Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit: A pilot study

Angela C. Garinis, Selena Liao, Campbell P. Cross, Johnathan Galati, Jessica L. Middaugh, Jess C. Mace, Anna Marie Wood, Lindsey McEvoy, Lauren Moneta, Troy Lubianski, Noe Coopersmith, Nicholas Vigo, Christopher Hart, Artur Riddle, Olivia Ettinger, Casey Nold, Heather Durham, Carol Macarthur, Cynthia (Cindy) McEvoy, Peter Steyger

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2–15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. Methods This was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. Results The mean level of ambient sound was 62.9 dBA (range 51.8–70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80% of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000–4000 Hz), was 5%; (ii) DPOAEs with a broad F2 frequency range (2063–10031 Hz) was 39%; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29%, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). Conclusion All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.

Original languageEnglish (US)
Pages (from-to)42-50
Number of pages9
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume97
DOIs
StatePublished - Jun 1 2017

Fingerprint

Neonatal Intensive Care Units
Gentamicins
Hearing
Referral and Consultation
Brain Stem Auditory Evoked Potentials
Hearing Loss
Term Birth
Cochlea
Aminoglycosides
Outcome Assessment (Health Care)
Guidelines

Keywords

  • Ambient sound level
  • Aminoglycosides
  • Critical care
  • Gentamicin
  • Hearing loss
  • Neonatal intensive care
  • Neonate
  • Newborn hearing screen
  • Noise
  • Sound pressure levels

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit : A pilot study. / Garinis, Angela C.; Liao, Selena; Cross, Campbell P.; Galati, Johnathan; Middaugh, Jessica L.; Mace, Jess C.; Wood, Anna Marie; McEvoy, Lindsey; Moneta, Lauren; Lubianski, Troy; Coopersmith, Noe; Vigo, Nicholas; Hart, Christopher; Riddle, Artur; Ettinger, Olivia; Nold, Casey; Durham, Heather; Macarthur, Carol; McEvoy, Cynthia (Cindy); Steyger, Peter.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 97, 01.06.2017, p. 42-50.

Research output: Contribution to journalArticle

Garinis, AC, Liao, S, Cross, CP, Galati, J, Middaugh, JL, Mace, JC, Wood, AM, McEvoy, L, Moneta, L, Lubianski, T, Coopersmith, N, Vigo, N, Hart, C, Riddle, A, Ettinger, O, Nold, C, Durham, H, Macarthur, C, McEvoy, CC & Steyger, P 2017, 'Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit: A pilot study', International Journal of Pediatric Otorhinolaryngology, vol. 97, pp. 42-50. https://doi.org/10.1016/j.ijporl.2017.03.025
Garinis, Angela C. ; Liao, Selena ; Cross, Campbell P. ; Galati, Johnathan ; Middaugh, Jessica L. ; Mace, Jess C. ; Wood, Anna Marie ; McEvoy, Lindsey ; Moneta, Lauren ; Lubianski, Troy ; Coopersmith, Noe ; Vigo, Nicholas ; Hart, Christopher ; Riddle, Artur ; Ettinger, Olivia ; Nold, Casey ; Durham, Heather ; Macarthur, Carol ; McEvoy, Cynthia (Cindy) ; Steyger, Peter. / Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit : A pilot study. In: International Journal of Pediatric Otorhinolaryngology. 2017 ; Vol. 97. pp. 42-50.
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abstract = "Objective Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2–15{\%}, compared to 0.3{\%} in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. Methods This was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. Results The mean level of ambient sound was 62.9 dBA (range 51.8–70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80{\%} of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000–4000 Hz), was 5{\%}; (ii) DPOAEs with a broad F2 frequency range (2063–10031 Hz) was 39{\%}; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29{\%}, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44{\%}. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). Conclusion All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.",
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author = "Garinis, {Angela C.} and Selena Liao and Cross, {Campbell P.} and Johnathan Galati and Middaugh, {Jessica L.} and Mace, {Jess C.} and Wood, {Anna Marie} and Lindsey McEvoy and Lauren Moneta and Troy Lubianski and Noe Coopersmith and Nicholas Vigo and Christopher Hart and Artur Riddle and Olivia Ettinger and Casey Nold and Heather Durham and Carol Macarthur and McEvoy, {Cynthia (Cindy)} and Peter Steyger",
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TY - JOUR

T1 - Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit

T2 - A pilot study

AU - Garinis, Angela C.

AU - Liao, Selena

AU - Cross, Campbell P.

AU - Galati, Johnathan

AU - Middaugh, Jessica L.

AU - Mace, Jess C.

AU - Wood, Anna Marie

AU - McEvoy, Lindsey

AU - Moneta, Lauren

AU - Lubianski, Troy

AU - Coopersmith, Noe

AU - Vigo, Nicholas

AU - Hart, Christopher

AU - Riddle, Artur

AU - Ettinger, Olivia

AU - Nold, Casey

AU - Durham, Heather

AU - Macarthur, Carol

AU - McEvoy, Cynthia (Cindy)

AU - Steyger, Peter

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2–15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. Methods This was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. Results The mean level of ambient sound was 62.9 dBA (range 51.8–70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80% of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000–4000 Hz), was 5%; (ii) DPOAEs with a broad F2 frequency range (2063–10031 Hz) was 39%; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29%, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). Conclusion All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.

AB - Objective Hearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2–15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. Methods This was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. Results The mean level of ambient sound was 62.9 dBA (range 51.8–70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80% of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000–4000 Hz), was 5%; (ii) DPOAEs with a broad F2 frequency range (2063–10031 Hz) was 39%; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29%, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). Conclusion All infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.

KW - Ambient sound level

KW - Aminoglycosides

KW - Critical care

KW - Gentamicin

KW - Hearing loss

KW - Neonatal intensive care

KW - Neonate

KW - Newborn hearing screen

KW - Noise

KW - Sound pressure levels

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