Importância da avaliação auditiva em recém-nascidos expostos à sífilis materna
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2020-02-18
Autores
Ribeiro, Georgea Espindola
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Universidade Estadual Paulista (Unesp)
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Introdução: A sífilis congênita é citada como indicador de risco para deficiência auditiva e apesar de ter sido erradicada após a era da penicilina, nos últimos anos houve um progressivo aumento de sua incidência no Brasil, no entanto poucos casos acarretam com o desfecho de deficiência auditiva, em decorrência da identificação precoce da sífilis materna, ainda no pré-natal, o que possibilita o tratamento precoce, evitando-se ao máximo a contaminação do feto pelo Treponema pallidum. Ainda assim, a literatura recomenda o acompanhamento do desenvolvimento auditivo dessas crianças, inclusive as que foram apenas expostas a sífilis materna na gestação. Objetivo: Analisar as respostas auditivas de recém-nascidos expostos à sífilis materna, por meio de exames eletroacústicos e eletrofisiológicos. Método: Participaram do estudo 90 recém-nascidos a termo, divididos em dois grupos: Grupo exposto à sífilis materna, composto por 41 recém-nascidos e Grupo controle, composto por 49 recém-nascidos sem indicadores de risco para deficiência auditiva. Os recém-nascidos foram atendidos no programa de triagem auditiva neonatal universal, do Hospital das Clínicas da Faculdade de Medicina de Botucatu, por meio do exame de emissões otoacústicas por estímulo transiente (EOE-t), com resultado “passa”, em ambas as orelhas, e potencial evocado auditivo de tronco encefálico (PEATE) com diferentes taxas de repetição do estímulo clique sendo: 21.1 c/s, 51.1 c/s e 91.1c/s. Resultados: Mesmo apresentando resultado “passa”, as amplitudes das EOE-t do Grupo exposto à sífilis apresentaram valores inferiores, quando comparados aos valores do Grupo controle, especialmente na frequência de 4 kHz à direita. Não foram encontradas diferenças nas latências do PEATE entre os participantes ao se empregar a taxa de repetição do estímulo clique de 21.1 c/s. A taxa de repetição de 51.1 c/s mostrou aumento do intervalo interpico III-V na orelha esquerda, para o grupo exposto à sífilis materna. Utilizando-se a taxa de repetição do estímulo clique de 91.1 c/s observou-se aumento da latência da onda V e do intervalo interpico III-V em ambas as orelhas, e aumento do intervalo interpico I-V à esquerda para o grupo exposto à sífilis. Conclusão: As amplitudes de respostas das EOE-t foram reduzidas nos recém-nascidos expostos à sífilis materna, o que mostra a importância também da análise desse aspecto na interpretação do resultado desse exame. As diferenças nas latências do PEATE com o aumento da taxa de repetição do estimulo clique, sugerem que recém-nascidos expostos à sífilis materna apresentam atraso na condução neural do som.
Introduction: Congenital syphilis is reported as a risk indicator for hearing loss and although it has been eradicated after the penicillin era, in recent years there has been a progressive increase in its incidence in Brazil; however, few cases lead to hearing loss due to early identification of maternal syphilis during prenatal care, which enables early treatment, and avoids, as much as possible, the contamination of the fetus by Treponema pallidum. Nevertheless, the literature recommends monitoring the auditory development of these children, including those who were only exposed to maternal syphilis during pregnancy. Objective: To analyze the auditory responses of newborns exposed to maternal syphilis through electroacoustic and electrophysiological assessments. Method: Ninety full term newborns participated in the study, divided into two groups: Group exposed to maternal syphilis, composed of 41 infants and Control group, composed of 49 newborns without risk indicators for hearing loss. The newborns were treated in the universal neonatal hearing screening program of Botucatu Medical School General Hospital through transient-evoked otoacoustic emission (TEOAE), with “pass” results, in both ears, and brainstem auditory evoked potential (BAEP) with different click stimuli repetition rates: 21.1 c/s, 51.1 c/s and 91.1c/s. Results: Even with the “pass” result, TEOAE amplitudes of the group exposed to syphilis presented lower values when compared to control group, especially at the 4 kHz on the right. No differences in BAEP latencies were found between groups using click stimuli repetition rate of 21.1 c s. Repetition rate of 51.1 c/s showed an increase in the III-V interpeak interval in the left ear for the group exposed to maternal syphilis. Using the 91.1-click stimuli repetition rate, an increase in wave V latency and III-V interpeak interval was observed in both ears and an increase in left I-V interpeak interval for the group exposed to syphilis. Conclusion: Response amplitudes were reduced in infants exposed to maternal syphilis, which shows the importance of TEOAE intrinsic analysis. The differences in BAEP latencies with the increase in the click stimulus repetition rate suggest that infants exposed to maternal syphilis have delayed sound neural conduction.
Introduction: Congenital syphilis is reported as a risk indicator for hearing loss and although it has been eradicated after the penicillin era, in recent years there has been a progressive increase in its incidence in Brazil; however, few cases lead to hearing loss due to early identification of maternal syphilis during prenatal care, which enables early treatment, and avoids, as much as possible, the contamination of the fetus by Treponema pallidum. Nevertheless, the literature recommends monitoring the auditory development of these children, including those who were only exposed to maternal syphilis during pregnancy. Objective: To analyze the auditory responses of newborns exposed to maternal syphilis through electroacoustic and electrophysiological assessments. Method: Ninety full term newborns participated in the study, divided into two groups: Group exposed to maternal syphilis, composed of 41 infants and Control group, composed of 49 newborns without risk indicators for hearing loss. The newborns were treated in the universal neonatal hearing screening program of Botucatu Medical School General Hospital through transient-evoked otoacoustic emission (TEOAE), with “pass” results, in both ears, and brainstem auditory evoked potential (BAEP) with different click stimuli repetition rates: 21.1 c/s, 51.1 c/s and 91.1c/s. Results: Even with the “pass” result, TEOAE amplitudes of the group exposed to syphilis presented lower values when compared to control group, especially at the 4 kHz on the right. No differences in BAEP latencies were found between groups using click stimuli repetition rate of 21.1 c s. Repetition rate of 51.1 c/s showed an increase in the III-V interpeak interval in the left ear for the group exposed to maternal syphilis. Using the 91.1-click stimuli repetition rate, an increase in wave V latency and III-V interpeak interval was observed in both ears and an increase in left I-V interpeak interval for the group exposed to syphilis. Conclusion: Response amplitudes were reduced in infants exposed to maternal syphilis, which shows the importance of TEOAE intrinsic analysis. The differences in BAEP latencies with the increase in the click stimulus repetition rate suggest that infants exposed to maternal syphilis have delayed sound neural conduction.
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Recém-Nascido, Sífilis Congênita, Audição, Eletrofisiologia, Infant newborn, Syphilis Congenital, Hearing, Electrophysiology