الفهرس 
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Abstract
Summary
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SUMMARY
Ø Neonates admitted to Neonatal Intensive Care Units (NICUs) face
various problems including hearing impairment, due to problems such as
prematurity, low Apgar scores, infection, and hyperbilirubinemia and the
risks associated with treatment strategies including; mechanical ventilation,
oxygen therapy, administration of antibiotics and other medications. (AL–
Kandari , Alshuaib., 2007).
Ø Hearing loss is the most common disorder at birth, occurring in 1 to
2 newborns per 1000 in the general population and 24% to 46% of
newborns that are admitted to a NICU. (Berg et al., 2005)
Ø Many factors might play a role in placing these NICU babies at an
increased risk of hearing loss, including underlying disease processes as
well as the treatment they receive. (Walton, Hendricks-Munoz., 1991) &
(Salamy et al., 1989).
Ø The use of ototoxic drugs, including loop diuretics or
aminoglycosides, has been associated with increased vulnerability of the
cochlea to damage from preexisting hypoxia. Although hearing loss has
been described in children who were critically ill as newborns, most of the
children had received aminoglycosides, diuretics and neuromuscular
blocking agents. (Syka , Melichar., 1985) , (Kawashiro et al.,1996).
Ø The cochlea is especially susceptible to ototoxicity because
medication is retained for a longer period and in a higher concentration in
the inner ear fluids than in any other body tissue or fluid, especially in
individuals with liver or kidney dysfunction. (Weinstein., 2013).
Ø Screening procedures to detect hearing impairment may be divided
into two categories: behavioral and electrophysiological, Behavioral
techniques produce a high number of false-negative results due to the
relative subjectivity. (Calevo et al., 2007).
Ø Electrophysiological procedures have greater sensitivity and
specificity and include measuring the following: auditory brainstem
responses (ABR), and evoked otoacoustic emissions (EOAE), Various
studies have analyzed the cost of auditory screening in the neonatal period
as well as the differences between the methods available. ( Mezzano et al .,
2009).
Ø When hearing loss is identified early (prior to 6 months of age) and
followed immediately (within 2 months) with appropriate intervention
services, outcomes in language development, communication competency,
and social emotional will be significantly better when compared with
children with later identified congenital hearing loss (Moeller., 2000) & (
Yoshinaga-Itano et al., 1999).