Children who have heart surgery as infants are at risk for
hearing loss, coupled with associated risks for language, attention and
cognitive problems, by age four. In a single-centre group of 348 preschoolers
who survived cardiac surgery, researchers found hearing loss in about 21%, a
rate 20 times higher than is found in the general population.

The researchers recommend that children who undergo heart
surgery have their hearing evaluated by age 24 to 30 months, to increase their
chances of receiving timely medical intervention. The study appeared in the
January 2017 issue of the Journal of

“Children born with life-threatening heart defects
require a great deal of sophisticated care before and after surgery,” said
study leader Nancy B. Burnham, RN, MSN, CRNP, a nurse-practitioner in the
Division of Cardiothoracic Surgery at Children’s Hospital of Philadelphia
(CHOP). “This study reminds healthcare providers not to overlook hearing
evaluations, because early detection and intervention can reduce later problems
in neurodevelopment.”

The researchers performed their analysis as part of a
prospective observational study of neurodevelopmental outcomes in
preschool-aged children who underwent infant surgery at CHOP for congenital
heart defects. The study cohort was 348 children who had a comprehensive
neurodevelopmental evaluation at age four between 2003 and 2008.

As surgical techniques have notably improved survival for
infants with complex heart defects, paediatric cardiologists have turned their attention
to long-term quality of life. Survivors are known to have an increased risk of
neurodevelopmental conditions, including learning disabilities. This is the
first study to focus on hearing loss and its impact on neurodevelopment in this

The study team found hearing loss in 21.6% of the cohort (75
of the 348 children). Potential risk factors associated with hearing loss were
gestational age younger than 37 weeks, a confirmed genetic anomaly and longer
postoperative length of stay. There was no association with modifiable surgical
management factors. Children with hearing loss had lower scores on measures of
language skills, cognition (IQ testing), and executive function and attention.

The authors mention possible contributors to hearing loss in
their patients, such as high-frequency noises in intensive care units and
exposure to medications with side effects that damage hearing, although the
study did not directly examine either potential risk factor.

The researchers did not know how many of the children had
hearing loss before surgery. Another study limitation is that over half of the
75 children with hearing loss had conductive hearing loss, which may be
temporary when caused by conditions such as middle ear infections.

The prevalence rate of 21.6% found in this study compares to
an estimated prevalence of 1% in all preschool age children. Study co-author
Carol Knightly, AuD, CCC-A, Senior Director of the Center for Childhood
Communication at CHOP, added that ideally, all newborns should be screened for
hearing loss by one month of age, with diagnosis by three months, and
intervention services begun by age six months. In addition to universal newborn
screening, the authors recommend that any child who undergoes cardiac surgery
by six months of age should have at least one audiologic evaluation by 24 to 30
months of age, to identify hearing loss in timely manner.


Reference: Hearing
Loss after Cardiac Surgery in Infancy: An Unintended Consequence of Life-Saving
Care. The Journal of Pediatrics, 2018; 192: 144.