Objective To investigate individual and concomitant risk factors for hearing loss during neonatal care.
Design Case–control study.
Population 237 children born <32 weeks of gestation; 57 with hearing loss and 180 with normal hearing born between 2009 and 2013, matched for sex, gestation and year of birth.
Main outcome measures Data were abstracted from clinical records for overall risk factors daily for the first 14 days and then weekly until discharge from neonatal care. All infants were screened for the presence of m.1555A>G mutation.
Results Children with hearing loss had lower birth weight for gestational age, more severe neonatal illness, with increased exposure to inotrope, steroid, gentamicin, vancomycin and furosemide, and more frequent physiological risk, elevated bilirubin and creatinine levels and acidosis, but no index child was found to have the m.1555A>G mutation, compared with one among controls. The duration of gentamicin, vancomycin or furosemide administration in the first 14 days was associated with impaired hearing (OR per dose: 1.25; 95% CI 1.14 to 1.38). Multivariate analyses revealed independent risks for hearing loss for each day when there was physiological risk (OR per day 1.15 (1.05 to 1.27)) and each day of medication exposure (OR 1.23 (1.1 to 1.37)).
Conclusion Although the relative contribution of underlying illness and medication cannot be identified by this study, cumulative use of ototoxic medication and the presence of physiologic risk factors independently increased the likelihood of hearing loss, warranting close monitoring of coincident therapy throughout neonatal critical care.
Data availability statement
Data are available on reasonable request. Data may be available on reasonable request by application to the corresponding author.
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Contributors KC wrote the first draft and produced the final version. NM and MB-G conceived the idea and obtained funding. Each has reviewed and contributed to this paper. MB-G sadly died before agreement of the final version. NM acts as guarantor for the data, conduct of the study and controlled the decision to publish.
Funding The study was fully funded by Action on Hearing Loss (ref: RNID G47) and the Rosetrees Trust; the funders have taken no role in the design, running of the study or in the interpretation of results. NM received a proportion of funding from the joint Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme at University College London Hospitals/University College London.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.