Andrew Elimian

Antecedents of newborn hearing loss

OBJECTIVE To determine what factors are associated with newborn hearing loss. METHODS We retrospectively reviewed hospital records of all neonates found on screening to have hearing loss as well as a cohort with normal audiometric findings from January 1998 through December 2000. The two groups were compared for various maternal, obstetric, and perinatal variables. RESULTS Sixty-four neonates had hearing loss. The controls consisted of 270 neonates with normal findings. There were no differences between groups when compared for various maternal and perinatal variables. The mean gestational age (35.9 ± 5.9 weeks versus 37.8 ± 3.1 weeks, P = .01) and birth weight (2698 ± 1173 g versus 3195 ± 816 g, P = .002) were significantly lower in the hearing-loss group. Only 32 of the 64 neonates (50%) had one or more of the ten clinical neonatal high-risk factors for newborn hearing loss. On multivariable analysis, very low birth weight of 1500 g or less (odds ratio [OR] 7; 95% confidence interval [CI] 3, 18; P = .001), 5-minute Apgar scores less than 7 (OR 5; 95% CI 2, 18; P = .009), positive family history of congenital deafness (OR 7; 95% CI 2, 197; P = .02), and structural and chromosomal anomalies (OR 64; 95% CI 14, 292; P = .001) were independently associated with the development of newborn hearing loss. CONCLUSION Congenital structural and chromosomal anomalies appear to be the most significantly associated risk factors for the development of newborn hearing loss. Very low birth weight, low Apgar scores, and family history are also independently associated with newborn hearing loss. However, most infants with hearing loss have no clinical risk factors.

The influence of genetic counselors on the acceptance of mid-trimester amniocentesis

Objective. To determine the effect of the genetic counselor on the acceptance of genetic amniocentesis. Methods. We studied women with singleton pregnancies who would be at least 35 years of age at the estimated date of delivery without fetal structural anomalies or family history of chromosomal abnormalities. The acceptance rate of genetic amniocentesis among women evaluated by each counselor was compared with the average acceptance rate for our population. Chi-square test, Fisher exact test and ANOVA were used for analysis. Results. Of the 2,180 women met our inclusion criteria, 1,719 (78.9%) accepted genetic amniocentesis. The maternal age at estimated date of delivery, the proportion of women who conceived by in vitro fertilization, and the proportion with history of miscarriage were similar among women evaluated by each of the six genetic counselors. However, the acceptance rate of genetic amniocentesis was significantly lower in women evaluated by counselor C [115/170 (67.6%), P = 0.001] and significantly higher in the group evaluated by counselor D [138/154 (89.6%), P = 0.002] compared with the overall study population rate [1719/2180 (78.9%)]. The acceptance rate of 80.4% (210/261, P = 0.52), 75.6 % (232/307, P = 0.23), 80.9% (443/547, P = 0.30] and 78.4% (581/741, P = 0.83) for Counselors A, B, E and F respectively did not differ from the overall study population rate. Conclusions. Considerable variation exists in the acceptance rate of genetic amniocentesis among women based on the genetic counselor.