Dear Lactnet Friends:
Birth by Cesarean Delivery and Failure on First Otoacoustic Emissions
Hearing Test

   1. Tatiana Smolkin<http://pediatrics.aappublications.org/search?author1=Tatiana+Smolkin&sortspec=date&submit=Submit>,
   MDa<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-1>
   ,b<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-4>
   ,
   2. Orna Mick<http://pediatrics.aappublications.org/search?author1=Orna+Mick&sortspec=date&submit=Submit>
   c<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-2>
   ,
   3. Maisam Dabbah<http://pediatrics.aappublications.org/search?author1=Maisam+Dabbah&sortspec=date&submit=Submit>
   a<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-1>
   ,b<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-4>
   ,
   4. Shraga Blazer<http://pediatrics.aappublications.org/search?author1=Shraga+Blazer&sortspec=date&submit=Submit>,
   MDa<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-1>
   ,b<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-4>
   ,
   5. Galina Grakovsky<http://pediatrics.aappublications.org/search?author1=Galina+Grakovsky&sortspec=date&submit=Submit>
   c<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-2>
   ,
   6. Noah Gabay<http://pediatrics.aappublications.org/search?author1=Noah+Gabay&sortspec=date&submit=Submit>
   c<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-2>
   ,
   7. Arie Gordin<http://pediatrics.aappublications.org/search?author1=Arie+Gordin&sortspec=date&submit=Submit>,
   MDb<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-4>
   ,d<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-3>,
   and
   8. Imad R. Makhoul<http://pediatrics.aappublications.org/search?author1=Imad+R.+Makhoul&sortspec=date&submit=Submit>,
   MD, PhDa<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-1>
   ,b<http://pediatrics.aappublications.org/content/130/1/e95.abstract#aff-4>

+ <http://pediatrics.aappublications.org/content/130/1/e95.abstract#>Author
Affiliations

   1. aDepartment of Neonatology, Meyer Children’s Hospital, and
   2. cAudiology Clinic, and
   3. dDepartment of Otolaryngology, Rambam Health Care Campus, Haifa,
   Israel; and
   4. bRappaport Faculty of Medicine, Technion–Israel Institute of
   Technology, Haifa, Israel

 ABSTRACT

*BACKGROUND:* Neonatal hearing screening occasionally fails. We noticed
that infants born by cesarean delivery (CD) appeared to fail the first
otoacoustic emissions (OAE) test more frequently than infants delivered
vaginally (VD). This might increase maternal anxiety. We aimed to evaluate
the influence of mode of delivery on failure to pass the first OAE.

*METHODS:* Overall, 1653 infants of >35 weeks’ gestation were evaluated.
OAE was performed before discharge. Perinatal-neonatal variables and
results of OAE were recorded retrospectively.

*RESULTS:* Compared with VD infants, CD infants had lower gestational age
and 1-minute Apgar, more small for gestational age (SGA), and earlier age
at first OAE. Univariate analysis: CD, male gender, gestational age 35 to
37 weeks, birth weight ≤2500 g, SGA, and younger age at first OAE were
significantly associated with failed first OAE. In infants weighing 2501 to
4000 g, CD infants had 3-fold higher rates of failed first OAE in
comparison with VD infants (20.7% vs 7.1%) before 48 hours of age. In the
multivariate analysis, variables independently significantly associated
with failed first OAE were male gender (odds ratio [OR] 1.42 [1.02–1.98]),
CD (emergency CD: OR 3.18 [2.21–4.57], elective CD: OR 3.32 [2.04–5.42]),
age 12 to 23 hours at first OAE (OR 3.1 [2.1–4.58]) and SGA (OR 2.2
[1.15–4.28]).

*CONCLUSIONS:* CD infants had significantly higher failure rates on first
OAE. We speculate that CD is accompanied by retained fluid in middle ear
which may impair neonatal hearing. The timing of first OAE after CD should
preferably be postponed beyond 48 hours of age to improve OAE passage and
minimize maternal anxiety and costs.

warmly,
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

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