Hearing impairment in congenital diaphragmatic hernia: the inaudible and noiseless foot of time.
OBJECTIVE
Infants with congenital diaphragmatic hernia (CDH) are at high risk of sensorineural hearing loss (SNHL). Extracorporeal membrane oxygenation is known to increase this risk, but little is known about other potential causes. We evaluated the impact of several risk factors on SNHL development in CDH survivors not treated with extracorporeal membrane oxygenation.


METHODS
All high-risk CDH survivors consecutively treated between 1999 and 2005 were included. SNHL was diagnosed based on formal assessment with standard audiologic tests. Patients with and without SNHL were compared for patient-related and treatment-related risk factors. Subsequently, a logistic regression analysis was performed to identify independent risk factors associated with SNHL development.


RESULTS
Out of 87 CDH survivors, 82 had a formal audiologic evaluation and 40 (49%) had SNHL. Patients with SNHL had significantly lower gestational age (P = .045); higher prevalence of sepsis (P < .001); older age at audiologic examination (P < .001); more episodes of hypocapnia (P = .045); higher prevalence of inhaled nitric oxide use (P = .005); longer mechanical ventilation (P = .009); and longer aminoglycosides (P = .006), furosemide (P = .004), and pancuronium bromide (P = .001) treatments. On logistic regression analysis, the only variable independently associated with the development of SNHL was patient's age at audiologic follow-up (P = .012).


CONCLUSIONS
Several risk factors were associated with SNHL development at univariate analysis. After logistic regression, only age at evaluation remained independently associated with SNHL. Routine audiologic follow-up is advocated in all CDH patients. Further studies are needed to define if other (genetic) factors may be involved in the pathogenesis of SNHL in patients with CDH.
Morini
Francesco
F
Newborn Surgery Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital, 00165 Rome, Italy. francesco.morini@opbg.net
Capolupo
Irma
I
Masi
Roberto
R
Ronchetti
Maria Paola
MP
Locatelli
Mattia
M
Corchia
Carlo
C
Bagolan
Pietro
P
D001299:Audiometry; D002675:Child, Preschool; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006548:Hernia, Diaphragmatic / Q000453:epidemiology* / Q000235:genetics* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric