Association of Refer Otoacoustic Emissions Test with Postnatal Risk Factors in Premature Neonates

Abstract

Background: Premature neonates are at elevated risk for auditory dysfunction due to underdeveloped cochlear structures and exposure to multiple postnatal complications. Early hearing loss in this population often goes undetected without targeted screening, potentially impairing language development and cognitive outcomes. Otoacoustic emissions (OAE) testing serves as a non-invasive, effective tool for early detection of cochlear-level hearing impairment. Objective: To determine the association between refer OAE test outcomes and postnatal risk factors in premature neonates, and to assess the cumulative impact of multiple concurrent complications on auditory screening results. Methods: A cross-sectional observational study was conducted from January to June 2024 across two tertiary hospitals in Lahore, Pakistan. A total of 122 premature neonates (≤3 months of age) underwent OAE screening using a handheld device. Data on 15 postnatal risk factors including hyperbilirubinemia, meningitis, low birth weight, septicemia, and NICU stay were collected via structured clinical proformas. Chi-square tests and multivariate logistic regression were used to analyze associations; p<0.05 was considered statistically significant. Results: Of 122 neonates, 69.7% had OAE outcomes. Significant associations were observed with hyperbilirubinemia (p=0.016), neonatal meningitis (p=0.003), low birth weight (p=0.005), and septicemia (p=0.005). A cumulative risk score demonstrated a dose-response increase in refer rates, reaching 90% in neonates with five risk factors. Conclusion: Postnatal risk factors, especially when concurrent, significantly increase the likelihood of failed OAE screening in premature neonates. Early, risk-based auditory screening is critical to enable timely diagnosis and intervention.