certain level and(or)blood-brain barrier damage,9 9/1212the serum free bilirubin can easily enter the brai
38、n through theblood-brain barrier,and toxic effects on the central nervoussystem.The group showed higher serum bilirubin concentration,the more obvious causes abnormal BAEP.bilirubin on the toxiceffects of nerve cells into aggregation,integration,anddeposition of three steps,the first two steps in ne
39、uronaldamage is reversible,do not show clinical symptoms,calledneonatal bilirubin neurotoxicity of subclinical symptoms orneonatal bilirubin encephalopathy,and to the deposition ofdisease has become irreversible steps,the typical clinicalsymptoms of neurological dysfunction that kernicterus isgenera
40、lly sequelae 7.Therefore,early prediction,timelyintervention,the prevention of kernicterus significance ofthe occurrence.As the baby of the auditory system in thenervoussystem,includingtherapiddevelopmentstage,especially in the first 6 months after birth,so the neonatalperiod was diagnosed in this g
41、roup there are different degreesof hearing loss in children with jaundice,when 116 patientsaged 3 months children participated in the 1st BAEP referral,abnormal rate of 27.59%,the average hearing threshold for the(70+-14.6)dBnHL,the vast majority of their degree of hearingloss,mild to moderate,indic
42、ating that there is more residual-最新资料推荐最新资料推荐-hearing,the proposed return visit about 6 months,116 casesof children in 60 cases of referral to participate in the 2ndBAEP,abnormal rate of 15%,the average hearing threshold forthe(42+-12.6)dBnHL,hearingthresholddecreasedsignificantly increased hearing
43、 threshold,indicating that aconsiderable portion of ear hearing loss during developmenthave been restored,a significant improvement in hearing status,there are different degrees of hearing loss reduced.Therefore,BAEP newborn hearing and understanding the important value ofbrain stem dysfunction.We b
44、elieve that abnormal BAEPtesting of newborns and infants,by tracking and follow-up in6 months or exclusion of patients diagnosed as deaf deaf infantsof hearing loss in children and parents to guide furtherinterventiontorelieveinfanthearinglossparents,psychological,economic burden,under the present s
45、ituation ofour country is economically viable.In short,the newborn andinfant hearing loss in the early detection and appropriateearlyinterventionforspeech,languageandcognitivedevelopment can play a key role,so that all hearing loss inchildren with language and(or)to develop communication skills.Refe
46、rences 1 Nine Nie Ying,Qi to win,Zhao Xiaotian,1111/1212et al.Otoacoustic emissions in the perinatal period in thevalue of Audiology J.Department of Otolaryngology Head andNeck Surgery,1999,6:207-211.2 Pan Ying convergence.Clinical Evoked Potential Studies M.2.Beijing:PeopleHealth Press,2019.350-351
47、.3 Lu Hui,Li Zhibin.Newborns with hyperbilirubinemia and brainstem auditory evokedpotential J.Guangdong Medicine,1997,18(1):45.4 LiYunzhu,YushanChang.ProgressinneonatalbilirubinencephalopathyJ.JournalofPediatrics,1996,34:286.5 Zhang Xiang,Wei Kelun,Xue Xin East.Newborns First AidM.Beijing:People Hea
48、lth Press,2019.559-562.6Ding Guofang,Zhang Suping,Yao Dan,etal.In some regions ofnormal newborn jaundice in the epidemiological investigationJ.Journal of Pediatrics,2019,38(10):624-627.7FORCES,satisfied ZY,Wei Qun Germany,and so on.Neonatalbehavioralneurologicalassessment20,thediagnosisofbrainstemauditoryevokedpotentialvalueofbilirubinencephalopathy J.Clinical,2019,17(3):211.Links tofree paper download
黑公网安备:91230400333293403D