Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Neonatal Hearing Screening in Neonatal Intensive Care Unit Graduate

신생아 집중치료실 퇴원아의 신생아 청력 선별검사

  • Cho, Sung-Hee (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Kim, Han-A (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Kim, El-Len A. (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Chung, Jong-Woo (Department of Otolaryngology, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Lee, Byong-Sop (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Kim, Ki-Soo (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center) ;
  • Pi, Soo-Young (Division of Neonatalogy, Department of Pediatrics, Children's Hospital, University of Ulsan Collage of Medicine, Asan Medical Center)
  • 조성희 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김한아 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 정종우 (울산대학교 의과대학 서울아산병원 이비인후과학교실) ;
  • 이병섭 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아과학교실)
  • Published : 2009.11.30

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Abstract

Purpose: Hearing loss is one of the common birth defects in humans, with a reported prevalence of 1-3 per 1000 newborns. We investigated the incidence of hearing loss and evaluated the use of neonatal hearing screening test in neonatal intensive care unit (NICU) graduates who are at greater risk for hearing loss than normal newborns. Methods: The neonates admitted to the NICU of Asan Medical Center from 1 March, 2003 to 30 March, 2008 who were available for follow-up were included. Those who failed the first auditory brainstem response prior to discharge were retested with the stapedial reflex test, auditory brainstem response and tympanometry in the Otolaryngology department. Results: Of 2,137 neonates, 2,000 (93.5%) neonates were tested prior to discharge. Sixty-seven neonates (3.4%) failed the first newborn hearing screening test. Of 67 infants, 52 infants were retested for a second hearing test. Excluding 10 infants (19.2%) who were lost during follow-up, 16 infants were confirmed to have hearing impairment of which 12 and 4 infants had unilateral and bilateral hearing loss, respectively. Of 16 infants, 5 did not meet the criteria set by the Korean National Health Insurance Corporation. Conclusion: The prevalence of hearing impairment in NICU graduates is about 0.8%, excluding those who were lost for follow up, necessitating a systemic and effective hearing assessment program among these high risk infants and more generous national insurance coverage.

목 적 : 의미 있는 난청은 정상 신생아에서 1,000명당 1-3명의 비율로 발생하는 흔한 질환으로 신생아 중환자실 집중치료를 받은 경우 1,000명당 2-4명의 비율로 발생하는 것으로 보고되고 있고, 난청의 발생률이 높은 신생아 집중치료를 받은 신생아들도 보험혜택의 제한과 추적관찰 실패율이 높은 실정이다. 이에 저자들은 지난 5년간 신생아 집중치료실에서 퇴원한 아기들의 난청 발병률 및 외래추적 관찰률을 확인하고, 신생아중환자실에서의 청각 선별검사의 의의에 대하여 알아보고자 하였다. 방 법 : 2003년 3월부터 2008년 3월까지 울산대학교 의과대학 서울아산병원 신생아 중환자실에서 집중치료를 받은 총 2,137명 중 2,000명을 대상으로 하였다. 신생아 중환자실 퇴원하기 전 신경과에 의뢰되어 뇌간유발 반응검사(AEP)로 1차 선별검사를 시행 후 비정상으로 나올 경우 신생아중환자실내 혹은 이비인후과 및 신생아 외래에서 추적관찰을 하였다. 결 과 : 2,123명 중 67명이 재검판정을 받아 재검률은 3.35%이었고 52명이 2차 청력검사를 시행 받았다. 세 번 이상의 청력검사를 받고 최종적으로 16명(0.8%)이 치료적 중재가 필요하거나 언어치료와 함께 외래 추적관찰이 필요한 비정상군으로 분류되었다. 비정상군의 평균 재태주령은 36주 6일, 평균 출생체중은 2,180 g, 1분 평균 아프가 점수는 각각 1분에 5점, 5분에 7점이었으며, 1차부터 3차까지의 평균 청력 검사 시행일은 각각 17일, 53일, 152일이었다. 전체 16명 중 남아는 6명이었으며 양측성 청력손실 4명, 편측성 청력손실 2명이었고, 여아는 양측성 청력손실 6명, 편측성 청력손실 4명으로 전체 남녀의 비율은 1:1.67 이었다. 경증, 중증도, 중증 난청 환아 수는 각각 3명, 1명, 2명이었고 최중증 난청 환아는 9명으로 이 중 5명은 양측성 4명은 편측성 청력손실이 있었다. 16명중 5명은 대한민국 보험공단에서 제시하는 고위험군에 포함되는 위험요소가 없었다. 결 론 : 본원 신생아중환자실에서 집중치료를 받은 환아의 0.8%에서 인공와우이식이나 언어치료가 필요한 청각이상을 나타내었다. 이는 정상 신생아에서 보고되는 청각이상에 비하여 약 10배 가량 높은 비율로 향후 의료진들의 신생아 난청의 심각성에 대한 의식변화와 제도적인 측면에서 더 많은 뒷받침으로 향상된 예후를 기대하여 본다.

Keywords

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