Kriangkrai Tantiwongkosri

Objectives: To determine the prevalence of sensorineural hearing loss (SNHL) in children who underwent congenital cardiac surgery (CCS) by using a pre- and postoperative hearing test, a conventional audiometry, an extended high-frequency audiometry (HFA) or auditory steady-state response (ASSR), and distortion-product otoacoustic emissions (DPOAE).Study design: This prospective study enrolled children with CCS in Siriraj Hospital, Thailand, between 2019 and 2023. Conventional audiometry including HFA or ASSR and DPOAE were performed pre- and postoperatively. The patients with bilateral abnormal hearing loss or an incomplete examination were excluded. Collected data included: demographics, cardiac surgery and ototoxic medication. Prevalence of SNHL by conventional audiometry and subclinical hearing impairment by HFA or DPOAE were ascertained, and risks were analysed.Results: Ninety-eight patients were eligible for the study. The median age (IQR) was 5.3 (1.5–9.6) years. Fifteen patients (15.3%) had univentricular hearts. The preoperative audiologic test was performed 1 day prior to the CCS. The postoperative test was performed at a median of 4.4 (IQR: 2.7–8.0) months postoperatively. Preoperative unilateral hearing impairments were reported in 17 patients (17.3%). Postoperatively, four patients (4.1%) showed significantly abnormal audiogram (> 25 dB) or 15 dB shift at 250–8000 Hz consistent to a new SNHL. Subclinical hearing impairment by HFA was affected in 10 patients (10.2%). Thirty-three patients (33.6%) had abnormal DPOAE exclusively. Therefore, new SNHL, including subclinical hearing loss, revealed a prevalence of ototoxicity up to 47.9%. Age <1 year at surgery was the independent risk of postoperative SNHL (adjusted OR 18.5, 95% CI 1.2 to 293.8, p=0.04).Conclusion: Routine post-CCS audiological surveillance especially CCS in infancy is recommended for early recognition and timely management based on the 43.8% subclinical and the 4.1% SNHL that was found in this study.Trial registration number: TCTR20200421001.

Objective: This study aimed to compare the outcomes of PDA (patent ductus arteriosus) ligation performed in NICU (neonatal intensive care unit) versus OR (operating room) and identify relevant influencing factors. Materials and Methods: In this retrospective review, spanning a decade (2012-2021) of NICU patients at Siriraj Hospital who underwent PDA ligation, patients were categorized into two groups: OR and NICU. Baseline clinical characteristics, operative details, and postoperative results (including hospital mortality, cause of death, and complications) were collected and analyzed. Results: A total of 118 patients were included, with 52 patients in the OR group and 66 patients in the NICU group. There were no statistically significant differences in postoperative outcomes between the two groups. The hospital mortality rates were 1.9% (1/52) and 10.6% (7/66), respectively (p = 0.08). Post hoc multivariable binary logistic regression analysis further confirmed that the location of PDA ligation was not associated with hospital mortality. However, higher oxygen requirements and lower postmenstrual age (PMA) were found to be independently associated with hospital mortality (OR 1.10, p =0.02 and OR 0.82, p<0.01 respectively). Hypothermia, defined as a body temperature less than 36C, was more prevalent in the OR group (30.8% vs 16.7%, p=0.07). Other postoperative complications were not statistically different between the two groups. Lastly, no case of surgical site infection was observed in the NICU group. Conclusion: PDA ligation can be safely and effectively performed in the NICU with comparable hospital mortality, potentially offering better temperature control, and without an increased risk of complications, including surgical site infection.