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Prognostic Value of Auditory Brainstem Response for Neurologic Outcome in Patients With Neonatal Indirect Hyperbilirubinemia

To investigate the value of the auditory brainstem response as a reliable test for the neurologic prognosis of infants with neonatal indirect hyperbilirubinemia, auditory brainstem response studies were performed in 22 infants. The patients were followed up until 12 months of age. Two patients demonstrated pathologic auditory brainstem response consistent with auditory neuropathy but had no neurologic finding except a lack of speech at 12 months of age. Two other patients had neurologic sequelae, one showing severe dyskinetic cerebral palsy, the other mild hypotonia and motor retardation, but their auditory brainstem response results were normal. These results suggested that auditory brainstem response examination might not provide reliable information for the neurologic prognosis. Neurologic disturbances resulting from bilirubin neurotoxicity can be seen in patients with a normal auditory brainstem response, but patients with an abnormal auditory brainstem response may not have any neurologic dysfunction apart from speech retardation. (J Child NeuroL 2001;16:772-775).

Noise levels in neonatal intensive care unit and use of sound absorbing panel in the isolette

OBJECTIVE The purposes of this study were to measure the noise level of a busy neonatal intensive care unit (NICU) and to determine the effect of sound absorbing panel (SAP) on the level of noise inside the isolette. METHODS The sound pressure levels (SPL) of background noise, baby crying, alarms and closing of isolettes door/portholes were measured by a 2235-Brüel&Kjaer Sound Level Meter. Readings were repeated after applying SAP (3D pyramidal shaped open cell polyurethane foam) to the three lateral walls and ceiling of the isolette. RESULTS The median SPL of background noise inside the NICU was 56dBA and it decreased to 47dBA inside the isolette. The median SPL of monitor alarms and baby crying inside the isolette were not different than SPL measured under radiant warmer (p>0.05). With SAP, the median SPL of temperature alarm inside the isolette decreased significantly from 82 to 72dBA, monitor alarm from 64 to 56dBA, porthole closing from 81 to 74dBA, and isolette door closing from 80 to 68dBA (p<0.01). There was a significant reduction in the noise produced by baby crying when SAP was used in the isolette (79dBA vs 69dBA, respectively) (p<0.0001). There was also significant attenuation effect of panel on the environmental noise. CONCLUSIONS The noise level in our NICU is significantly above the universally recommended levels. Being inside the isolette protects infants from noise sources produced outside the isolette. However, very high noises are produced inside the isolette as well. Sound absorbing panel can be a simple solution and it attenuated the noise levels inside the isolette.

Auditory neuropathy in hyperbilirubinemia: is there a correlation between serum bilirubin, neuron-specific enolase levels and auditory neuropathy?

This study evaluated whether a correlation exists between increased serum bilirubin and neuron-specific enolase (NSE) assays (a biochemical index of neuronal damage) and auditory neuropathy. Nineteen term neonates without hemolysis whose serum bilirubin levels were above 20 mg/dl and 27 healthy term newborns with bilirubin levels <13 mg/dl were included in the study. Auditory brainstem responses (ABRs) and transient evoked otoacoustic emissions (TEOAEs) of patients with hyperbilirubinemia were obtained before discharge. This preliminary study did not show any correlation between the serum NSE and bilirubin values. However, infants who had auditory neuropathy had significantly higher NSE levels, and thus these patients, being in the high-risk group, need close follow-up. Sumario Este estudio evala cu ndo existe una correlacin entre la bilirrubina s rica aumentada y los niveles neuronaespecficos de enolasa (NSE) (un índice bioqumico de da o neuronal) con la neuropata auditiva. Diez y nueve neonatos a t rmino sin hemlisis, cuya bilirrubina s rica estuvo por arriba de 20 mg/dl y 27 neonatos de trmino sanos, con niveles de bilirrubina de <13 mg/dl, se incluyeron en este estudio. Las respuestas auditivas del tallo cerebral (ABRs) y las emisiones otoac sticas evocadas por transitorios (TEOAEs) de los pacientes con hiperbilirrubinemia se obtuvieron despus del alta hospitalaria. Este estudio preliminar no mostró ninguna correlacin entre la NSE en suero y los valores de bilirrubina. No obstante, los ni os que tuvieron neuropata auditiva presentaron niveles NSE significativamente mayores por lo que esos pacientes, estando en el grupo de alto riesgo, requieren un seguimiento m s cercano.

Clinical Characteristics and Prognostic Factors in Childhood Bacterial Meningitis: A Multicenter Study

OBJECTIVE To evaluate clinical features and sequela in children with acute bacterial meningitis (ABM). STUDY DESIGN Multicenter retrospective study. MATERIAL AND METHODS Study includes retrospective chart review of children hospitalised with ABM at 11 hospitals in İstanbul during 2005. Follow up visits were conducted for neurologic examination, hearing evaluation and neurodevelopmental tests. RESULTS Two hundred and eighty three children were included in the study. Median age was 12 months and 68.6% of patients were male. Almost all patients had fever at presentation (97%). Patients younger than 6 months tended to present with feeding difficulties (84%), while patients older than 24 months were more likely to present with vomitting (93%) and meningeal signs (84%). Seizures were present in 65 (23%) patients. 26% of patients were determined to have at least one major sequela. The most common sequelae were speech or language problems (14.5%). 6 patients were severely disabled because of meningitis. Presence of focal neurologic signs at presentation and turbid cerebrospinal fluid appearance increased sequelae significantly. Childen under 24 months of age developed neurologic sequelae more commonly than older children. CONCLUSION Symptoms and signs were largely depending on the age of the patient. Speech or language problems were the most common sequelae following meningitis.

Yüksek Riskli Yenidoğanların İşitsel Beyin Sapı Davranım Odyometrisi ve Uyarılmış Otoakustik Emisyon Testi ile Taranması

Isitme kaybi acisindan risk tasiyan yenidoganlarda isitsel beyin sapi davranim odyometrisi ABR ve uyarilmis otoakustik emisyontesti TEOAE ile yapilan isitme taramasinin sonuclari sunulmaktadir Calismaya 1995 1998 yillari arasinda hastanemiz yenidogan yogun bakim unitesinde tedavi goren gestasyon yaslari 24 42 hafta dogum agirliklari ise 680 4400 gram arasinda degisen 55 bebek alindi Amerikan Pediatri Akademisi nin isitme tarama programinca belirlenen yuksek risk kriterlerini tasiyan hastalara klinik durumlari uygun oldugunda ABR ve TEOAE uygulandi Ilk testte 55 bebegin 43 u 78 ABR den 45 i 82 ise TEOAE den gecerken yedi hasta her iki testten kalmistir Ilk ABR den kalan bebeklerin besi TEOAE den gecmistir Ilk testte ABR taramasindan kalan 12 hastanin altisi tanisal testte ABR den gecerken uc hasta tekrar kalmis uc hasta ise takipten cikmistir Test sonucunda ABR den kalan uc hastadan ikisi TEOAE den de kalmis ve cok ileri derecede sensorinoral isitme kaybi tanisi almistir Bu olgulardan biri iki aylikken sepsis nedeniyle eksitus olmus diger olguya ise isitme aleti ile rehabilitasyona baslanmistir Ancak ilerleyen zaman icinde isitme cihazindan beklenen yararin saglanamadigi hastada koklear implant yerlestirilmesi amaciyla yapilan cerrahi girisim esnasinda Mondini deformitesi saptanmistir Ucuncu olguda ise TEOAE de yuksek amplitutlu emisyon elde edilmis ve Isitsel Noropati tanisi konmustur Yuksek riskli yenidoganlarin isitmeleri degerlendirilirken bu iki testin birlikte kullanilmasi koklear ve retrokoklear lezyonlarm ayirici tanisini yapmada ve isitme cihazi kullanma endikasyonunu belirlemede yararli olmaktadir Anahtar kelimeler: Riskli Yenidogan Isitme Kaybi Isitme Testi