Risk factors associated with retinopathy of prematurity and visual alterations in infants with extremely low birth weight.

OBJECTIVE: Retinopathy of prematurity (RoP) is a retinal vascular disease and a frequent cause of blindness in infants. Our objective was to measure the frequency of RoP in infants with extremely low birth weight (ELBW, < 1,000 g) at the National Institute of Perinatology, Neonatal Intensive Care Unit (NICU), weighing the association of RoP with several risk factors and their results, such as refractive errors and strabismus. MATERIAL AND METHODS: We carried out two cross-sectional observations of our prospective study: one near birth, and the second, after a long-term follow-up. Funduscopic examination was performed while the infants were in the NICU to detect RoP. Infants with RoP were followed up by means of visual examinations during an average 8-year period and results were compared with those of infants with ELBW without RoP. RESULTS: Of the 139 screened infants at the NICU, 24.4% were identified with RoP: 79% of these with grade I retinopathy; 18% with grade II, and one infant with grade III retinopathy. The zones involved were as follows: zone 1, 12%; zone 2, 79%, and zone 3, 9%. The following were associated with retinopathy: eclampsia (p = 0.003); gestational age (0.01); multiple gestation (0.03); days of stay at NICU (< 0.001); mechanical ventilation (0.001); hypoxia (0.01); oxygen therapy (< 0.001); apnea (0.005); acidosis (0.001), and hypercapnia (0.001). Retinopathy was self-limited in all children. We found no differences in frequency of refractive errors and strabismus between children with RoP and controls. CONCLUSIONS: We observed a moderately high frequency of RoP in infants with ELBW in Mexico City and recommended early mandatory screening for early intervention.

Cochleopalpebral reflex: sensitivity and specificity in the auditory screening of newborns discharged from the neonatal intensive care unit.

BACKGROUND: The sensitivity and specificity of the clinical audiological evaluation in newborns are debatable compared to neurophysiological methods of a hearing evaluation. This study aimed to determine the sensitivity and specificity of the cochleopalpebral reflex as a clinical test for hearing screening in newborns. METHODS: A case-control study was designed. Newborns discharged from a neonatal intensive care unit (NICU) were included. Brainstem evoked auditory potentials were recorded. A wooden rattle was used to explore the cochleopalpebral reflex. The sensitivity and specificity of the cochleopalpebral reflex were calculated. Continuous data were analyzed with Student's t-test, with statistically significant p-values < 0.05. RESULTS: We selected 450 newborns who were divided into two groups: group A, with bilateral sensory neural hearing loss (n = 150), and group B, with normal hearing (n = 300). Group A showed a significantly lower gestation age at birth (p = 0.005) compared to group B (32.5 ± 2.6 vs. 34.4 ± 3.5 weeks). In group A, the cochleopalpebral reflex's sensitivity was 80% using the wooden rattle. In group B, the specificity was 98%. CONCLUSIONS: The NICU discharged newborns' clinical hearing evaluation is not enough to exclude hearing loss. Although it may be the only diagnostic tool for hearing loss in some settings, its limitations should be considered.

Body mass index in offspring of mothers with diabetes mellitus: follow-up at 2, 4, 6, and 8 years of age.

Background: Offspring of mothers with diabetes mellitus (DM) during pregnancy may be at high risk for developmental alterations. This study aimed to identify the effects of maternal pre- and gestational diabetes on the body mass index of infants and children at two, four, six, and eight years of age. Methods: We studied children of mothers with type 1, type 2, and gestational diabetes and a control group. Maternal and neonatal variables were analyzed for associations with children overweight/obesity. Results: Mothers with DM were older than controls (32 ± 6 vs. 22 ± 6 years, p < 0.001). The frequency of preeclampsia in mothers with DM was 28%. Gestational age and weight at birth were lower in infants from the groups of mothers with DM in comparison with controls (32.8 ± 3.1 vs. 36.4 ± 2.2 weeks, p < 0.001, and 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectively). At 8 years of age, 47% of the offspring of mothers with DM type 2 had overweight/obesity (odds ratio (OR 8.25) 95% confidence interval (CI) 1.3-51, p = 0.01), while 27% of offspring of mothers with type 1 DM had overweight/obesity, and 10% of offspring of mothers with gestational diabetes presented overweight/obesity. Conclusions: Offspring of pre-gestational DM mothers have a higher risk to develop overweight/obesity, as was observed with follow-up until school age, for which they require continuous vigilance.

Introducción: Los hijos de madres con diabetes mellitus durante el embarazo pueden tener un alto riesgo de alteraciones del desarrollo. El objetivo de este estudio fue buscar los efectos de la diabetes pregestacional y gestacional en el índice de masa corporal de niños a los 2, 4, 6 y 8 años de edad. Métodos: Se estudiaron los hijos de madres con diabetes tipo 1, 2 y gestacional, así como un grupo control. Se analizaron las variables maternas y neonatales en búsqueda de una asociación con sobrepeso u obesidad en los niños. Resultados: La edad de las madres con diabetes mellitus fue mayor que la del grupo control (32 ± 6 vs. 22 ± 6 años, p < 0.001). La frecuencia de preeclampsia en las madres con diabetes mellitus fue del 28%. La edad gestacional y el peso al nacer fueron menores en los hijos de las madres con diabetes en comparación con los controles (32.8 ± 3.1 vs 36.4 ± 2.2 semanas, p < 0.001, y 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectivamente). A los 8 años, el 47% de los hijos de madres con diabetes tipo 2 tuvieron sobrepeso u obesidad (RM: 8.25; intervalo de confianza del 95%: 1.3-51; p = 0.01), frente al 27% de los hijos de madres con diabetes tipo 1 y el 10% de los hijos de madres con diabetes gestacional. Conclusiones: Los hijos de madres con diabetes pregestacional presentan un mayor riesgo de desarrollar sobrepeso u obesidad, como se observó en el seguimiento hasta la edad escolar, por lo que requieren una vigilancia continua.

Results of the Universal Neonatal Hearing Screening in a Tertiary Care Hospital in Mexico city.

INTRODUCTION: Universal Neonatal Hearing Screening (UNHS) includes as its main objective, that all Newborns (NB) receive an audiological evaluation during their first month of life. OBJECTIVE: To determine the prevalence of hearing loss in a population of healthy NB in a tertiary care hospital in Mexico City. MATERIAL AND METHODS: A prospective cross-sectional study was designed. The period was from October 1, 2011 to May 15, 2019. UNHS was performed with a flowchart in three phases using Transient Evoked Otoacoustic Emissions and Brainstem auditory evoked potentials. Data were analyzed using descriptive statistics. RESULTS: 14,000 NB were evaluated, 28,000 ears. Gender was distributed in n = 7038 (50.3%) males and n = 6962 (49.7%) females. The mean age at the time of the first UNHS study was 48.3 ± 22.2 days. Hearing loss was confirmed in n = 31 (0.22%) NB, in 20 (64%) of the cases with hearing loss there were no documented audiological risk factors. CONCLUSIONS: The prevalence of hearing loss was 2.2 per 1000 NB in a tertiary care hospital in Mexico City. Diagnosis and early habilitation of hearing loss in NB constitute quality indicators in health care and guarantee the best prognosis for NB with hearing loss.

Risk factors associated with sensorineural hearing loss in infants at the neonatal intensive care unit: 15-year experience at the National Institute of Perinatology (Mexico City).

BACKGROUND: Infants from neonatal intensive care units (NICU) are at high risk for sensorineural hearing loss (SNHL); however, risk factors may change from NICU to NICU and from country to country. Our objective was to describe the main causes associated with SNHL in infants from a tertiary level NICU in Mexico City and to show the associated audiometric profiles. METHODS: We performed a comparison of follow-up of infants from NICU with SNHL and a control group with the same history but with normal hearing. Infants were examined at birth by brainstem auditory evoked potentials (BAEP) and followed by audiometric tests. Hearing loss was associated with clinical variables. RESULTS: SNHL group had 146 children and the control group had 272 children. Mean weight at birth in the SNHL group was 1530+/-581 g and in the control group, 1723+/-805 g (p<0.01). Days spent at the NICU and under mechanical ventilation were higher in the SNHL group (p<0.001). In addition, serum bilirubin levels were higher in the SNHL group than in the control group (p<0.001). Blood exchange, intraventricular hemorrhage, and neonatal meningitis comprised the main SNHL-associated variables. Use of prenatal steroids and pulmonary surfactant demonstrates protection against SNHL. Audiometric profiles disclosed mainly severe SNHL. CONCLUSIONS: Low birth weight, longer stay in NICU and under mechanical ventilation, higher serum bilirubin levels, prevalence of blood exchange, intraventricular hemorrhage, and meningitis in high-risk newborns were the main risk factors associated with SNHL and merit hearing screening and early intervention in high-risk infants.

Changes in tonal audiometry in children with progressive sensorineural hearing loss and history of Neonatal Intensive Care Unit discharge. A 20 year long-term follow-up.

OBJECTIVE: Newborns from Neonatal intensive care units (NICU) are at high-risk for sensorineural hearing loss (SNHL) a follow-up is needed for early diagnosis and intervention. Our objective here was to describe the features and changes of SNHL at different periods during a follow-up of almost 20 years. METHODS: Risk factors for SNHL during development were analyzed. The audiological examination included: Brainstem auditory evoked potentials (BAEP), and Transient evoked otoacoustic emissions (TEOAE). At birth; tonal audiometry (between 125 and 8000 Hz), and tympanometry were performed at 5, 10, 15, and 20 years of age. RESULTS: Sixty-five percent of cases presented bilateral absence of BAEP. At 5 years of age, the most frequent SNHL level was severe (42.5%), followed by moderate (22.5%), and profound level (20%), in all cases, the SNHL was symmetrical with a predominance of lesion for the high frequencies. Exchange transfusion was associated with a higher degree of SNHL (OR = 6.00, CI = 1.11-32.28, p < 0.02). In 55%, SNHL remained stable, but in 40% of the cases it was progressive. At the end of the study six cases with moderate loss progressed to the severe level and seven cases with severe level progressed to profound. CONCLUSIONS: Forty percent of infants with SNHL discharged from NICU may present a progression in the hearing loss. Exchange transfusion was associated with a higher degree of SNHL. NICU graduates with SNHL merit a long-term audiological follow-up throughout their lifespan.

Association between intelligence quotient scores and extremely low birth weight in school-age children.

BACKGROUND: Extremely low birth weight (ELBW) has been associated with poor cognitive development in children. We performed this research to establish the association between ELBW and the influence of biological and socioeconomic factors in the intelligence quotient (IQ) score in school-age children. METHODS: This study comprised 184 children with mean and standard deviation of 6.9 +/- 0.8 years of age. The children were divided into four groups based on their birth weight as follows: group A (n = 25), < or =1000 g; group B (n = 52), 1001-1500 g; group C (n = 66), 1501-2500 g; and group D (n = 41), > or =2501 g. The Stanford-Binet after the Terman-Merril Intelligence Scale was used to determine IQ scores. RESULTS: Mean and standard deviation (SD) of IQ values were 95.3 +/- 11.3 for group A, 103.1 +/- 14.4 for group B, 105.1 +/- 12.3 for group C, and 106.8 +/- 11.7 for group D (p = 0.003). Frequencies of children with scores below normal distribution were the following: 28% in group A; 10% in group B; 15% in group C, and 5% in group D (chi(2) = 0.04). Bronchopulmonary dysplasia and parental education were associated with lower IQ scores (p <0.05). CONCLUSIONS: IQ scores of children born with ELBW were significantly lower when compared to children born with a higher birth weight. Additional studies are important to determine whether these neurodevelopmental delays persist into adulthood, and whether there are additional factors associated with catch-up and recovery.

Cochleopalpebral reflex: sensitivity and specificity in the auditory screening of newborns discharged from the neonatal intensive care unit / Reflejo cocleopalpebral: sensibilidad y especificidad en el tamiz auditivo de recién nacidos egresados de una unidad de cuidados intensivos neonatales

Abstract Background: The sensitivity and specificity of the clinical audiological evaluation in newborns are debatable compared to neurophysiological methods of a hearing evaluation. This study aimed to determine the sensitivity and specificity of the cochleopalpebral reflex as a clinical test for hearing screening in newborns. Methods: A case-control study was designed. Newborns discharged from a neonatal intensive care unit (NICU) were included. Brainstem evoked auditory potentials were recorded. A wooden rattle was used to explore the cochleopalpebral reflex. The sensitivity and specificity of the cochleopalpebral reflex were calculated. Continuous data were analyzed with Student's t-test, with statistically significant p-values < 0.05. Results: We selected 450 newborns who were divided into two groups: group A, with bilateral sensory neural hearing loss (n = 150), and group B, with normal hearing (n = 300). Group A showed a significantly lower gestation age at birth (p = 0.005) compared to group B (32.5 ± 2.6 vs. 34.4 ± 3.5 weeks). In group A, the cochleopalpebral reflex's sensitivity was 80% using the wooden rattle. In group B, the specificity was 98%. Conclusions: The NICU discharged newborns' clinical hearing evaluation is not enough to exclude hearing loss. Although it may be the only diagnostic tool for hearing loss in some settings, its limitations should be considered.

Resumen Introducción: La sensibilidad y la especificidad de la evaluación audiológica clínica en recién nacidos son cuestionables en comparación con los métodos neurofisiológicos de evaluación auditiva. El objetivo de este estudio fue determinar la sensibilidad y la especificidad del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en recién nacidos. Métodos: Se diseñó un estudio de casos y controles en el que se incluyeron recién nacidos egresados de una unidad de cuidados intensivos neonatales (UCIN). Se les efectuaron potenciales auditivos evocados de tallo cerebral. Para la exploración del reflejo cocleopalpebral se utilizó una matraca de madera. Se calcularon la sensibilidad y la especificidad del reflejo cocleopalpebral. Los datos continuos se analizaron con la prueba t de Student y se consideraron estadísticamente significativos los valores de p < 0.05. Resultados: Se seleccionaron 450 recién nacidos y se dividieron en dos grupos: el grupo A (n = 150) con hipoacusia sensorineural y el grupo B (n = 300) con audición normal. El grupo A mostró una diferencia significativa (p = 0.005) en cuanto a la edad de gestación al nacer en comparación con el grupo B (32.5 ± 2.6 vs. 34.4 ± 3.5 semanas). En el grupo A, la sensibilidad del reflejo cocleopalpebral fue del 80% utilizando la matraca de madera. En el grupo B se encontró una especificidad del 98%. Conclusiones: La evaluación del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en una población de recién nacidos egresados de una UCIN no es suficiente para descartar la pérdida de la audición. Aunque puede ser la única herramienta de diagnóstico para evaluar la pérdida de la audición en algunos casos, es importante considerar sus limitaciones.

Body mass index in offspring of mothers with diabetes mellitus: follow-up at 2, 4, 6, and 8 years of age / Índice de masa corporal en hijos de madres con diabetes mellitus: seguimiento a los 2, 4, 6 y 8 años de edad

Abstract Background: Offspring of mothers with diabetes mellitus (DM) during pregnancy may be at high risk for developmental alterations. This study aimed to identify the effects of maternal pre- and gestational diabetes on the body mass index of infants and children at two, four, six, and eight years of age. Methods: We studied children of mothers with type 1, type 2, and gestational diabetes and a control group. Maternal and neonatal variables were analyzed for associations with children overweight/obesity. Results: Mothers with DM were older than controls (32 ± 6 vs. 22 ± 6 years, p < 0.001). The frequency of preeclampsia in mothers with DM was 28%. Gestational age and weight at birth were lower in infants from the groups of mothers with DM in comparison with controls (32.8 ± 3.1 vs. 36.4 ± 2.2 weeks, p < 0.001, and 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectively). At 8 years of age, 47% of the offspring of mothers with DM type 2 had overweight/obesity (odds ratio (OR 8.25) 95% confidence interval (CI) 1.3-51, p = 0.01), while 27% of offspring of mothers with type 1 DM had overweight/obesity, and 10% of offspring of mothers with gestational diabetes presented overweight/obesity. Conclusions: Offspring of pre-gestational DM mothers have a higher risk to develop overweight/obesity, as was observed with follow-up until school age, for which they require continuous vigilance.

Resumen Introducción: Los hijos de madres con diabetes mellitus durante el embarazo pueden tener un alto riesgo de alteraciones del desarrollo. El objetivo de este estudio fue buscar los efectos de la diabetes pregestacional y gestacional en el índice de masa corporal de niños a los 2, 4, 6 y 8 años de edad. Métodos: Se estudiaron los hijos de madres con diabetes tipo 1, 2 y gestacional, así como un grupo control. Se analizaron las variables maternas y neonatales en búsqueda de una asociación con sobrepeso u obesidad en los niños. Resultados: La edad de las madres con diabetes mellitus fue mayor que la del grupo control (32 ± 6 vs. 22 ± 6 años, p < 0.001). La frecuencia de preeclampsia en las madres con diabetes mellitus fue del 28%. La edad gestacional y el peso al nacer fueron menores en los hijos de las madres con diabetes en comparación con los controles (32.8 ± 3.1 vs 36.4 ± 2.2 semanas, p < 0.001, y 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectivamente). A los 8 años, el 47% de los hijos de madres con diabetes tipo 2 tuvieron sobrepeso u obesidad (RM: 8.25; intervalo de confianza del 95%: 1.3-51; p = 0.01), frente al 27% de los hijos de madres con diabetes tipo 1 y el 10% de los hijos de madres con diabetes gestacional. Conclusiones: Los hijos de madres con diabetes pregestacional presentan un mayor riesgo de desarrollar sobrepeso u obesidad, como se observó en el seguimiento hasta la edad escolar, por lo que requieren una vigilancia continua.

Relación entre la adquisición del gateo y la marcha independiente en el niño de alto riesgo en seguimiento / Relationship between gait acquisition and independent gait in the high-risk child in follow-up

Resumen Introducción: El gateo representa la primera forma de locomoción autónoma. Se han mencionado las implicaciones de la adquisición del gateo para lograr la marcha independiente y el control motor en el niño, pero son pocos los estudios relacionados con el gateo y sus efectos en el niño de alto riesgo biológico. Por eso se intentó conocer la relación entre la adquisición del gateo y la marcha independiente en una población de niños nacidos de alto riesgo en un programa de seguimiento pediátrico. Material y métodos: Estudio observacional, retrospectivo y descriptivo de una cohorte de niños de alto riesgo que acuden al seguimiento pediátrico, en el cual se revisó el periodo de adquisición del patrón de gateo y la marcha independiente. Resultados: Se integraron cuatro grupos: gateo normal, gateo limítrofe, gateo con retraso y gateo nulo. Se estudió a 558 lactantes; los grupos se integraron con gateo normal, 238 niños; gateo limítrofe, 96 lactantes; retraso en la adquisición del gateo, 207 niños; y gateo nulo, 17 niños. Por género, las niñas gatean mejor, con peso y edad gestacional mayores y predominio en los gateadores. La escala de Bayley señala mejores puntuaciones para los gateadores. En los niños con gateo normal, la marcha independiente se adquirió en el periodo normal a diferencia del grupo con retraso en el gateo en el cual la marcha independiente apareció con retraso. Conclusiones: En este estudio se identificó una relación entre la edad de inicio del gateo con la edad de adquisición de la marcha independiente, con mejor evolución en los niños gateadores.

Abstract Background: Crawling represents the first form of autonomous human locomotion. Much has been said about the implications that an adequate acquisition of crawling has on development in order to achieve independent gait in the short term and the child's motor control in the long term. There are few studies related to crawling and its implications in children who were high biologic risk newborns. Therefore, we wanted to know the relation between crawling acquisition and independent gait in a population of children who were high risk at birth in our Pediatric Follow up clinic. Material and Methods: An observational, retrospective, and analytical study of a cohort of children who were high risk at birth, and attended our pediatric follow-up clinic was done. The period between crawling acquisition and independent gait was reviewed. Results: 4 groups were integrated; normal crawling, borderline crawling, delayed crawling and null crawling. 558 infants were studied; the groups were integrated by: normal crawling 238 children; borderline crawling with 96 infants; delayed crawling with 207 children and null crawling with 17 children. By gender distribution, girls achieved better crawling. Weight and higher gestational age predominated in children with normal crawling. Crawlers had the best scores in the Bayley Scale. In children with normal crawling, independent gait was acquired within the normal period unlike the group with delay in crawling where independent gait was behind. Conclusions: In this study, we found a relation between the age of onset of crawling with the age of acquisition of the independent gait, with better skill in children who crawled.

[Cry analysis of hypoacoustic children and normal hearing children]. / Análisis del llanto del niño hipoacúsico y del niño normo-oyente.

OBJECTIVE: We analyzed the spectrograms of the cry of deaf children and compared the results with those of normal children. MATERIAL AND METHODS: Twenty deaf children (0-2 years of age, both sexes) and 20 normal hearing children of both sexes within the same age range were studied. The deaf cases were selected from patients with high-risk pregnancies who are followed up at the National Institute of Perinatology (INPer), Department of Human Communication. Brainstem evoked potential responses were carried out in order to corroborate hearing loss in the affected group and to verify normal hearing in the other group. During physical examination in the Human Communication Clinic of the Inper, the cry was recorded with a Fisher tape recorder and MK2 unidirectional microphone. Sonograms were analyzed in the "Laboratorio de Bioacústica" of the Institute of the Human Communication (CNR) using the Software Cool Edit 96. We registered the fundamental frequency and 6 harmonic F1 at F6 (Hz). The cry frequencies of the deaf children were compared and of the normal hearing children using one-way analysis of variance. A typology of frequencies was organized by means of cluster analysis by the method of Ward and was compared with the study groups by means of contingency analysis (chi square). RESULTS: No significant difference was demonstrated in the fundamental frequency or in the harmonic by means of the one-way analysis. With cluster analysis, 8 types were obtained that were not different when compared with the study groups. The hypothesis was rejected with the obtained data. CONCLUSIONS: Upon confirmation of the obtained results, analysis of the spectrogram of deaf children at early ages does not have the ability to identify the problem and thus cannot be used as a method for early detection of deafness.

Hearing and neurological impairment in children with history of exchange transfusion for neonatal hyperbilirubinemia.

The objective was to determine frequency of sensorineural hearing loss (SNHL), identified by abnormal threshold in evoked potentials, absence of otoacoustic emissions and behavioral responses, auditory neuropathy (AN) (absence of evoked potentials, with preservation of otoacoustic emissions), and neurological comorbidity in infants with hyperbilirubinemia (HB) treated with exchange-transfusion (ET). From a total of 7,219 infants, ET was performed on 336 (4.6%). Inclusion criteria were fulfilled in 102; 234 children did not meet criteria (182 outside of the study period, 34 did not have complete audiological evaluation, and 18 rejected the followup). Thirty-five children (34%) were born at-term and 67 (66%) were preterm. Children had a mean age of 5.5 ± 3.9 years. Main causes of ET were Rh isoimmunization in 48 (47%), ABO incompatibility in 28 (27.5%), and multifactorial causes in 26 (25.5%). Fifteen (15%) children presented with SNHL. Preterm newborns presented more often with SNHL. Indirect bilirubin level was higher in children with SNHL (22.2 versus 18.7 mg/dL, P = 0.02). No cases of AN were documented. An increased risk of neurologic sequelae was observed in children with SNHL. In conclusion, we disclosed a high frequency of SNHL in children with neonatal HB and ET and neurological alterations. No cases of AN were observed.

Hearing loss, auditory neuropathy, and neurological co-morbidity in children with birthweight <750 g.

BACKGROUND AND AIMS: The current literature considers a birthweight <1,500 g as a risk factor for sensorineural hearing loss (SNHL, hearing threshold >25 decibels), auditory neuropathy (AN), and several neurological sequelae. The aim of the study was to determine the frequency and risk factors associated with SNHL, AN, and neurological morbidity in a group of children with birthweights of <750 g treated at a neonatal care unit and recruited into a long-term follow-up program. METHODS: A case-control study was carried out. Inclusion criteria were birthweight <750 g and born between the years 2000 and 2010. We performed brainstem auditory-evoked potentials (BAEP), evoked otoacoustic emissions (EOAE) and free-field audiometry (FFA) in this population. Neonatal variables and procedures were compared between children with SNHL and children with normal bilateral hearing (NBH). RESULTS: A total of 93 children with a mean age of 4 years were included in the follow-up. Six children (6.4%) had SNHL and 87 had NBH. We were unable to identify AN in the sample. Mean weight for this sample was 673 ± 68 g and gestational age 27.5 ± 2 weeks. Variables reflecting differences between groups included days under mechanical ventilation, furosemide treatment, and bronchopulmonary dysplasia. In the SNHL group, three patients had periventricular leukomalacia, two had hydrocephalus, and one patient had cerebral palsy. CONCLUSIONS: Frequency of SNHL in children with birthweights <750 g was higher than in other premature infants and was related with mechanical ventilation, furosemide application, and bronchopulmonary dysplasia. Association with other neurological morbidities was frequent. Early diagnosis and intervention are required.

Cognitive performance of school children with unilateral sensorineural hearing loss.

BACKGROUND AND AIMS: Some studies have shown low school performance of children with early-onset unilateral sensorineural hearing loss (U-SNHL). We undertook this study to compare cognitive performance of school-children with perinatal U-SNHL with that of a group of bilateral normal hearing (BNH) children. METHODS: We performed a cross-sectional observation from our prospective study that included children discharged from the Neonatal Intensive Care Unit (NICU) who were followed to determine their hearing, language, and neurocognitive development. We performed audiometric studies and Stanford-Binet intelligence scale after Terman-Merrill version examinations. Statistical comparisons were carried out with Student t and chi(2) tests. We calculated U-SNHL-associated relative risk with a 95% confidence level. RESULTS: We followed 21 children with U-SNHL and 60 with BNH. Median age of both groups at the time of study was 7 years. Hearing loss severity ranged from severe to profound. Average number of days of stay at the NICU in the U-SNHL group was 26+/-4 days, whereas for the BNH group this was 8+/-2 days (p<0.001). U-SNHL-associated variables included hyperbilirubinemia, bronchopulmonary dysplasia, furosemide exposure, and hypoglycemia. Average and standard deviation of total and of both Terman-Merrill intelligence subscale coefficients were significantly lower in the U-SNHL group. CONCLUSIONS: Children with U-SNHL may present lower intelligence coefficients than children with BNH. It is important to observe whether this handicap continues throughout the child's lifetime and to ascertain whether there are certain factors associated with reversibility of disability.

Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad

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Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.

Evaluación audiológica del niño con peso extremadamente bajo al nacer / Audiologic assessment of extremely low birth weiaght infants

Introducción. Los recién nacidos con peso extremadamente bajo al nacer presentan frecuencia elevada de hipoacusia. Objetivos: describir la frecuencia de hipoacusia en una cohorte de niños con peso al nacer igual o menor de 1 000 g. Identificar qué factores muestran asociación con esta lesión.Material y métodos. Durante 1990-2000 se incluyeron a 216 niños, con edad media de 35.6 ñ 27 meses. Se evaluaron algunas variables de riesgo para hipoacusia sensorio-neural. Se les realizó estudio de potenciales auditivos provocados de tallo cerebral (Paptc) y audiometrías. Las variables se analizaron mediante un análisis de regresión logística bivariada.Resultados. Se distribuyeron dos grupos: el grupo A con 187 niños (86.6 por ciento) con audición normal bilateral; y el grupo B con 29 niños (13.4 por ciento) con hipoacusia. El promedio de días de estancia en la unidad de cuidados intensivos neonatales fue significativamente mayor para el grupo B (21.5 ñ 19 vs 49.8 ñ 34 días, P =0.004). El promedio de días de ventilación mecánica fue significativamente mayor para el grupo B (10.8 ñ 12.7 vs 26.5 ñ 16 días, P =0.008).Se encontraron diferencias significativamente mayores en el grupo B en las variables: hiperbilirrubinemia (P =0.007), hemorragia intraventricular (P =0.005) y meningitis neonatal (P =0.005). Los Paptc resultaron sin respuesta en 8 por ciento de los casos.Conclusiones. La frecuencia de hipoacusia documentada en niños con peso al nacer igual o menor de 1 000 g fue de 13 por ciento. La etiología de esta lesión es posiblemente multifactorial.

Perfil audiométrico del niño hipoacúsico egresado de una Unidad de Cuidado Intensivo Neonatal: análisis de 40 casos / Audiometric profiles of hipoacusic children six years after discharge from a Neonatal intensive care unit

Introducción. En este estudio se describe el perfil audiométrico del niño hipoacúsico egresado de una Unidad de Cuidado Intensivo Neonatal (UCIN).Material y métodos. En una clínica de seguimiento pediátrico longitudinal se estudiaron mediante potenciales auditivos evocados de tallo cerebral y audiometrías a 40 niños con hipoacusia adquirida durante su estancia en una UCIN; se describen algunos factores asociados con hipoacusia en el período neonatal, y sus características audiométricas a 6 años de seguimiento longitudinal.Resultados. La edad gestacional promedio al nacer fue de 32.4 semanas con peso promedio de 1 557.5 g. El 0.82 ameritó ventilación mecánica intermitente y el promedio de días estancia en UCIN fue de 22 días.El factor asociado más frecuente fue la exposición a amikacina en 0.95 de los casos, seguido de la hiperbilirrubinemia con 0.82. Se detectaron 5 factores promedio presentes en cada niño. Los resultados de los potenciales auditivos evocados de tallo cerebral indicaron 23 casos (0.57) sin respuesta bilateral y 6 casos (0.15) sólo registraron onda V a 95 dB. La audiometría tonal mostró 0.93 con hipoacusia bilateral, probablemente de tipo sensorio-neural, simétrica, de grado severo a profundo con mayor alteración en las frecuencias agudas; 0.05 presentaron hipoacusia unilateral profunda con audición normal en el lado contrario.Conclusión. Estas observaciones sugieren que en nuestro medio el recién nacido pretérmino con peso promedio de 1 500 g, con historia neonatal complicada, y exposición prolongada a aminoglucósidos e hiperbilirrubinemia está en alto riesgo de presentar hipoacusia, justificando valoración audiológica durante sus primeros meses de vida.

Factores de riesgo para hipoacusia y hallazgos audiométricos en una población preescolar egresada de cuidados intensivos neonatales / Risk factores for hypoacusis and audiometric findings in preschool children admitted to a neonatal intensive care unit

En un estudio de corte transversal se analizaron por audiometría de tonos puros entre las frecuencias de 125 a 8000 Hz, por condicionamiento operante, en 30 niños sobrevivientes de una unidad de cuidados intensivos neonatales, entre 36 y 72 meses de edad, encontrándose que tres padecían hipoacusia. Los factores de riesgo encontrados con mayor frecuencia en la muestra estudiada fueron hiperbilirrubinemia, asfixia al nacer y administración de fármacos ototóxicos. Todos los pacientes con hipoacusia tenían antecedente de parto pretérmino; además uno había sufrido hipoxia al nacimiento y otros dos hiperbilirrubinemia; los pacientes presentaron un promedio de 2.26 facotres de riesgo. Se concluye que el daño auditivo de origen perinatal es de etiología multicausal en la génesis de este tipo de hipoacusia

Thirty preschool children who survived from a neonatal intensive care unit were studied with pure tone audiometry between 125 to 8000 Hertz. Examinations were performed in a cross-sectional study at 36 to 72 postnatal months of age. Hypoacusis was found in three patients. Risk factors most frequently found in hypoacustic children were hyperbilirubinemia, hypoxia neonatorum and ototoxic exposure. All hypoacustic children had a history of preterm birth, one suffered hypoxia neonatorum, and two hyperbilirubinemia. The patients' group had an average of 2.26 risk factors. These data suggest that perinatal auditory damage occurs in the presence of additional hearing damage risk factors leading to hypoacusis.

El neurodesarrollo a los dos años de vida de neonatos tratados en una unidad de cuidados intensivos neonatales / Neurological development at age two of children who had been treated in a neonatal intensive care unit

El objetivo principal de este estudio fue evaluar de forma prospectiva, a los 2 años de vida, el desarrollo de un grupo de neonatos tratados en la unidad de cuidados intensivos neonatales (UCIN) del Instituto Nacional de Perinatología de México. Se estudió desde el punto de vista neurológico, psicológico, auditivo, linguístico, motor y neuromuscular a todos los neonatos nacidos entre el 1 de enero de 1992 y el 31 de diciembre de 1993 que hubieran ingresado a la UCIN y permanecido en ella 3 días o más. Se incluyó a 134 pacientes con una edad gestacional promedio de 32 semanas y un peso promedio al nacer de 1 677 g. De ellos, 75 por ciento habían sido sometidos a ventilación mecánica, con una estancia hospitalaria promedio de 51 días. En el examen efectuado a los 2 años, 66,5 por ciento de los niños fueron normales y 8,2 por ciento tuvieron alteraciones graves. Se encontraron asociaciones significativas entre el estado neurológico y los días de ventilación artificial (P 0,0001), los días de estancia en la UCIN (P 0,000004) y la edad gestacional en semanas (P 0,03). No hubo ninguna asociación entre el sexo y el resultado de las valoraciones. En conclusión, los resultados obtenidos en este trabajo muestran una disminución de las alteraciones del neurodesarrollo en comparación con los resultados obtenidos en estudios similares hace 10 años

The principal objective of this study was to evaluate, at 2 years of age, the neurological development of a group of children who had been treated in the neonatal intensive care unit (NICU) of the National Institute of Perinatology of Mexico. All the children born between 1 January 1992 and 31 December 1993 who had entered the NICU and stayed for 3 or more days were studied from the neurological, psychological, auditory, linguistic, motor, and neuromuscular standpoint. This group included 134 patients, who had had an average gestational age of 32 weeks and an average birthweight of 1 677 g. They had stayed in the hospital an average of 51 days, and 75% of them had undergone artificial respiration. In the examination done at age 2, 66.5% of the children were normal and 8.2% had serious impairments. There were statistically significant associations between their neurological condition and the days of artificial respiration (P < 0.0001), the days spent in the NICU (P < 0.000004), and the gestational age in weeks (P < 0.03). There was no association between the children's sex and the results of the assessments. The study results showed a decrease in neural abnormalities in comparison with the results obtained in similar studies 10 years earlier

El neurodesarrollo a los dos años de vida de neonatos tratados en una unidad de cuidados intensivos neonatales / Neurological development at age two of children who had been treated in a neonatal intensive care unit

El objetivo principal de este estudio fue evaluar de forma prospectiva, a los 2 años de vida, el desarrollo de un grupo de neonatos tratados en la unidad de cuidados intensivos neonatales (UCIN) del Instituto Nacional de Perinatología de México. Se estudió desde el punto de vista neurológico, psicológico, auditivo, linguístico, motor y neuromuscular a todos los neonatos nacidos entre el 1 de enero de 1992 y el 31 de diciembre de 1993 que hubieran ingresado a la UCIN y permanecido en ella 3 días o más. Se incluyó a 134 pacientes con una edad gestacional promedio de 32 semanas y un peso promedio al nacer de 1 677 g. De ellos, 75 por ciento habían sido sometidos a ventilación mecánica, con una estancia hospitalaria promedio de 51 días. En el examen efectuado a los 2 años, 66,5 por ciento de los niños fueron normales y 8,2 por ciento tuvieron alteraciones graves. Se encontraron asociaciones significativas entre el estado neurológico y los días de ventilación artificial (P 0,0001), los días de estancia en la UCIN (P 0,000004) y la edad gestacional en semanas (P 0,03). No hubo ninguna asociación entre el sexo y el resultado de las valoraciones. En conclusión, los resultados obtenidos en este trabajo muestran una disminución de las alteraciones del neurodesarrollo en comparación con los resultados obtenidos en estudios similares hace 10 años