Evaluación del muy bajo peso (≤ 1.500 g) al nacer como indicador de riesgo para la hipoacusia neurosensorial

Introduction and objectiveHearing plays an essential role in the acquisition, development and maintenance of the properties of the speech and language. Birth weight is an indicator of biological maturation of the newborn. Premature newborns with very low birth weight (VLBW < 1,500 g) constitute a group with the highest risk of sensorineural hearing loss. Our objective was to ascertain the degree of hearing loss, sensorineural hearing loss and presence of the association to other risk factors for hearing loss in VLBW infants included in the Universal Hearing Loss Screening Programme at the University Mother-Child Hospital of Gran Canaria (Spain) in the 2007-2010 period.Material and methodsThis was a retrospective study of 364 infants with VLBW, measured by transient evoked otoacoustic emissions and auditory brainstem response.ResultsThere were 112 newborn (30.8%) referred for auditory brainstem response. A diagnosis of hearing loss was given to 22 newborns (2.2%), 14 had conductive hearing loss and 8, sensorineural hearing loss (SNHL), of which 2 had bilateral profound hearing loss. The VLBW newborn presented the association to another risk factor in more than a quarter of the sample studied. All those diagnosed with SNHL were premature.ConclusionsThe percentage of VLBW newborns diagnosed with hearing loss is higher than expected in the general population. All those diagnosed with SNHL were premature and presented one or 2 hearing risk factors associated with VLBW.     

Outcome of neonatal screening for hearing loss in neonatal intensive care unit and well-born nursery infants

A newborn hearing screening was conducted on 319 neonatal intensive care unit (NICU) and 1200 well-born nursery (WBN) infants. Mean NICU birth weight was 1997 g and mean gestational age 34 weeks. Auditory brainstem response was studied in screening in NICU infants. Otoacoustic emission (OAE) or automated auditory brainstem response (AABR) was used in primary WBN screening. All infants not bilaterally passing hearing screening before discharge were recalled for outpatient retesting. If the outcome was still failure, ABR screening was conducted. The prevalence of infants diagnosed with hearing loss was 1.1% (16 of 1519). Of these 16, 75% were from the NICU and 75% were at risk for hearing loss. Mean age at hearing loss identification was 12.9 weeks in the WBN and mean age at hearing aid fitting was 16.1 weeks. Mean age at hearing aid fitting was lower for WBN than for NICU infants. Hearing loss identification and hearing aid fitting are thus feasible in NICU and WBN infants in universal newborn hearing screening.     

天津市新生儿听力筛查及信息化建设

目的通过对新生儿听力筛查及信息化管理,早期发现和诊断先天性听力损失,及时干预。方法新生儿出生3～5d采用畸变产物耳声发射(distoetion product otoacoustic emissions,DPOAE)进行初筛;42d用DPOAE和自动判别听性脑干反应(auto auditory brainstem response,AABR)进行复筛;3个月和6个月分别用听性脑干反应(auditory brainstem responses,ABR)、多频稳态反应(auditory steady state response,ASSR)和声导抗检查进行两次诊断;有听力障碍的患儿适时干预措施,并定期复查和随访。结果 2009～2010年在天津市出生活产婴儿106547人,104224例生后3d开始进行听力测试,全市建立了新生儿听力筛查信息化网络管理。初筛率为97.82%;初筛时正常新生儿未通过率为9.12%(9075/99484),高危儿为23.65%(1121/4740),高危儿未通过率明显高于正常新生儿(χ2=1.082,P<0.01);42d复筛率为53.44%;3个月接受第一次诊断的有362例;6个月接受诊断的有117例,其中100例(161耳)有不同程度听力损失,中重度和极重度听力障碍患儿在6个月确诊后进行干预。结论①通过建立新生儿听力筛查信息网络化管理系统,初筛率达97%以上;②42d新生儿听力复筛采用DPOAE和AABR检测技术联合应用,减少了漏筛和漏诊;③高危新生儿初筛阳性率为23.65%,明显高于正常新生儿。     

An initial overestimation of sensorineural hearing loss in NICU infants after failure on neonatal hearing screening

Objective

Infants admitted to neonatal intensive care units have a higher incidence of significant congenital hearing loss. We classified audiologic diagnoses and follow-up in infants who had been admitted to our neonatal intensive care unit.

Methods

We included all infants admitted to the neonatal intensive care unit at Sophia Children's Hospital between 2004 and 2009 who had been referred for auditory brainstem response measurement after failing neonatal hearing screening with automated auditory brainstem response. We retrospectively analyzed the results of auditory brainstem response measurement.

Results

Between 2004 and 2009 3316 infants admitted to our neonatal intensive care unit had neonatal hearing screening. 103 infants failed neonatal hearing screening: 46 girls and 57 boys. After first auditory brainstem response measurement we found 18% had normal hearing or a minimal hearing loss. The remainder had a type of hearing loss, distributed as follows: 15% conductive, 32% symmetric sensorineural, 14% asymmetric sensorineural, and 21% absent auditory brainstem responses. Repeated auditory brainstem response measurement showed a shift in hearing outcome. The main difference was an improvement from symmetric sensorineural hearing loss to normal hearing. However, in a small percentage of children, the hearing deteriorated.

Conclusions

As many as 58% of infants in this high-risk population who failed the neonatal hearing screening were diagnosed with sensorineural hearing loss or absent auditory brainstem responses. An initial overestimation of sensorineural hearing loss of about 10% was seen at first auditory brainstem response measurement. This may be partially explained by a conductive component that has resolved. Finally, in a small percentage of children the hearing deteriorated.     

Volunteer-based universal newborn hearing screening program

OBJECTIVE: To evaluate efficacy and costs of a volunteer-based universal newborn hearing screening program. METHODS: The Lucile Packard Children's Hospital at Stanford newborn hearing screening program database was reviewed. Results and costs of the hearing screens were analyzed. RESULTS: Hearing screens were performed on 5771 newborns treated in the well-baby nursery and nine infants from this population were identified with hearing loss, seven of whom had no risks factors for hearing loss. Using volunteers to perform the first-line screen with the automated auditory brainstem response (AABR) technology, 91% of infants registered for screening were evaluated prior to discharge. An additional 4% of infants were screened as outpatients. If an infant failed the AABR on two occasions, he or she was rescreened with the AABR or transient evoked otoacoustic emissions by a licensed audiologist, often while the infant was still in the hospital. Using this algorithm, 5% of infants tested in the well-baby nursery needed additional follow-up as an outpatient. Cost analysis of this volunteer-based program reveals a per/baby screening cost of $27.41. CONCLUSIONS: A volunteer-based hearing screening program is a viable option for hearing screening in well-baby nurseries but does not result in significant cost savings during the first 2 years of the program.     

Community-based newborn hearing screening program in Taiwan

OBJECTIVE: Congenital bilateral hearing impairment occurs in approximately 1 in every 1000 live births. Universal newborn hearing screening (UNHS) programs are the most effective method for early diagnosis. Previously, newborn hearing screenings in Taiwan were often hospital-based. Our study is a community-based program designed to test the feasibility of performing neonatal hearing screening with a pay-for-test model, and to evaluate its acceptability to parents. METHODS: From March 2000 to December 2002, two hospitals and four obstetric clinics in Tainan city participated in this study. The subjects were healthy newborns whose parents agreed to pay for otoacoustic emissions (OAE) hearing screening. They were tested in the newborn nursery before discharge. The protocol used an initial transient evoked otoacoustic emissions screening followed by a diagnostic auditory brainstem response (ABR) test. RESULTS: A total of 10,008 healthy neonates were recruited, and 5938 newborns (59.3%) were tested. Prior to hospital discharge, 5403 of the newborns (91.0%) had passed the transient evoked otoacoustic emissions test. Referral for further testing was made in 9.0% of cases (535/5938). There were 140 babies lost to 1-month follow up. Only 395 infants (73.8%) of the infants that failed their first otoacoustic emissions tests underwent a second session at the outpatient clinic, and 91 babies failed. They were referred for further auditory brainstem response testing. Ultimately, nine babies were diagnosed with sensorineural hearing loss (SNHL). CONCLUSIONS: There are difficulties in performing universal newborn hearing screening within Taiwan's health insurance system. This study was performed with the cooperation of hospitals and obstetric clinics, and was undertaken with a pay-for-screening model. Our program, with a pay-for-test model, of newborn hearing screening is feasible and was well regarded by parents in Tainan city. It could be run without the government's financial support.     

A comparison of auditory brain stem response and behavioral screening in high risk and normal newborn infants

A total of 345 newborn infants received a behavioral screening consistent with protocol adopted by the Joint Committee on Infant Hearing. Infants were divided into three groups consisting of 108 at-risk for hearing loss, 80 intensive care nursery graduates, and 157 normal control infants. Of the total, 315 newborns received auditory brain stem response (ABR) assessment. The results suggest that 4% of the high risk population had irreversible hearing loss to such a degree that amplification was warranted. Discussion focuses on the questionable use of behavioral screening in the newborn nursery and the application of ABR in a high risk population.     

新生儿听力普遍筛查模式的初步探讨

目的 寻找适合于中国国情的新生儿听力普遍筛查模式,获得新生儿听力损失发病的基本资料。方法 新生儿在出院前接受耳声发射（otoacoustic emissions,OAE)测试,通过者予以出院;对未通过者在1个月后再次复查OAE,仍未通过者行听性脑干反应（auditory brainstem response,ABR)检查。所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估,以确定听力损失的性质和程度。耳声发射测试采用畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE),通过标准：1．5－6kHz的5个测试频率中的4个信噪比大于6dB。ABR通过测试的标准为波V反应阈值≤35dBnHL。结果 2998例新生儿中2710位通过出院前的OAE测试,1个月后288例复查OAE,其中263例通过。需要ABR检查者共有25例,未通过者6例。经过全面的听力学诊断和评估,6例婴儿（占全体新生儿的2‰）有听力损失。结论 新生儿听力普查十分必要,OAE和ABR联合应用的两步筛查法是较适合的筛查模式。     

北京市8200例和西宁市1940例新生儿听力筛查结果对比分析

目的对比分析8 200例北京市新生儿和1 940例西宁市新生儿的听力筛查结果。方法回顾性分析2009年1月～2011年10月北京大学第三医院8 200例、青海大学附属医院1 940例活产新生儿听力筛查的结果,均采用瞬态诱发耳声发射(TEOAE)进行初筛、复筛,其中,北京大学第三医院对具有听力损害高危因素儿采用了TEOAE联合自动听性脑干反应(AABR)进行复筛。结果北京大学第三医院活产新生儿初筛率为100%,复筛率为83.39%,最终确诊为先天性听力损失者正常儿中25例,高危儿中35例。青海大学附属医院活产新生儿初筛率为85.98%,复筛率为68.21%,最终诊断为听力损失者正常儿中1例,高危儿中6例。北京大学第三医院初筛率和复筛率均较青海大学附属医院高,差异有统计学意义(P<0.05)。结论 2009～2011年北京大学第三医院活产新生儿听力筛查结果达到推荐筛查标准,而青海大学附属医院尚未达到筛查标准,应进一步加强宣教和随访。     

Audiological outcome of infants with congenital cytomegalovirus infection in a prospective study

The aim of this study was to evaluate the audiological outcome of long-term follow-up of infants with asymptomatic congenital cytomegalovirus (CMV) infection as defined by the presence of CMV DNA in neonatal urine. 12599 pregnant women underwent screening for CMV IgG and IgM antibodies between 1996 and 2003. Eighteen infants with congenital CMV infection were identified. These infants underwent the newborn hearing screening test or auditory brainstem response test. Follow-up hearing assessments were performed with the auditory brainstem response and behavioral audiometry. The seropositive rate of CMV IgG antibody among the pregnant women was 75.3%, and the yearly seropositive rate decreased over the study period. One hundred and forty-six pregnant women were positive for IgM antibody, and 18 neonates (12.3%) had congenital CMV infection. Sensorineural hearing loss (SNHL) was detected in 4 (25%) of the 16 infants with asymptomatic infection and 1 (50%) of the 2 infants with symptomatic infection during the first 6 months of life. Two infants who passed the newborn hearing screening had a delayed-onset SNHL in follow-up examinations up to 4 years of age. Two had progressive hearing loss and 2 had improvement of hearing loss. Screening of pregnant women for CMV infection and repeated audiological examinations of infants are necessary because there are infants with delayed-onset SNHL or improved SNHL caused by asymptomatic congenital CMV infection.     

The New York State universal newborn hearing screening demonstration project: ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention

OBJECTIVE: To determine the ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention through a multi-center, state-wide universal newborn hearing screening project. DESIGN: Universal newborn hearing screening was conducted at eight hospitals across New York State. All infants who did not bilaterally pass hearing screening before discharge were recalled for outpatient retesting. Inpatient screening and outpatient rescreening were done with transient evoked otoacoustic emissions and/or auditory brain stem response testing. Diagnostic testing was performed with age appropriate tests, auditory brain stem response and/or visual reinforcement audiometry. Infants diagnosed with permanent hearing loss were considered for hearing aids and early intervention. Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention were investigated regarding nursery type, risk status, unilateral versus bilateral hearing loss, loss type, loss severity, and state regions. RESULTS: The prevalence of infants diagnosed with permanent hearing loss was 2.0/1000 (85 of 43,311). Of the 85 infants with hearing loss, 61% were from neonatal intensive care units (NICUs) and 67% were at risk for hearing loss. Of the 36 infants fitted with hearing aids, 58% were from NICUs and 78% were at risk for hearing loss. The median age at identification and enrollment in early intervention was 3 mo. Median age at hearing aid fitting was 7.5 mo. Median ages at identification were less for infants from the well-baby nurseries (WBNs) than for the NICU infants and for infants with severe/profound than for infants with mild/moderate hearing loss, but were similar for not-at-risk and at-risk infants. Median ages at hearing aid fitting were less for well babies than for NICU infants, for not-at-risk infants than for at-risk infants, and for infants with severe/ profound hearing loss than for infants with mild/ moderate hearing loss. However, median ages at early intervention enrollment were similar for nursery types, risk status, and severity of hearing loss. CONCLUSIONS: Early ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention can be achieved for infants from NICUs and WBNs and for infants at risk and not at risk for hearing loss in a large multi-center universal newborn hearing screening program.     

新生儿听力普遍筛查模式的初步探讨

目的寻找适合于中国国情的新生儿听力普遍筛查模式,获得新生儿听力损失发病的基本资料.方法新生儿在出院前接受耳声发射(otoacousticemissions,OAE)测试,通过者予以出院;对未通过者在1个月后再次复查OAE,仍未通过者行听性脑干反应(auditorybrainstemresponse,ABR)检查.所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估,以确定听力损失的性质和程度.耳声发射测试采用畸变产物耳声发射(distortionproductotoacousticemissions,DPOAE),通过标准1.5～6kHz的5个测试频率中的4个信噪比大于6dB.ABR通过测试的标准为波V反应阈值≤35dBnHL.结果2998例新生儿中2710位通过出院前的OAE测试,1个月后288例复查OAE,其中263例通过.需要ABR检查者共有25例,未通过者6例.经过全面的听力学诊断和评估,6例婴儿(占全体新生儿的2‰)有听力损失.结论新生儿听力普查十分必要,OAE和ABR联合应用的两步筛查法是较合适的筛查模式.     

A model of two-stage newborn hearing screening with automated auditory brainstem response

Our purpose was to evaluate a two-stage newborn hearing screening program using automated auditory brainstem response (AABR) before discharge and to describe our follow-up program. This study used 4085 infants born in the Seirei-Hamamatsu and Mikatahara General Hospitals during a 2-year period. The initial screening test was performed 2 or 3 days after birth at an intensity of 35 dBnHL. For the infants who were referred from this test, the re-screening test was performed 5 or 6 days after birth. Diagnostic work-up with auditory brainstem response (ABR), otoacoustic emissions (OAE), and a conditioned orientation reflex audiometry (COR) test were performed by the age of 3-6 months. The referral rate was 1.20% (49/4085 infants) in the first test and 0.71% (29/4085 infants) in the two-stage screening. The two-stage screening procedure was able to reduce the false-positive rate from 0.83 to 0.34%. The incidence of bilateral and unilateral congenital hearing loss diagnosed by ABR was 8/4085 (0.20%) infants and 7/4085 (0.17%) infants, respectively. One infant with congenital cytomegalovirus infection, who passed the two-stage AABR tests, was diagnosed with hearing loss 1 month after birth, using ABR. The two-stage measurement of AABR is effective and time efficient due to significant decreases in the referral rate and the false-positive rate.     

Newborn hearing screening with combined otoacoustic emissions and auditory brainstem responses

Accurate assessment of neonatal hearing screening performance is impossible without knowledge of the true status of hearing, a prohibitive requirement that necessitates a complete diagnostic evaluation on all babies screened. The purpose of this study was to circumvent this limitation by integrating two types of screening measures obtained near simultaneously on every baby. Peripheral auditory function was defined by otoacoustic emission results. A complete diagnostic evaluation was performed on every baby who received a "Refer" outcome for auditory brainstem response screening. The integrated results for auditory brainstem response screening in an unselected group of 300 newborns estimated sensitivity at 100%, specificity at 99.7%, overall referral rate at 2.0%, and a positive predictive value of 83.3%. Conductive loss associated with amniotic fluid in the middle ear can persist several weeks after birth; conductive loss can produce a "Refer" outcome for auditory brainstem response screening; and auditory neuropathy can be detected with screening measures. Prevalence results were consistent with the published literature. The implications of this study are that otoacoustic emissions and auditory brainstem measures provide much more information than either alone and that both are needed for a comprehensive hearing screening program.     

Sequenzielles Neugeborenen-Hörscreening (TEOAE/AABR) reduziert Recall-Rate

BACKGROUND: 1-2/1,000 newborns are affected by connatal permanent hearing impairment. Clinical diagnosis is often delayed. This demands newborn hearing screening (NHS). Some questions regarding the optimal method remain unsolved. METHODS: The newborns in the obstetrical department (low-risk group) are tested by automated transitory evoked otoacustic emissions (TEOAE). TEOAE-fail is followed by automated auditory brainstem response (AABR) examination. All sick newborns admitted to the pediatric department (high-risk group) are primarily tested using AABR. Pathological AABR-testing leads to pedaudiological diagnostic work-up. RESULTS: In the low-risk group, 82 out of 1,584 newborns failed TEOAE-testing (recall 5.18%). Only 5 of these patients failed consecutive AABR examination (recall 0.32%). Permanent hearing loss was finally confirmed in 3 children (0.13%). 10 out of 755 newborns in the high-risk group failed AABR-testing (1.32%). In 6 of these children, hearing loss was confirmed (0.79%). CONCLUSION: A two-tier screening process as described is able to reduce recall rate, overall expenses and parental anxiety.     

A universal newborn hearing screening program in Taiwan

OBJECTIVE: Mackay Memorial Hospital and the Children's Hearing Foundation established a pilot universal newborn hearing screening program in November 1998. Our objective was to assess the feasibility, accuracy and cost effectiveness of implementing universal newborn hearing screening in Taiwan. METHOD: Between November 1998 and October 2000 a total of 6765 newborns were screened for hearing loss prior to discharge from the wellborn nursery at Mackay Memorial Hospital. The average age of the subjects at the initial screening test was 52 h. The program employed a three stage hearing screening protocol using transient evoked otoacoustic emmisions (TEOAE) screening with referral for diagnostic auditory brainstem response assessment. RESULTS: The mean TEOAE screening time per ear was 41.43 s. The overall pass rate at the time of hospital discharge was 93.6%. Thus achieving an acceptable referral rate of 6.4% for diagnostic audiological assessments. Nine newborns were identified with permanent bilateral hearing impairment. 26 newborns were identified with permanent unilateral hearing impairment. Infants identified with bilateral hearing loss were immediately referred to the Children's Hearing Foundation for hearing aid assessment and fitting. Infants as young as 5 weeks of age were successfully fitted with hearing instruments and enrolled in the family centered early intervention program at the Children's Hearing Foundation. CONCLUSION: The frequency of bilateral congenital hearing loss requiring amplification in this population is shown to be approximately 1 in 752 newborns. This finding is consistent with previous research, which has indicated hearing loss to be the most frequently occurring birth defect. Universal newborn hearing screening using TEOAEs proved to be a cost effective and feasible method of identifying congenital hearing loss in Taiwan. The existence of many successful screening programs worldwide and the availability of fast, objective, reliable and inexpensive hearing screening procedures means that universal newborn hearing screening is becoming the standard of care.     

A multisite study to examine the efficacy of the otoacoustic emission/automated auditory brainstem response newborn hearing screening protocol: introduction and overview of the study

PURPOSE: This article is the 1st in a series of 4 articles on a recently completed multistate study of newborn hearing screening. METHOD: The study examined the efficacy of the 2-stage otoacoustic emission/automated auditory brainstem response (OAE/A-ABR) protocol for identifying hearing loss in newborns. RESULTS: The study found that the 2-stage OAE/A-ABR protocol did miss a significant number of babies who exhibited a permanent hearing loss by 1 year of age. Three subsequent articles will describe the research design and results in detail, discuss the behavioral assessment of infants, and summarize the implications of the study for policy, practice, and research.     

Newborn hearing screening on infants at risk

Objectives

This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007.

Materials and methods

All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40 dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management.

Results

Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500 g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss.

Conclusion

Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.     

The effects of hypoxia, premature birth, infection, ototoxic drugs, circulatory system and congenital disease on neonatal hearing loss

OBJECTIVES: To investigate the incidence of neonatal hearing loss in well-baby populations and in a neonatal intensive care unit and to identify potential risk factors for hearing loss in a neonatal intensive care unit which the Joint Committee on Infant Hearing (JCIH) had not recommended. METHODS: Auditory screening was conducted in 226 infants (452 ears) born in Tohoku University from 2000 to 2001. The cases included 124 healthy newborn infants (248 ears), and 102 newborn infants (204 ears) treated in the neonatal intensive care unit (NICU). Hearing impairment was confirmed through a primary screening of the automated auditory brainstem response (AABR) and a secondary test of the auditory brainstem response (ABR) with otolaryngologic evaluation. Based on these examinations, we divided infants into two groups, 'Pass' and 'Refer'. RESULTS: Nine patients (15 ears) in Refer group were identified through our protocol. The incidence of the Refer group was 0.8% (1 out of 124) in the well-baby nursery, 7.8% (8 out of 102) in the NICU populations. The infants in Refer group were shown to have a higher incidence of congenital infection (P < 0.01), high C-reactive protein (CRP) (> or =10 mg/dl), chromosomal aberration, and central nervous system abnormality (P < 0.05). On the other hand, there were no statistical differences between the Pass and Refer groups in NICU, birth weight (<2200 g), gestational age, the values of total serum bilirubin, the values of arterial blood gases (pH, PaCO2 , PaO2 ), percutaneous oxygen saturation (SpO2), hemodynamics (blood pressure and heart rate) (P > 0.1). Respiratory status such as the Apgar score (the abbreviation for appearance, pulse, grimace, activity, respiration) (1 min; < or =4), (5 min; < or =6), Silverman retraction score, ototoxic drug use, respiratory distress syndrome (RDS), Meconium aspiration syndrome (MAS), and persistent pulmonary hypertension of newborn (PPHN) were also not statistically related to hearing loss (>0.999). CONCLUSION: Even in a small number of infants, there are positive relationships between hearing loss and congenital infection, high CRP (> or =10 mg/dl), chromosomal aberration and central nervous system abnormality. The CRP (> or =10 mg/dl) variable are not listed in the high-risk register published by the JCIH, but we can say that the variable may predict hearing impairment in our patient population. The possibility of autosomal recessive inheritance of genes for deafness is supposed when newborns have no other risk factors for hearing loss. This leads us to conclude that hearing screening is an effective way to find out hearing loss population.