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Comprehensive evaluation of risk factors for neonatal hearing loss in a large Brazilian cohort

Journal of Perinatology volume 41, pages 315–323 (2021)Cite this article

Subjects

Abstract

Objectives

To determine the incidence and risk factors of hearing loss (HL) in Brazilian neonates.

Study design

11,900 neonates were screened for hearing and congenital CMV (cCMV). Low and high-risk babies who did not pass their hearing screening and infants with cCMV were scheduled for a diagnostic audiologic evaluation.

Results

The incidence of HL was 2 per 1000 live-born infants (95% CI: 1–3). HL was higher in high-risk neonates than in low risk babies (18.6 vs. 0.3/1000 live births, respectively). Among infants exposed to isolated risk factors, association of HL with craniofacial abnormalities/syndromes (RR = 24.47; 95% CI: 5.9–100.9) and cCMV (RR = 9.54; 95% CI: 3.3–27.7) were observed. HL was 20 to 100-fold more likely in neonates exposed to ototoxic drugs in combination with cCMV or craniofacial/congenital anomalies.

Conclusions

Strategies for the prevention of cCMV and exposure to ototoxic drugs may decrease the incidence of HL in this population.

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Fig. 1: Flowchart of the hearing screening protocol and referral evaluations.
Fig. 2: Conditional inference tree associating risk factors to hearing loss: Study subjects were classified according to the presence of hearing loss (nodes 5, 6, 7, 8, 10, 11, 12 e 13).

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Funding

All phases of this study were supported by FAPESP, Brazil, (Grant 2013/06579-0 to MMMP); and Eunice Kennedy Shriver NICHD, USA (Grant 2R01HD061959-07A2 to WJB).

Author information

Authors and Affiliations

  1. Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

    Adriana R. T. Anastasio, Alessandra K. S. Manfredi & Juliana M. S. Cavalcante

  2. Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil

    Aparecida Y. Yamamoto, Davi C. Aragon & Marisa M. Mussi-Pinhata

  3. Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School-University of São Paulo, São Paulo, Brazil

    Eduardo T. Massuda & Bruno C. P. Lopes

  4. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Suresh Boppana, Karen B. Fowler & William J. Britt

Authors
  1. Adriana R. T. Anastasio
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  2. Aparecida Y. Yamamoto
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  3. Eduardo T. Massuda
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  4. Alessandra K. S. Manfredi
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  5. Juliana M. S. Cavalcante
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  6. Bruno C. P. Lopes
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  7. Davi C. Aragon
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  8. Suresh Boppana
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  11. Marisa M. Mussi-Pinhata
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Contributions

ARTA conceptualized and designed the study, drafted the initial manuscript, revised critically and approved the final version of the manuscript. She also supervised the application of the hearing screening and audiological tests. AYY conceptualized and designed the study, supervised the CMV screening and the follow up of CMV-infected infants, was in charge of data management, revised critically and approved the final version of the manuscript. ETM conceptualized and designed the study, provided supervision and care for infants with suspected and confirmed hearing loss, helped with data acquisition, revised critically and approved the final version of the manuscript. MM M-P conceptualized the BRACHS cohort study, obtained funds, supervised activities for data collection, took part of the manuscript preparation, and definition of data analysis, revised critically and approved the final version of the manuscript. AKSM and JMSC participated in the application of the hearing screening and audiological tests, being in charge of the completeness of the audiological protocol activities and data acquisition, revised critically and approved the final version of the manuscript. BCPL participated in the care of the children who underwent electrophysiological examinations under anesthesia, helped with data acquisition, revised critically and approved the final version of the manuscript. DCA carried out the statistical analyses and interpretation of data, revised critically and approved the final version of the manuscript. SB conceptualized the BRACHS cohort study, and reviewed the manuscript for important intellectual content and approved the final version of the manuscript. KBF participated in the conceptualization and data managing planning for the BRACHS cohort study, reviewed and approved the final version of the manuscript. WJB conceptualized the BRACHS cohort study, and reviewed the manuscript for important intellectual content, and approved the final version of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects related to the accuracy or integrity of any part of the work.

Corresponding author

Correspondence to Adriana R. T. Anastasio.

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Anastasio, A.R.T., Yamamoto, A.Y., Massuda, E.T. et al. Comprehensive evaluation of risk factors for neonatal hearing loss in a large Brazilian cohort. J Perinatol 41, 315–323 (2021). https://doi.org/10.1038/s41372-020-00807-8

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