EBNEO Commentary: Risk stratification of sensorineural hearing impairment in preterm infants

Hemmingsen D, Moster D, Engdahl BL, Klingenberg C. Sensorineural hearing impairment among preterm children: a Norwegian population-based study. Arch Dis Child Fetal Neonatal Ed 2024;0: F1–F7. doi: 10.1136/archdischild-2024-326870. The incidence of moderate to severe bilateral hearing deficit (>50 dB) is estimated to occur in 1–3 per 1000 live births in healthy infants and 2–4 per 100 infants admitted to the NICU.1 SNHI can lead to developmental delays as well as psychological and mental health issues, which adds to the existing challenges of being born prematurely.2 Risk factors associated with SNHI include family history of hearing loss, craniofacial anomalies, complex congenital abnormalities, congenital infections (such as TORCH), low birth weight, prematurity, hyperbilirubinemia requiring exchange transfusion, use of ototoxic medications, bacterial meningitis, a low Apgar score (<7 at 5 min), mechanical ventilation for at least five days, and NICU care lasting >7 days.2, 3 This extensive study included over 60 000 preterm infants over a 16-year period, focusing on the risk of SNHI in preterm infants born between 22 and 36 weeks. It allowed a follow-up period of five years to capture cases of late-onset hearing impairment. The findings align with previous studies, showing a higher prevalence of SNHI (1.4%) in preterm infants compared to the reference group (0.7%), with the highest risk observed (5.2%) in extreme preterm infants (gestational age 22–27 weeks). The increased incidence of SNHI in younger gestational age is related to the development of the auditory system, as the structural auditory system develops in the first 20 weeks of life, while the neurosensory system only becomes functional around 25 weeks.4 Insults to this developmental process can result in varying degrees of hearing impairment. Routine hearing screenings for infants involve non-invasive methods such as otoacoustic emissions (OAE) and confirmatory Auditory Brainstem Response (cABR) testing.1 Infants with hearing loss due to neural conduction disorders or auditory neuropathy may require ABR testing, as OAE alone may not detect their SNHI.3 This study made use of either diagnostic methods which may not have captured all infants with hearing impairment (HI) due to neurodysfunction. It also did not grade the severity of HI nor disclosed cases of isolated conductive HI and other forms of HI were broadly classed as ‘unspecified’. Overall, while this study provides valuable insights into the prevalence and risk factors of SNHI in preterm infants, addressing these limitations could further enhance understanding in this area. URL LINK: https://ebneo.org/ebneo-commentary-risk-stratification-of-sensorineural-hearing-impairment-in-preterm-infants/ Chidi Anakebe: Writing – review and editing. Sohaib Bin Nawaz: Writing – review and editing. Haji Sheeraz Khan: Supervision; writing – review and editing. BRIDGE Paediatric Research Network, Yorkshire and Humber, for article selection and editing. Dr. Khan has received a speaker honorarium from Vertex Pharmaceuticals (Europe) Limited for an educational non-promotional talk.