Risk indicators for hearing loss and language acquisition and their relationship with socioeconomic, demographic and obstetric variables in preterm and term babies

Nascimento, Gicélia Barreto; Kessler, Themis Maria; Souza, Ana Paula Ramos de; Costa, Inaê; Moraes, Anaelena Bragança de

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Original Article • Codas 32 (1) • 2020 • https://doi.org/10.1590/2317-1782/20192018278 copy

Risk indicators for hearing loss and language acquisition and their relationship with socioeconomic, demographic and obstetric variables in preterm and term babies

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To compare the frequency of risk indicators in preterm and full-term babies; to analyze the possible relationships among the presence of risk for hearing loss with language acquisition and socioeconomic, demographic and obstetric variables.

Methods

This is a longitudinal cohort study, with a sample of 87 babies. Gestational, obstetric and sociodemographic data were collected from mothers and babies. The socioeconomic classification status of the families were classified using the Brazilian Criteria for Economic Classification. The risk for language was assessed using the Language Acquisition Enunciation Signs and the Denver II test. The data were analyzed using the STATISTICA 9.1 software, using the chi-square and the Mann-Whitney U tests and simple and multiple linear regression models.

Results

Permanence in a neonatal intensive care (65.52%), ototoxic (48.28%), mechanical ventilation (39.66%) and hyperbilirubinemia (46.55%) were the more frequent risk indicators in the sample. Regarding socioeconomic, demographic and obstetric factors, there was a correlation among prenatal care, gestational age, birth weight, feeding with hearing risk. Acquisition and development of language showed statistical significance with varicella, HIV, Apgar score and birth weight >1500 grams.

Conclusion

Preterm babies showed higher frequency of risk indicators compared to full-term babies. Among environmental factors, prenatal care, which interferes in the outcome of gestational age, birth weight, Apgar score and presence of infectious diseases, as well as feeding, emerged as significant factors related to hearing and language acquisition. Prematurity was the relevant biological factor related to hearing and language risk.

Keywords
Hearing; Language; Child Development; Risk Factors; Premature Birth

IRDA	PRETERM	FULL-TERM	TOTAL	P VALUE
IRDA	N (%)	N (%)	N (%)	N (%)
Family history for hearing loss
YES	8 (13.79%)	4 (13.79%)	12	1.000
NO	50 (86.21%)	25 (86.21%)	75
Birth weight < 1.500g
YES	10 (17.24%)	0 (0.00%)	10	0.003^* * p < 0.05; Yes / No: Means having risk or not in the mother and baby health history; NICU: Neonatal Intensive Care Unit, considering the stay of the baby for more than 5 days; Apgar altered: it is considered altered when the score is 0 to 4 in the 1st minute or 0 to 6 in the 5th minute
NO	48 (82.76%)	29 (100.00%)	77
NICU stay
YES	38 (65.52%)	3 (10.34%)	41	< 0.001*
NO	20 (34.48%)	26 (89.66%)	46
Use of ototoxic medication
YES	28 (48.28%)	4 (13.79%)	32	< 0.001*
NO	30 (51.72%)	25 (86.21%)	55
Use of mechanical ventilation
YES	23 (39.66%)	2 (6.90%)	25	< 0.001*
NO	35 (60.34%)	27 (93.10%)	62
Hyperbilirubinemia
YES	27 (46.55%)	11 (37.93%)	38	0.443
NO	31 (53.45%)	18 (62.07%)	49
Toxoplasmosis
YES	1 (1.72%)	4 (13.79%)	5	0.026*
NO	57 (98.28%)	25 (86.21%)	82
Syphilis
YES	1 (1.72%)	3 (10.34%)	4	0.080
NO	57 (98.28%)	26 (89.66%)	83
Varicella
YES	0 (0.00%)	2 (6.90%)	2	0.034*
NO	58 (100.00%)	27 (93.10%)	85
HIV positive
YES	2 (3.45%)	2 (6.90%)	4	0.481
NO	56 (96.55%)	27 (93.10%)	83
Apgar altered
YES	6 (10.34%)	5 (17.24%)	11	0.371
NO	52 (89.66%)	24 (82.76%)	76
Drug use during pregnancy
YES	11 (18.97%)	4 (13.79%)	15	0.540
NO	47 (81.03%)	25 (86.21%)	72

	IRDA Total
Variables		N	Mean ± Standard deviation	Median	p-value
Economic Class	A	0	0.00±0.00	0.00
	B1 e B2	1	3.00±0.00	3.00	0.564
	C1 e C2	33	3.03±1.84	3.00
	D-E	49	2.77+1.80	2.00
Education Level	Elementary	23	3.21 ±1.90	3.00	0.327
	High school	48	2.77 ±1.77	2.00
	University	12	2.66 ±1.77	2.00
Marital Status	Single	15	3.13 ±1.64	3.00	0.399
Marital Status	Married	68	2.82 ±1.84	2.00	0.399
Ocupation	Housewife	39	3.00 ±1.79	2.00	0.558
Ocupation	Works ouside the home	42	2.83 ±1.84	3.00	0.558
Pregnancy Planning	Yes	37	3.02 ±1.70	3.00	0.370
Pregnancy Planning	No	46	2.76 ±1.88	2.00	0.370
Type of Delivery	Normal	27	3.00 ±2.13	2.00	0.992
Type of Delivery	Cesarean section	56	2.82 ±1.64	3.00
Feeding	Breast Milk	36	1.88 ±1.21	1.50	0.001^* * p < 0.05; N: Number of subjects for each variable; mixed: breast milk feeding and formula
	Formula	27	4.03 ±1.99	5.00
	Mixed	20	3.10 ±1.44	3.00

Simple Linear Regression Model	IRDA
Independent variables	Β	p-value
Prenatal	-0.193	0.001^* * p < 0.05; R2 = Quality of the model Coefficient
Gestacional age	-0.054	0.000*
Birth weight	-0.001	0.000*
Breastfeeding	0.074	0.002*
Multiple Linear Regression Model	IRDA (R2=0.565)
Independent variables	B	p-valor
Prenatal	-0.095	0.027*
Gestacional age	-0.054	0.000*

IRDA	SEAL 1	SEAL 2	DENVER 1	DENVER 2	DENVER 3	DENVER 4
IRDA	p-value	p-value	p-value	p-value	p-value	p-value
Family history for hearing loss	0.770	0.487	0.067	0.968	0.612	0.987
Birth weight < 1.500g	0.119	0.046*	0.407	0.000*	0.661	0.897
NICU stay	0.670	0.152	0.758	0.932	0.125	0.633
Use of ototoxic medication	0.486	0.277	0.912	0.336	0.291	0.165
Use of mechanical ventilation	0.356	0.768	0.177	0.956	0.706	0.873
Hyperbilirubinemia	0.732	0.924	0.470	0.552	0.838	0.461
Toxoplasmosis	0.253	0.890	0.211	0.621	1.000	1.000
Syphilis	0.177	0.083	0.128	0.350	0.670	0.338
Varicella	0.803	0.910	0.012^* * p < 0.05; NICU: Neonatal Intensive Care Unit, considering the stay of the baby for more than 5 days; Apgar altered: it is considered altered when the score is 0 to 4 in the 1st minute or 0 to 6 in the 5th minute	1.000	1.000	1.000
HIV positive	0.591	0.340	0.012*	1.000	1.000	1.000
Apgar altered	0.730	0.638	0.035*	0.410	0.940	0.726
Drug use during pregnancy	0.593	0.438	0.125	0.162	0.412	0.63

IRDA		SEAL 1		SEAL 2		DENVER 1		DENVER 2		DENVER 3		DENVER 4
IRDA		M±SD	Med	M±SD	Med	M±SD	Med	M±SD	Med	M±SD	Med	M±SD	Med
Family history for hearing loss	YES	6.75±1.54	7.00	2.80±1.22	3.00	96.00±1.22	100.00	95.83±6.25	100.00	95.00±9.25	100.00	88.88±22.04	100.00
Family history for hearing loss	NO	6.33±2.18	7.00	2.42±1.48	3.00	98.23±10.21	100.00	94.75±9.81	100.00	88.80±21.05	100.00	88.82±23.20	100.00
Birth weight < 1.500g	YES	5.55±2.45	5.00	1.42±1.61	1.00	100.00±0.00	100.00	71.87±15.72	75.00	80.00±3.25	100.00	87.50±25.00	100.00
Birth weight < 1.500g	NO	6.50±2.04	7.00	2.59±1.39	3.00	97.68±10.59	100.00	96.59±6.11	100.00	90.18+19.19	100.00	88.94±22.90	100.00
NICU stay	YES	6.51±2.03	7.00	2.21±1.53	2.00	98.88±4.64	100.00	94.19±11.52	100.00	93.84±14.71	100.00	87.03±25.35	100.00
NICU stay	NO	6.29±2.17	7.00	2.72±1.34	3.00	97.14±12.93	100.00	95.56±6.88	100.00	86.25±22.96	100.00	90.51±20.50	100.00
Use of ototoxic medication	YES	6.67±1.83	7.00	2.20±1.47	2.00	98.62±5.15	100.00	92.61±12.59	100.00	93.68±14.98	100.00	95.23±12.79	100.00
Use of ototoxic medication	NO	6.23±2.24	7.00	2.62±1.43	3.00	97.55±11.99	100.00	96.28±6.49	100.00	87.69±21.82	100.00	85.00±26.56	100.00
Use of mechanical ventilation	YES	6.78±1.70	7.00	2.42±1.42	3.00	100.00±0.00	100.00	92.50±14.79	100.00	92.00±16.56	100.00	89.06±20.34	100.00
Use of mechanical ventilation	NO	6.25±2.22	7.00	2.50±1.47	3.00	97.24±11.51	100.00	95.73±6.57	100.00	88.83±21.06	100.00	88.75±23.98	100.00
Hyperbilirubinemia	YES	6.22±2.34	7.00	2.44+1.45	2.00	96.57±14.13	100.00	94.90±11.10	100.00	88.14±23.04	100.00	86.00±27.08	100.00
Hyperbilirubinemia	NO	6.53±1.90	7.00	2.50±1.46	3.00	99.06±4.26	100.00	94.92±7.68	100.00	90.96±17.00	100.00	91.12±18.87	100.00
Toxoplasmosis	YES	5.80±1.78	6.00	2.33±1.52	2.00	96.00±8.94	100.00	93.75±8.83	93.75	100.00±0.00	100.00	50.00±0.00	50.00
Toxoplasmosis	NO	6.43±2.12	7.00	2.48±1.45	3.00	98.08±10.09	100.00	94.95±9.40	100.00	89.47±20.03	100.00	89.54±22.40	100.00
Syphilis	YES	6.00±0.81	6.00	1.25±0.50	1.00	95.00±10.00	100.00	87.50±17.67	87.50	90.00±14.14	90.00	75.00±35.35	75.00
Syphilis	NO	6.41±2.14	7.00	2.55±1.45	3.00	98.10±10.00	100.00	95.17±9.07	100.00	89.64±20.17	100.00	89.35±22.57	100.00
Varicella	YES	7.00±1.41	7.00	2.50±0.70	2.50	90.00±0.00	90.00	87.50±0.00	87.00	80.00±0.00	80.00	100.00±0.00	100.00
Varicella	NO	6.38±2.11	7.00	2.47±1.47	3.00	98.15±9.89	100.00	95.04±9.34	100.00	89.82±20.04	100.00	88.63±22.98	100.00
HIV positive	YES	6.66±0.57	7.00	1.50±0.70	1.50	90.00±14.14	90.00	75.00±0.00	75.00	0.00±0.00	0.00	0.00±0.00	0.00
HIV positive	NO	6.38±2.13	7.00	2.50±1.46	3.00	98.15±9.89	100.00	95.25±9.01	100.00	89.65±19.90	100.00	88.83±22.82	100.00
Apgar altered	YES	6.18±2.27	7.00	2.75±1.28	3.00	88.88±26.66	100.00	97.91±5.10	100.00	91.42±15.73	100.00	95.00±11.18	100.00
Apgar altered	NO	6.43±2.08	7.00	2.44±1.47	3.00	99.13±4.10	100.00	94.57±9.65	100.00	89.41±20.53	100.00	88.23±23.63	100.00
Drug use during pregnancy	YES	6.73±2.01	7.00	2.10+1.72	1.50	96.66±7.78	100.00	98.61±4.16	100.00	94.28±15.11	10.00	78.12±24.77	87.50
Drug use during pregnancy	NO	6.32±2.12	7.00	2.54±1.40	3.00	98.18±10.36	100.00	94.25±9.84	100.00	89.01±20.51	100.00	90.62±22.25	100.00

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[1] Conflict of interests: nothing to declare.