Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl Hearing screening failure rate in newborn infants with hypoxic ischemic encephalopathy Gülsüm Kadıoğlu Şimşek a,* , H.Gözde Kanmaz Kutman a , Fuat Emre Canpolat a , Mehmet Büyüktiryaki a , Yaprak Engin Üstün b a Department of Neonatology, NICU, Zekai Tahir Burak Health Practice and Research Center, University of Medical Sciences, 06240, Hamamönü, Altındağ, Ankara, Turkey b Department of Obstetrics and Gyneacology, Chief of Hospital, Zekai Tahir Burak Health Practice and Research Center, University of Medical Sciences, 06240, Hamamönü, Altındağ, Ankara, Turkey ARTICLE INFO Keywords: Hypoxic ischemic encephalopathy Neonate Therapeutic hypothermia Apgar score Birth asphyxia Neonatal hearing screening ABSTRACT Objective: The objective of this study was to establish the local incidence of hearing screening failure rate in newborns with all three stages of hypoxic ischemic encephalopathy (HIE). Methods: This retrospective cohort study was undertaken in a tertiary neonatal intensive care unit. Medical records and hearing secreening test results were collected for two years. Results: One hundred and ninety seven infants diagnosed with HIE, 20 of them died, 177 screened. Thirty five of 177 (19%) infants failed in screening test for hearing. Screening failure rate was 10/51 (19%), 20/105 (19%) and 5/21 (23%) in stage 1, 2 and 3, respectively and did not differ between HIE stages (p = 0.88). Furthermore failure rates were similar between infants who received therapeutic hypothermia or not (20% vs 19%, p = 0.84). Conclusion: Hearing screening failure rate in HIE is quite high even in Stage 1 infants. Management and treat- ment of these infants should be made carefully concerning additional risks for hearing loss and long term follow- up even in Stage 1 HIE infants should be planned strictly. 1. Introduction Infants with hypoxic ischemic encephalopathy or neonatal en- cephalopathy are at risk for developing hearing loss [1]. Early detection of hearing impairment has improved since the introduction of the newborn hearing screening programs in many countries as in Turkey. The program screens infants before age 44 postmenstrual weeks and ideally before hospital discharge and at least one more visit after dis- charge [2]. Hypoxic ischemic encephalopathy is an important risk factor for hearing loss in near-term/term infants [3]. Therapeutic hypothermia (TH) has become a standard care for infants with HIE. Randomized controlled trials of therapeutic hypothermia for HIE found a 3.5%–7.8% rate of severe hearing impairment in cooled infants at the 18-month follow-up [4] which is quite high compared to normal neonatal popu- lation. The aim of this study was to define the incidence of hearing im- pairment in HIE, also identify risk factors associated with permanent hearing loss in infants with HIE. 2. Material and methods This retrospective cohort study was undertaken in a tertiary neo- natal intensive care unit (NICU) at a large perinatal center which has a NICU with 130 beds and 18,000 birth per year, in Ankara, Turkey. Our NICU cares for both inborn and out born infants and has three servo- controlled cooling machine. Eligible newborns received therapeutic hypothermia for moderate (Stage 2) to severe (Stage 3) HIE in ac- cordance with international and national guidelines [5,6]. Infants un- derwent whole body cooling using a servo controlled machine with a body wrap (Arctic Sun ® and Tecoderm ®), to a rectal temperature of 33.0 °C–34.0 °C for 72 h before being gradually rewarmed over a 12 h period according to our national guidelines [5]. During the study period from January 2017 to December 2018 in- fants diagnosed with HIE according to following criteria stated in Turkish guideline [5], (1) A 5th and 10th minute Apgar score of < 5; (2) A pH value of < 7.00 or BE value of < -12 mmol/L in the fetal cord blood gas; (3) observation of encephalopathy-compatible brain injury on imaging; (4) Presence of multi-organ failure or involvement. https://doi.org/10.1016/j.ijporl.2019.109691 Received 3 July 2019; Received in revised form 11 September 2019; Accepted 18 September 2019 * Corresponding author. Department of Neonatology, NICU, Zekai Tahir Burak Education and Research Hospital, Hamamönü, Altındağ, Ankara, Turkey. E-mail addresses: glsmkadioglu@gmail.com (G. Kadıoğlu Şimşek), gzdekanmaz@gmail.com (H.G.K. Kutman), femrecan@gmail.com (F.E. Canpolat), mbuyuktiryaki@yahoo.com (M. Büyüktiryaki), ustunyaprak@yahoo.com (Y.E. Üstün). International Journal of Pediatric Otorhinolaryngology 128 (2020) 109691 Available online 19 September 2019 0165-5876/ © 2019 Elsevier B.V. All rights reserved. T