RESUMO
OBJECTIVES: To estimate the prevalence of childhood permanent hearing loss (PHL) after early cardiac surgery. STUDY DESIGN: This prospective observational (1996-2015) study after complex cardiac surgery with cardiopulmonary bypass at ≤6 weeks of life reports audiology follow-up by registered pediatric-experienced audiologists at 6-8 months postsurgery, age 2 years, and as required throughout and thereafter to complete diagnoses. PHL at any frequency (500-4000 Hz) is defined as responses of >25-decibel hearing level in either ear. PHL was evaluated by type (conductive or sensorineural), pattern (flat or sloping), and severity (mild to profound). RESULTS: Survival rate was 83.4% (706 of 841 children) with a 97.9% follow-up rate (691 children); 41 children had PHL, 5.9% (95% CI 4.3%, 8.0%). By cardiac defect, prevalence was biventricular, 4.0% (95%CI 2.5%, 6.1%); single ventricle, 10.8% (95%CI 6.8%, 16.1%). Eighty-seven (12.6%) of 691 had syndromes/genetic abnormalities with known association with PHL; of these, 17 (41.5%) had PHL. Of 41 children, 4 had permanent conductive, moderate to severe loss (1 bilateral); 37 had moderate to profound sensorineural loss (29 bilateral with 20 sloping and 9 flat), 6 with cochlear implant done or recommended. CONCLUSIONS: Infants surviving complex cardiac surgery are at high risk for PHL. Over 40% with PHL have known syndromes/genetic abnormalities, but others do not have easily identifiable risk indicators. Early cardiac surgery should be considered a risk indicator for PHL.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Perda Auditiva/diagnóstico , Perda Auditiva/epidemiologia , Cardiopatias Congênitas/cirurgia , Fatores Etários , Pré-Escolar , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
Enhanced quality of patient care and the prevention of errors are emphasized greatly in today's health care settings. Nurses are now held accountable for the care they provide and, as a result, nurses are responsible for incorporating solid scientific evidence into their practice. Published meta-analyses represent one source of such evidence. Meta-analyses offer statistical summarizations of all studies conducted about a particular phenomenon and more objective evaluation of the research often results. This article examines seven basic processes for evaluating meta-analyses and determining the value of their results for use in nursing practice.