Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : SC23 - SC27 Full Version

Comparison of Hearing Impairment among Healthy and High-risk Neonates at a Tertiary Care Hospital, Rajasthan, India: A Cross-sectional Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/61451.18102
Suresh Kumar Yadav, Akansha Sisodia, Shubha Tak, Achala Arya, Kiran Yadav

1. Assistant Professor, Department of Paediatrics, Hind Institute of Medical Sciences, Ataria, Sitapur, Uttar Pradesh, India. 2. Assistant Professor, Department of Paediatrics, Hind Institute of Medical Sciences, Ataria, Sitapur, Uttar Pradesh, India. 3. Audiologist, Department of Otorhinolaryngology, JLN Medical College, Ajmer, Rajasthan, India. 4. Professor, Department of Paediatrics, JLN Medical College, Ajmer, Rajasthan, India. 5. Associate Professor, Department of Microbiology, Government Medical College, Tirwa, Kannauj, Uttar Pradesh, India.

Correspondence Address :
Dr. Kiran Yadav,
Associate Professor, Department of Microbiology, Government Medical College, Tirwa, Kannauj-209732, Uttar Pradesh, India.
E-mail: emailkiran123@gmail.com

Abstract

Introduction: Hearing impairment is caused by damage in the inner ear (can be even birth defect), ear infection, ruptured eardrum and so on. It can be prevented using early detection thus, helps in avoiding severe psychosocial, educational, and linguistic repercussions. It is necessary to diagnose hearing impairment before six months of age to prevent future delays in speech and language development.

Aim: To determine the prevalence of hearing impairment in high-risk neonates and to establish the fact that, these neonates have higher prevalence of hearing impairment as compared to normal population.

Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan, India. The duration of the study was six months, from December 2012 to May 2013. A total of 500 babies including 297 normal and 203 high-risk babies were enrolled into the study. All the neonates were screened using Behavioural Observation Audiometry (BOA) and Distortion Product Oto-acoustic Emission (DPOAE) preferably within three days of life. Those, who failed under this test, underwent for Brain stem Evoked Response Audiometry (BERA). Data was collected in the Microsoft Excel and analysis done by Statistical Package for Social Sciences (SPSS) version 23.0.

Results: The mean age of the newborns on admission, was 3.86±4.25 days and the mean weight was 2560±510 g. Out of 500 newborns screened, 58 babies had abnormal results with the first screening test. When these 58 babies subjected to BERA, eight babies showed Hearing Loss (HL). Sepsis, Neonatal Intensive Care Unit (NICU) stay more than five days and use of aminoglycosides more than seven days were the important risk factors associated with hearing impairment. Prevalence of hearing impairment in the present study was came out to be 16/1000. This finding was statistically significant with p-value <0.05.

Conclusion: There was high prevalence of hearing impairment in high-risk newborns, majority of which were bilateral. The authors recommend multistage screening in all newborns at birth or within month’s time at all level of healthcare facility. Newborns with sepsis, NICU stay more than five days and use of aminoglycosides more than seven days should have mandatory audiologic evaluation at discharge.

Keywords

Behavioural observation audiometry, Brain stem evoked response, Distortion product oto-acoustic emission, Hearing loss

Significant HL is one of the most common birth related congenital illnesses, that occur in about 1 to 3 in 1,000 healthy neonates and of 100 neonates, 2 to 4 will be reported in the Neonatal Intensive Care Unit (NICU) (1),(2),(3). Although, the prevalence of hearing impairment varies with the age group surveyed and the testing methods used (4). There are many aetiological factors which results in severe HL in neonates. Among the various factors, genetic causes responsible for atleast 50% to 60% of childhood HL (5). Environmental causes of HL include rubella embryopathy, prematurity, bacterial meningitis, and head trauma (5). The initial signs of HL are very subtle, and systematic neonatal hearing screening is the most effective means of early detection. The early identification of HL is necessary to minimise the consequences of hearing impairment on the future communication skills of a baby (6),(7).

The following are the various methods that assess HL in neonates i.e., electrophysiological and behavioural assessment methods. Behavioural techniques have been noted with high number of false negative results [8,9]. As electrophysiologic methods have greater sensitivity and specificity, the following may be used: Auditory Brainstem Response (ABR), Automated Auditory Brainstem Response (AABR) and Evoked Oto-Acoustic Emissions (EOAE). ABR and EOAE are mostly used for universal hearing screening tools for neonates. However, it is better to minimise false-positive results and developing a more reliable newborn hearing screening program. EOAE and ABR tools are evolving and becoming more and more automated (10).

The present study was aimed to determine the prevalence of hearing impairment in high-risk neonates and to establish the fact that, high-risk neonates have higher prevalence of hearing impairment as compared to normal population.

Material and Methods

This cross-sectional study was conducted in the Department of Paediatrics in Jawaharlal Nehru Medical College (JLN Medical College and Hospital), Ajmer, Rajasthan, India. The duration of the study was six months, from December 2012 to May 2013. Ethical clearance for the present study was obtained from Institutional Ethical Committee (IEC). Informed written consent was taken from parents/guardian of the neonates after fully explaining the nature and purpose of the study.

Inclusion criteria: The subjects were divided into two groups:

• Normal newborns: Newborns included in this group had no risk factor for HL. Out of 297 newborns, four were from Special Neonatal Care Unit (SNCU) and 293 were those, who born in the JLN Hospital, were included in the study.
• High-risk newborns: Newborns included in this group had one or more risk factors for HL. Out of 203 newborns, 147 were from SNCU suffering from diseases having risk for HL. The remaining 56 babies were from JLN hospital having one or more maternal risk factors (elderly pregnancy, high/low blood pressure, viral & bacterial infections, oto-toxic medications, history of sibling death and diabetes mellitus), family history of permanent hearing, history of NICU admission more than five days, preterm babies having weight >1.8 kg and neonatal seizures. Neonates with the following risk factors were enrolled for the study i.e., family history of permanent HL, neonatal intensive care of more than five days. Exposure to oto-toxic medication more than seven days, hyperbilirubinemia requiring exchange transfusion, infection, maternal risk factors, birth asphyxia, prematurity, congenital anomaly, Very Low Birth Weight (VLBW) and neonatal seizures (7).

Exclusion criteria: Upon considering the aspect of the research study, neonates with the following characteristics were not considered for the study- neonates, who were on ventilator support from birth to death, active ear infection and parents of neonate not willing to give informed consent to participate were excluded from the study.

Sample size calculation: With 95% confidence level and 5% absolute precision, the required sample size came out to be 122 high-risk subjects, but to be on better side, 203 high-risk samples were included [11-13]. Along with that, 297 normal newborns were also included in the study to establish the fact that, high-risk babies have higher prevalence of hearing impairment as compared to normal population.

Study Procedure

History regarding demographic details, gestational history of mother, family history of deafness, any complication during pregnancy was taken. All eligible newborns enrolled in the present study, were screened by BOA and DPOAE preferably within three days of life in both risk factor group and normal newborns group. The study was deferred for few days in very sick babies. These babies were screened after discharge from SNCU and were fit enough to undergo the test within one month of age. The babies, who had probable HL in initial screening was subjected to ABR to confirm and grading the degree of HL after one month of initial screening (Table/Fig 1).

Behavioural Observation Audiometry (BOA): Stimuli like pure tones at 500 Hz or 4 kHz, narrow band noise or white noise were presented in a well lit, noise free environment at a level of 2480 decibel (dB) HL using paediatric audiometer PA5 device (interacoustics) such that, the distance between the loudspeaker and the ear of the infant was around 50 cm and the loudspeaker of the device facing the infant’s ear. The response was observed in the form of any change in the behaviour such as startle reflex, auropalpebral reflex, arousal from sleep or cessation of the activity. The result of the test was recorded as ‘pass’ or ‘probable HL’ based on the presence or absence of the response.

Distortion Product Oto-Acoustic Emission (DPOAE): It was conducted using Oto-read device (interacoustics) in a noise free environment, on a calm baby after ensuring no debris or other obstruction in the external auditory canal. A miniature earphone and microphone were placed in ear. Two sounds of simultaneous pure tones 65 dB and 55 dB were produced and response was measured by microphone in the ear canal with the frequency range of 2 kHz to 5 kHz. Result of test was indicated as ‘pass’ or ‘refer (probable HL)’ such that, pass indicated patient having normal outer hair cells functioning and probable HL suggesting possibility of a sensory neural HL or any conductive HL, which indicates requirement of further diagnostic hearing evaluation.

Brainstem Evoked Response Audiometry (BERA): In order to carry out the further diagnostic procedure, this was performed in a quiet room for about 30-45 minutes, post feeding and while they were in natural deep sleep. Those, who remained awake were being done sedation with oral Triclofos. The placement of the electrodes was such that, the negative electrode was kept at the mastoid process of the test ear, positive electrode placed at the forehead and ground electrode at the mastoid process of the non testing ear. It was made sure that, the resistance should be kept below 5000 ohms (O). The stimulus was presented individually to the right and left ears with refraction clicks of 0.1 millisecond (msec) duration administered at the rate of 30.1/second using EAR-3A 10 O insert earphones, inserted into the test ear. Four thousand responses were averaged with filter setting of 30-3000 Hz on the non destructive interventions. Minimum of two sets were performed for reproducibility. Auditory brain stem response developed within 15 msec time and was seen at a gain of 200 nanovolt/division (nv/div). Initially the high intensity of 70 dB normal hearing level (nHL) was administered. Then the intensity was decreased insteps of 10 dB till 30 dBnHL, which was taken to be the normal threshold for producing wave V. This was a prominent trough like deflection crossing well below the baseline on the oscilloscope after seven msec. An infant was considered to have normal hearing threshold if, wave V is present at 30 dBnHL in both ears or in one ear at 45 dBnHL.

Statistical Analysis

Data of the present study was compiled in Microsoft Excel-2007 and the statistical analysis done by SPSS version 23.0. The descriptive analysis of the screening procedures outcome and the prevalence of HL were calculated. Chi-square test was used to analyse the data, p<0.05 considered to be statistically significant in the study.

Results

A total of 500 eligible newborns with 203 high-risk and 297 normal newborns were included in the study. Total 280 (56%) of the study population were male child and 220 (44%) were female child, giving a male:female ratio of 1.27:1. Their age ranges from one day to 28 days (Table/Fig 2). The majority of newborns were term (n=441, 88.2%) while 57 (11.4%) were preterm. In the present study, maximum newborns (61%), had >2.5 kg weight, 4.4% had VLBW (Table/Fig 3). The mean age±SD on admission was 3.86±4.25 days in the study group. The mean weight±SD of the newborns was 2560±510 g. Fifty-eight newborns out of total 500 newborns had abnormal testing when subjected to hearing screening with BOA and DPOAE test. 8 (1.6%) neonates had abnormal finding, when those 58 newborns with abnormal testing screened with BERA (Table/Fig 4). Prevalence of hearing impairment in the present study, was came out to be 16/1000. This finding was significant with p<0.05. In the present study, hearing impairment was found to be associated with sepsis, prematurity, VLBW, NICU stay more than five days, use of aminoglycoside more than seven days and hyperbilirubinemia requiring exchange transfusion.

Discussion

The effect of hearing impairment on the newborn, the family and the society is lifelong if, timely intervention not sought. Diagnosis in early phase and timely intervention remains the only way to reduce its effect on speech, language, and cognitive development. In the present study, hearing impairment was found in 58 newborns following the initial screening by BOA and DPOAE. These 58 newborns when screened with BERA, only eight newborns (seven high-risk neonates, one normal newborn) were found to have HL. The high prevalence of abnormal results during initial screening test may be due to presence of amniotic fluid or debris in the middle ear, which is expected during early age, but it improved with time as it gets cleared naturally. In the present study, the prevalence of failed results reduced with time that supports the use of multistage screening for hearing impairment in newborns. In the present study, the prevalence of hearing impairment was 3.37/1000 in normal newborns and 34.48/1000 in high-risk newborns. In the present study, the authors noted, there was an increased prevalence of hearing loss among high-risk newborns which had also been seen in various other studies in the past. In a study, done by Nagapoornima P et al., the incidence of hearing loss in normal (4.7/1000) and high-risk (10.75/1000) (11). According to study done by Paul AK reported the incidence of 0.98/1000 and 10.3/1000 in normal and high-risk babies group respectively after a study period of seven years (14). In the present study, hearing impairment was found to be associated with sepsis, prematurity, VLBW, NICU stay more than five days, use of aminoglycoside more than seven days and hyperbilirubinemia requiring exchange transfusion. (Table/Fig 5) shows comparative chart of various studies done in the past (4),(12),(13),(15),(16),(18),(19). According to the study done by Balasubramanian J et al., main risk factor associated with hearing impairment was severe birth asphyxia (15). In the present study, there was no role of birth asphyxia, neonatal seizures, maternal risk factors, congenital and history of hearing loss. In the present study, bilateral hearing impairment 6 (1.2%) was more common than unilateral hearing loss 2 (0.4%). Labaeka AA et al., also reported predominance of bilateral hearing loss (5.45%) (16).

Congenital hearing loss affect 2-3 per 1000 newborns (20). It is one of the most common sensorial deficits presenting at time of birth of a neonate (21). Aetiology in almost 50% cases of congenital deafness follow genetic level and rest are due to environmental reasons [22,23]. The Joint Committee on Infant Hearing (JCIH) advises for universal hearing screening, soon after delivery or before their discharge from hospital. The guideline issued by JCIH in 2007 recommends screening within first month of life. Newborns, which are not able to pass the screening test, must undergo detailed hearing assessment before three months of age and if, confirmed must be provided with appropriate intervention within six months of age (7). The goal of early diagnosis of hearing loss is to achieve better verbal and social communication. Delayed diagnosis may have a negative impact on the patient’s verbal, educational, psychological and socioeconomic abilities.

In the present study, hearing loss was not only present in high-risk babies, but also seen in normal newborns although, the prevalence was low compared to them. Therefore, screening only those newborns, who are having one or more associated risk factors for hearing loss can miss many cases. Hence, universal screening of all the newborns must be done for hearing loss so that, it can be identified at early age and timely intervention can gives better response. It is universally accepted that, screening for hearing loss in all neonates is crucial. In a study by Farhat A et al., in his comparative study, identified neonates, those who were hospitalised in NICU, was more valuable to hearing impairment than screening just those, who were hospitalised in the NICU, when compared to that healthy neonates (24).

Limitation(s)

In the present study, congenital hearing loss cases of less severity and the progressive or late onset hearing impairment cases had not been detected by the screening methods.

Conclusion

There was high prevalence of hearing impairment in high-risk newborns, majority of which were bilateral. Sepsis, prematurity, VLBW, NICU stay more than five days, use of aminoglycoside more than seven days and hyperbilirubinemia requiring exchange transfusion were important risk factors. Based on the present study, authors recommend for multistage screening in all newborns at birth or within month’s time at all level of healthcare facility, as screening of only high-risk babies may led to missing of many cases of congenital deafness. Newborns, who fail on screening, should be given a diagnostic test and proper intervention within three months. Those, who have high-risk factor should be follow-up at interval of six months, even if they cleared the screening test.

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DOI and Others

DOI: 10.7860/JCDR/2023/61451.18102

Date of Submission: Nov 22, 2022
Date of Peer Review: Jan 10, 2023
Date of Acceptance: Apr 19, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 10, 2022
• Manual Googling: Mar 16, 2023
• iThenticate Software: Apr 14, 2023 (19%)

Etymology: Author Origin

EMENDATIONS: 6

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