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

Objective: We determined the sensitivity and specificity of neonatal brain-stem auditory evoked potentials (BAEP) as markers for subsequent hearing impairment and for developmental problems found later in infancy and childhood. Methods: BAEP studies were performed before discharge in infants treated...

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Published in:The Journal of pediatrics 1997-08, Vol.131 (2), p.233-239
Main Authors: Desai, Shobhana, Kollros, Peter R., Graziani, Leonard J., Streletz, Leopold J., Goodman, Michael, Stanley, Christian, Cullen, James, Baumgart, Stephen
Format: Article
Language:English
Subjects:
Acoustic Impedance Tests
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Audiometry
Auditory Threshold - physiology
Biological and medical sciences
Child
Child, Preschool
Counseling
Emergency and intensive care: neonates and children. Prematurity. Sudden death
Evoked Potentials, Auditory, Brain Stem - physiology
Extracorporeal Membrane Oxygenation - adverse effects
Follow-Up Studies
Forecasting
Hearing - physiology
Hearing Disorders - diagnosis
Hearing Disorders - physiopathology
Hearing Loss, Sensorineural - diagnosis
Hearing Loss, Sensorineural - physiopathology
Humans
Infant
Infant, Newborn
Intensive care medicine
Language
Language Development
Language Development Disorders - diagnosis
Language Development Disorders - physiopathology
Language Disorders - diagnosis
Language Disorders - physiopathology
Medical sciences
Patient Discharge
Probability
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Survivors
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Summary:Objective: We determined the sensitivity and specificity of neonatal brain-stem auditory evoked potentials (BAEP) as markers for subsequent hearing impairment and for developmental problems found later in infancy and childhood. Methods: BAEP studies were performed before discharge in infants treated with extracorporeal membrane oxygenation (ECMO), and two specific abnormalities were analyzed: elevated threshold and delayed central auditory conduction. Behavioral audiometry was repeated during periodic follow-up until reliable responses were obtained for all frequencies, and standardized developmental testing was also conducted. The sensitivity and specificity of an elevated threshold on the neonatal BAEP for detecting subsequent hearing loss, and the relationship of any neonatal BAEP abnormality to language or developmental disorders in infancy, were calculated. Results: Test results for 46 ECMO-treated infants (57.5%) were normal, and those for 34 infants (42.5%) were abnormal, with either elevated wave V threshold, prolonged wave I-V interval, or both on neonatal BAEP recordings. Most significantly, 7 (58%) of the 12 children with subsequent sensorineural hearing loss had left the hospital after showing normal results on threshold tests. There was no significant difference in the frequency of hearing loss between subjects with abnormal (5/21, or 24%) and those with normal BAEP thresholds (7/59, or 12%; Fisher Exact Test, p = 0.28). Therefore the sensitivity of neonatal BAEP testing for predicting subsequent hearing loss was only 42%. Neonatal BAEP specificity for excluding subsequent hearing loss was 76%. In contrast, on language development testing, 19 children demonstrated receptive language delay. Of these children, 12 (63%) had abnormal neonatal BAEP recordings and 7 (37%) had a normal BAEP threshold, normal central auditory conduction test results, or both ( p = 0.04). Conclusions: Neonatal BAEP threshold recordings were of limited value for predicting subsequent hearing loss common in ECMO-treated survivors. However, an abnormal neonatal BAEP significantly increased the probability of finding a receptive language delay during early childhood, even in those with subsequently normal audiometry findings. Because neonatal ECMO is associated with a high risk of hearing and receptive language disorders, parents should be counseled that audiologic and developmental follow-up evaluations in surviving children are essential regardless of the results of neon
ISSN:0022-3476
1097-6833
DOI:10.1016/S0022-3476(97)70159-8