Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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변조 이음향방사(DPOAE)를 이용한 고위험군 신생아 청각선별검사

Neonatal hearing screening in a neonatal intensive care unit using distortion product otoacoustic emissions

  • 김도영 (순천향대학교 의과대학 부천병원 소아과) ;
  • 김성신 (순천향대학교 의과대학 부천병원 소아과) ;
  • 김창휘 (순천향대학교 의과대학 부천병원 소아과) ;
  • 김시찬 (순천향대학교 의과대학 부천병원 이비인후과)
  • Kim, Do Young (Department of Pediatrics, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Kim, Sung Shin (Department of Pediatrics, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Kim, Chang Hwi (Department of Pediatrics, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Kim, Shi Chan (Department of Otolaryngology, College of Medicine, Soonchunhyang University, Bucheon Hospital)
  • 투고 : 2005.12.23
  • 심사 : 2006.02.28
  • 발행 : 2006.05.15
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초록

목 적 : 신생아 난청은 신생아 1,000명당 1-3명에서 발생하며 조기에 발견하여 중재하지 않으면 유소아의 언어 습득과 발달 지연에 영향을 미친다. 저자들은 신생아 고위험군을 대상으로 청각 선별검사로서 DPOAE를 이용하여 난청의 유병률과 위험 인자와의 관련성에 대해 조사하였다. 방 법 : 2001년 5월부터 2004년 12월까지 순천향대학교 부천 병원 신생아 집중치료실에 입원하여 청각 선별검사로 변조 이음향방사를 시행받은 871명을 대상으로 의무기록을 후향적으로 검토하였다. 변조 이음향방사에서 통과된 경우 Pass 군으로, 통과되지 못한 경우를 Refer 군으로 나누어 출생 체중, 재태 기간, 산모의 위험 인자, 가족력, 인공호흡기 사용, 빌리루빈 수치, 이독성 약물의 사용 등 청각에 영향을 미치는 인자에 대해 연구하였다. 결 과 : 총 871명 중 106명(12.1%)이 Refer 군으로 우측 이상이 36명(4.1%), 좌측 이상이 23명(2.6%), 양측 이상이 47명(5.4%)이었다. Refer군 106명 중 20명(18.9%)이 3개월 후 변조 이음향방사를 재시행 하였으며 40명(37.7%)에서 ABR를 시행하였다. 총 871명 중 Pass 군과 Refer 군 사이에 성별, 출생 장소(본원 및 외부병원), 청각장애의 가족력, 재태 연령에 따른 출생 체중(부당 경량아, 부당 중량아, 적정 체중아), 산모의 위험 인자(임신성 고혈압, 임신성 당뇨, 조기 양막 파수), 빌리루빈 수치 및 gentamicin 사용 등의 인자와는 유의한 차이가 없었다. 총 871명 중 Pass 군과 Refer 군 사이에 출생 체중 1,500 g 미만, 재태 연령 37주 이하, 심폐 소생술 시행, 낮은 Apgar 점수(1분에 5점 이하, 5분에 6점 이하), 두경부 이상(구개순, 구개열, 이개 앞 피부 돌출), 인공호흡기 사용, 패혈증, vancomycin 사용 등의 인자에서 유의한 차이(P<0.05)를 보였다. 결 론 : 60 dB 이상의 난청이 18명(2%)에서 관찰되었으며 이는 전체 신생아 유병률(1-3명/1,000명)보다 높은 수치이다. 그러므로 신생아 집중치료실 입원 환자에게는 청각 선별검사를 반드시 시행하여야 하며 변조 이음향방사가 선별검사의 방법으로 이용될 수 있다. 또한 이번 연구를 기초로 하여 전체 신생아를 대상으로 한 신생아 청각 선별검사의 보편화 할 것을 추천하며 이상이 있는 경우 더욱 적극적인 추적 관찰이 필요할 것으로 사료된다.

Purpose : Early detection and intervention of hearing impairment is believed to improve speech and language development and behavior of children. The aim of this preliminary study was to determine the prevalence of hearing impairments, and to identify the association of risk factors relating to refer response in high risk neonates who were screened using distortion product otoacoustic emissions (DPOAE). Methods : The subjects included 871 neonates who were admitted to the neonatal intensive care unit of the Pediatric Department in Soonchunhyang University Bucheon Hospital from May, 2001 to December, 2004. They were screened using DPOAE. Based on DPOAE, we divided the neonates in two groups : 'Pass' and 'Refer'. The differences in risk factors between the pass group and the refer group were analyzed. Results : The incidence of the refer group was 12.1 percent(106 out of 871). The bilateral refer rate was 5.4 percent(47 out of 871). And the unilateral refer rate was 6.7 percent(59 out of 871). Gender, birth place, family history of hearing loss, small/large for gestational age, obstetrical factor, hyperbilirubinemia and use of gentamicin were not statistically related to the refer rate. Statistically related to refer rate were birth weight, resuscitated neonates, Apgar score, craniofacial anomaly, mechanical ventilator application, sepsis, using of vancomycin(P<0.05). The prevalence of hearing impairment (${\geq}60dB$) in this study was 2 percent(18 out of 871). Conclusion : This study showed a higher prevalence of hearing impairment in high-risk neonates. Thus neonatal hearing screening should be carried out in high-risk neonates.

키워드

참고문헌

  1. American Academy of Pediatrics. Joint Committee on Infant Hearing 1994 Position Statement. Pediatrics 1995;95: 152-6
  2. American Academy of Pediatrics Task Force on Newborn and Infant Hearing. Newborn and infant hearing loss : detection and intervention. Pediatrics 1999;103:527-30 https://doi.org/10.1542/peds.103.2.527
  3. Ramey CT, Ramey SL. Prevention of intellectual disabilities : early interventions to improve cognitive development. Prev Med 1998;27:224-32 https://doi.org/10.1006/pmed.1998.0279
  4. Kuhl PK, Andruski JE, Chistovich IA, Chistovich LA, Kozhevnikova EV, Ryskina VL, et al. Cross-language analysis of phonetic units in language addressed to infants. Science 1997;277:684-6 https://doi.org/10.1126/science.277.5326.684
  5. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics 1998;102:1161-71 https://doi.org/10.1542/peds.102.5.1161
  6. Downs MP. Auditory screening. Otolaryngol Clin North Am 1978;11:611-29
  7. Joint Committee on Infant Hearing. Year 2000 position statement : principles and guidelines for early hearing detection and intervention programs. Pediatrics 2000;106:798-817 https://doi.org/10.1542/peds.106.4.798
  8. Pappas DG. A study of the high-risk registry for sensorineural hearing impairment. Otolarlyngol Head Neck Surg 1983;91:41-4 https://doi.org/10.1177/019459988309100108
  9. Harrison M, Roush J. Age of suspicion, identification, and intervention for infants and young children with hearing loss : a national study. Ear Hear 1996;17:55-62 https://doi.org/10.1097/00003446-199602000-00007
  10. Kuhl PK, Williams KA, Lacerda F, Stevens KN, Lindblom B. Linguistic experience alters phonetics perception in infants by 6 months of age. Science 1992;255:606-8 https://doi.org/10.1126/science.1736364
  11. Sininger YS, Doyle KJ, Moore JK. The case for early identification of hearing loss in children : auditory system development, experimental auditory deprivation, and development of speech perception and hearing. Pediatr Clin North Am 1999;46:1-14 https://doi.org/10.1016/S0031-3955(05)70077-8
  12. Moon SK, Park HJ, Kim YJ, Park MS, Choung YH, Park KH. Result and cost-effectiveness of newborn hearing screening program in Ajou University Hospital. Korean J Otolaryngol 2002;45:1052-6
  13. Oostenbrink R, Maas M, Moons KG, Moll HA. Sequelae after bacterial meningitis in childhood. Scand J Infect Dis 2002;34:379-82 https://doi.org/10.1080/00365540110080179
  14. Newton V. Adverse perinatal condition and the inner ear. Semin Neonatol 2001;6:543-51 https://doi.org/10.1053/siny.2001.0076
  15. Tomski SM, Grundfast KM. A stepwise approach to the diagnosis and treatment of hereditary hearing loss. Pediatr Clin North Am 1999;46:35-48 https://doi.org/10.1016/S0031-3955(05)70079-1
  16. Doyle KJ, Burggraaff B, Fujikawa S, Kim J, Macarthur CJ. Neonatal hearing screening with otoscopy, auditory brain stem response, and otoacoustic emissions. Otolarygol Head Neck Surg 1997;116:597-603 https://doi.org/10.1016/S0194-5998(97)70234-1
  17. Kennedy CR, Kimm L, Dees DC, Evans PIP, Hunter M, Lenton S, et al. Otoacoustic emissions and auditory brainstem response in the newborn. Arch Dis Child 1991;66: 1124-9 https://doi.org/10.1136/adc.66.10_Spec_No.1124
  18. Kemp DT, Ryan S. Otoacoustic emission tests in neonatal screening programmes. Acta Otolaryngol(Stockh) 1991;482 (Suppl):73-84
  19. Uziel A, Piron JP. Evoked otoacoustic emissions from normal newborns and babies admitted to an intensive care baby unit. Acta Otolaryngol(Stockh) 1991;482(Suppl):85-91
  20. Thompson DC, McPhillips H, Davis RL, Lieu TA, Homer CJ, Helfand M. Universal newborn hearing screening. J Am Med Assoc 2001;286:2000-10 https://doi.org/10.1001/jama.286.16.2000
  21. Joint Committee on infant Hearing. Joint Committe on infant hearing 1994 Position Statement. Otolaryngol Head Neck Surg 1995;113:191-6 https://doi.org/10.1016/S0194-5998(95)70105-2
  22. Eavey RD, Bertero MC, Thornton AR, Herrmann BS, Joseph JM, Gliklich RE, et al. Failure to clinically predict NICU hearing loss. Clin Pediatr 1995;34:138-45 https://doi.org/10.1177/000992289503400304
  23. Marlow ES, Hunt LP, Marlow N. Sensorineural hearing loss and prematurity. Arch Dis Child Fetal Neonatal Ed 2000;82:141-4 https://doi.org/10.1136/fn.82.2.F141
  24. Spivak L, Dalzell L, Berg A, Bradley M, Cacace A, Campbell D, et al. New York State universal newborn hearing screening demonstration project : inpatient outcome measures. Ear Hear 2000;21:92-103 https://doi.org/10.1097/00003446-200004000-00004
  25. Park HJ, Park KH, Oh JH, Lee JS. TEOAE as a newborn hearing screening. Korean J Otolaryngol 1999;42:565-9