Hearing threshold in preterm and term infantsby auditory brainstem response

doi:10.1016/S0022-3476(85)80030-5

The Journal of Pediatrics

Volume 107, Issue 4, October 1985, Pages 593-599

https://doi.org/10.1016/S0022-3476(85)80030-5 Get rights and content

Hearing thresholds were established in preterm and term newborn infants by auditory brainstemresponses in the first week of life. The presence of wave V was the criterion for threshold sensitivity in infants considered neurologically optimal on the basis of stringent clinical criteria and sequential ultrasound examination. The hearing threshold was found to be at 40 dB in preterm infants between 28 and 34 weeks gestational age, at 30 dB in infants between 35 and 38 weeks, and below 20 dB in term infants. This study confirms that the thresholds of newborn infants diminish with increasing age, and there is no apparent difference whether maturation occurs inside or outside the uterus. The data should provide a baseline for objective and quantitative assessment of hearing loss early in the neonatal period.

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Cited by (97)

Use of sound-elicited fetal heart rate accelerations to assess fetal hearing in the second and third trimester
2020, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
On the other hand, the presence and absence of FHR accelerations were independent of the FHR baseline variability, namely sleep conditions, during 20–27 weeks GA. Regarding the development of human fetal hearing, previous studies have reported that the auditory brainstem response occurs in premature infants at 25–28 weeks GA [11–13], and the appearance of otoacoustic emissions at 33 weeks GA [14]. Thus, the unstable appearance of sound-elicited FHR accelerations during 20–27 weeks GA may be brought about by individual differences in the development of auditory pathways.
We previously reported that fetal heart rate (FHR) accelerations could be obtained after fetal sound stimulation. We examined FHR accelerations during 20–37 weeks gestational age (GA) in order to assess the optimal time for the test.
The fetus was stimulated from the maternal abdomen with pure tone 2000 Hz, 90 dB, 5 s. Changes in the FHR before and after the sound stimulation were measured by a cardiotocometer.
Compared with the positive rate of FHR accelerations at 20–21 weeks GA, significant increases were recognized in 26–27, 28 to 29, 30 to 31, and 34–35 weeks GA. Comparing the positive rate of FHR accelerations between the minimal and moderate variability of FHR baseline, no significant differences were observed at 20–27 weeks GA. On the other hand, at 28–37 weeks GA, the positive rate to detect FHR accelerations due to sound stimulation was 100% in moderate FHR baseline variability.
Considering development of human fetal hearing, the method should be performed between 28 and 37 weeks GA and during moderate FHR variability corresponding to active sleep conditions. The method developed in the present study may provide a promising tool for evaluating the fetal hearing.
Evaluation of fetal exposure to external loud noise using a sheep model: quantification of in utero acoustic transmission across the human audio range
2019, American Journal of Obstetrics and Gynecology
There is mounting evidence that neural memory traces are formed by auditory learning in utero and that premature newborns are particularly sensitive to the intense, sustained noises or impulses sounds associated with the use of intensive care equipment. One area of critical importance is the determination of sound level exposure in utero associated with maternal occupation. The attenuation factors provided by the abdomen and tissue as well as the routes by which the inner ear receives stimulation need careful consideration and investigation to provide prenatal protection from external sound levels and frequencies that may cause harm.
To measure how sound from external sound sources is transmitted to the fetus inside the uterus of a pregnant sheep in 6 Hz frequency steps between 100 Hz and 20 kHz (ie, across most of the human audio range).
We measured acoustic transfer characteristics in vivo in 6 time-mated singleton pregnant Romney ewes (gestational age, 103–130 days, weight, 54–74 kg). Under general anesthesia and at hysterotomy, a calibrated hydrophone was attached to the occiput of the fetal head within the amniotic sac. Two calibrated microphones were positioned in the operating theater, close to the head and to the body of each ewe. Initial experiments were carried out on 3 pregnant ewes 3 days after transport recovery to inform the data acquisition protocol. This was followed by detailed data acquisition of 3 pregnant ewes under general anesthesia, using external white noise signals. Voltage signals were acquired with 2 calibrated microphones, located near the head and the body of each ewe and with a calibrated hydrophone located in the amniotic fluid.
Measurement of acoustic transmission through the maternal abdominal and uterine walls indicates that frequency contents above 10 kHz are transmitted into the amniotic sac and that some frequencies are attenuated by as little as 3 dB.
This study provides new data about in utero sound transmission of external noise sources beyond physiological noise (cardiovascular, respiratory, and intestinal sounds), which help quantity the potential for fetal physiological damage resulting from exposure to high levels of noise during pregnancy. Fine-frequency acoustic attenuation characteristics are essential to inform standards and clinical recommendations on exposure of pregnant women to noise. Such transfer functions may also inform the design of filters to produce an optimal acoustic setting for maternal occupational noise exposure, use of magnetic resonance imaging during pregnancy, and for neonatal incubators.
Piezoelectric vibrator-stimulated potential and heart rate accelerations detected from the fetus
2017, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
The fetus is well known to have a substantial capacity for sound recognition in the uterine environment [1]. In premature human infants [2–4], auditory-evoked potentials can be recorded from 25 to 28 weeks gestational age (GA), and otoacoustic emissions are elicited as early as 30 weeks GA [5]. Furthermore, a number of studies revealed fetal cortical activation in response to auditory stimuli using both magnetic resonance imaging and magnetoencephalography [6].
The fetus is well known to have a substantial capacity for sound recognition in the uterine environment. The aim of this study was to develop a sound stimulus system equipped with a piezoelectric vibrator (PV), record the PV-stimulated potential (PVSP) of the fetus and monitor changes of the fetal heart rate (FHR) under PV stimulation.
The relationship between the input voltage applied to a piezoelectric vibrator and the sound pressure generated in the uterus was calibrated based on a model of the maternal abdomen. Fourteen fetuses for the measurement of the PVSP and 22 fetuses for the measurement of the heart rate changes from low-risk pregnant women were recruited.
The PVSP responses were obtained in 9 out of 14 fetuses. All the tested fetuses accelerated the FHR after the 2 kHz tone stimulation at 70 dB intensity generated by PV from 32 to 37 weeks gestational age.
Using a newly developed sound stimulus system equipped with PV, the electric responses of a fetus recorded from electrodes placed on the mother's abdomen may be closely related to the auditory evoked response. Significant accelerations of FHR were objectively, accurately and readily obtained after the sound stimulation.
Early Development of the Human Auditory System
2017, Fetal and Neonatal Physiology, 2-Volume Set
Comparison of maturational process of hearing threshold in early life between at-risk and low-risk preterm infants
2016, Early Human Development
Citation Excerpt :
As a well-documented good objective estimate of peripheral auditory sensitivity, the threshold of brainstem auditory evoked response (BAER) has been widely used to assess peripheral hearing in infants and children [2–8]. The BAER can be recorded in preterm infants at as early as 26–28 weeks of gestation [5,9,10]. Shortly after birth, the threshold of BAER in preterm infants is higher than that in term infants, and then decreases with increasing age, from 30 to 40 dB nHL at 28 weeks to 10–20 dB at term date.
To detect any abnormality in the maturational process of hearing threshold during the early life in at-risk preterm infants.
The threshold of brainstem auditory evoked response was recorded and analyzed longitudinally from 30 to 42 weeks of postconceptional age in 357 at-risk infants born at 23–36 weeks of gestation. The results were compared with those in 82 low-risk infants born at 30–42 weeks at various postconceptional ages.
From 31 to 42 weeks, the response threshold in the at-risk infants was consistently slightly higher than that in the low-risk infants. No statistically significant difference was found between the two groups of infants at any designated postconceptional ages. The threshold in the at-risk infants born at 23–29 weeks of gestation tended to be higher than those born at 30–36 weeks at various postconceptional ages, but the difference did not reach statistical significance. There was also no significant difference in the slope of BAER threshold-age function between the at-risk infants, irrespective of gestational ages, and the low-risk infants.
During the early life, hearing threshold in at-risk preterm, mainly very preterm, infants is marginally elevated, but the maturational process of the threshold is generally similar to that in low-risk infants, without notable abnormality.
Designing artificial circadian environments with multisensory cares for supporting preterm infants’ growth in NICUs
2023, Frontiers in Neuroscience

View all citing articles on Scopus

¹: Supported by the National Fund for Research into Crippling Diseases (Action Research) and the Medical Research Council.

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Hearing threshold in preterm and term infantsby auditory brainstem response1

J Pediatr

Int J Pediatr Otorhinolaryngol

J Pediatr

Otolaryngol Clin North Am

J Pediatr

Electroencephalogr and Clin Neurophysiol

Cochlear audiometry (electrocochleography) during the neonatal period

Dev Med Child Neurol

Routine use of electrocochleography (cochlear audiometry) on human subjects

Audiology

Evaluation of the auditory system: an update

Ann Otol Rhinol Laryngol

Computing false positive and false negative sites for the crib-o-gram

J Speech Hear Disord

Long term follow-up of newborns tested with the auditory response cradle

Arch Dis Child

Development of auditory function in newborn infants revealed by auditory brainstem potentials

Pediatrics

Hearing defects in preterm infants

Arch Dis Child

Assessment of hearing

Auditory brainstem response in neurologically normal pretern and full-term newborn infants

Neuropediatrics