Page 91 - Portuguese Journal - SPORL - Vol 61. Nº1
P. 91
Proposal for review of UNHS in Portugal for auditory neuropathy, and noise exposure in
the NICU may also contribute to hearing loss.
6
1. Risk factors to be included (Table 1) EUSCREEN suggests that this group should
a) Parental consanguinity be assessed by AEP. 5
Population studies conducted in the Middle It should be noted that the Société Française
East have shown the existence of up to 3.5 de Pédiatrie also suggests the inclusion of
times more cases of childhood hearing loss preterm infants under 32 weeks of gestation
in the offspring of blood-related couples. 16,17 in the at-risk group, as well as those with
Therefore, it is pertinent to include NBs of brain complications related to prematurity .
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blood-related couples in the at-risk group for Because this is a controversial issue due to the
UNHS in Portugal. overlap between this group of NBs and NBs
requiring NICU admission or those exposed to
b) Intrauterine Zika virus infection other risk factors that were already included in
NBs with intrauterine Zika virus infection the at-risk group 27-29 , we chose not to include
(mother with laboratory findings of Zika virus this risk factor as an isolated factor.
infection during labor and NBs with laboratory
confirmation of infection) should be included e) ECMO
in the at-risk group for UNHS according to Children undergoing ECMO were included
the recommendation of the JCIH , even by the JCIH due to the increased risk of late-
6
when asymptomatic. This risk group should onset hearing loss. 3,6,14
preferably be evaluated using AEP. 6
f) Fetal Alcohol Syndrome
c) Intrauterine exposure to toxic substances The Société Française de Pédiatrie recommends
and/or tobacco the inclusion of all NBs with documented
Following the guidelines of the Société Française intrauterine exposure to alcohol . Despite the
13
de Pédiatrie, all NBs with intrauterine exposure association shown between fetal alcohol
to tobacco and/or toxic substances were syndrome and childhood hearing loss 30,31 ,
included. Some studies have demonstrated studies conducted in recent years on children
that NBs exposed to tobacco during diagnosed with diseases of the fetal alcohol
pregnancy had lower amplitudes of OAE 18,19 . spectrum did not demonstrate an increased
Intrauterine exposure to tobacco was recently prevalence of hearing loss in this population
associated with an increased risk of hearing compared to healthy children . However, we
32
loss in childhood and adolescence. deemed that NBs diagnosed with fetal alcohol
21
20
Intrauterine exposure to toxic substances such syndrome should be included in the at-risk
as cocaine and/or opioids has been shown to group of hearing loss.
be associated with worse auditory outcomes
in several studies. 22–26 g) Ventriculoperitoneal shunt
Recent evidence suggests that 40% of children
d) Hospitalization in the Neonatal Intensive (18 years old and less) develop hearing loss of
Care Unit (NICU) longer than five days at least 15 dB in three consecutive frequencies
All NBs admitted to NICUs for more than after ventriculoperitoneal shunt placement. 33,34
five days should be included, regardless of For this reason, EUSCREEN suggests that
whether they underwent invasive mechanical all children should be considered at risk of
ventilation, as suggested by the JCIH. An hearing loss after ventriculoperitoneal shunt
association between this population and the placement and have their hearing evaluated
increased risk of auditory neuropathy has in accordance with their ability to collaborate. 5
been established. The use of aminoglycosides
6
and hyperbilirubinemia are known risk factors
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