This cross-sectional descriptive study was performed on 150 neonates hospitalized and treated in NICU of Besat Hospital in 2018-2019 using an available census sampling method. Inclusion criteria included all neonates hospitalized and treated in NICU. Exclusion criteria included all neonates whose parents did not consent to participate in this study. Researchers were justified in obtaining informed written consent from the parents. The patients were enrolled in the study with the written informed consent of their parents. This study was approved by Hamadan University of Medical Sciences with a code of ethics (IR.UMSHA.REC.1396.158).
A researcher-made checklist was used to collect data. The checklist included the following variables: gender, gestational age (term, pre-term), birth weight (below 2700 g, 2700 to 4200 g, over 4200 g), infant age at admission (under one week, one to two weeks, two to three weeks, more than three weeks), aminoglycoside intake (had, did not have), positive family history of hearing loss (has, does not have), needs oxygen (does, does not),  the number of days in hospital (under one week, one to two weeks, two to three weeks, over three weeks), OAE test (Fail, Pass), ABR test (normal 0-25db, mild 25-40db, moderate 40-55db, Moderate to severe 55-70db, severe 70-90db, deep more than 90db), reduction, hearing loss of both ears (right ear, left ear, both ears, none), use of furosemide (does, does not), respiratory (had, did not have), and neuropathy audiometry.  The ABR test was performed using the Labat device made in Italy and the OAE test was performed using the Homoth device made in Germany. Hearing tests were performed by a hearing expert. (Leibnizstraße, Kaltenkirchen, Germany). SPSS 16 (SPSS Inc., Chicago, Ill., USA) was used to analyze the data. Descriptive statistics and Chi-square test were used to describe and analyze the data.

 

Table1 shows the result of the demographic variables.  According to the results, 63.3% of study participants were male, and 36.7% were female. The time of hospitalization was below one week of age.
Table 2 illustrates the hearing loss status of the participants. In this study, 3.3% of study participants had moderately-severe hearing loss.
Table 3 shows the results of the study participants' associations with hearing disorder (ABR test). A significant statistical relationship was found between age variables at infant hospitalization, oxygen demand, bilateral hearing loss, and OAE fail, with hearing disorder (ABR test).
Furthermore, between aminoglycoside intake, age, positive familial hearing loss, number of days of hospitalization, type of illness with hearing disorders ( ABR test) were not significantly related.  It showed that none of the participants in the study consumed furosemide. Also, none of the participants in the audiometric study had neuropathy.
 

Table 1. Results of Demographic Variables

Table 2.  Hearing Loss Status of Participants

Table 3. Results of the Relationship between Research Variables and Hearing Disorders of Study Participants

Discussion

Based on the results of this study, 63.3% of study participants were male, and 36.7% were female. Also, 64.7% of study participants were less than a week old at the time of hospitalization. There was no statistically significant correlation between the gestational age and the birth weight with hearing disorder (ABR test), which was consistent with some similar studies (16,17). However, in some other studies, there was a correlation between the gestational age and the birth weight with hearing disorder. There was a statistically significant difference that could be attributed to the large sample size of the studies, which is consistent with the results of this study (18–20). Similar research, studying factors related to hearing disorders, have reported ototoxic drugs, mechanical ventilation, and low Apgar score at one and five min of birth (21,22). 
The results of this study showed that 3.3% of study participants had moderately-severe hearing loss. This finding is similar to a study conducted in high-risk newborns (23).
Based on the results of this study, the age of the patients at the time of hospitalization had significant statistical relationship with hearing disorders (ABR test), and the patients, who were less than two weeks old at the time of hospitalization, had more hearing disorder. This finding was less well-considered in similar studies. The results of this study showed the highest percentage of neonates hospitalized due to seizure. These findings are consistent with similar studies in neonatal hearing disorders, which have reported these seizures as one of the major causes of hearing disorder (12,22).  The results of this study showed that none of the participants in the study had Furosemide consumption. Also, none of the participants in the study needed a respirator and none of the participants had a neuropathic audiometry. This finding was inconsistent with some similar studies. The different nature of the patients was the cause of this difference (12). Based on the results of this study, there is a significant relationship between the need for oxygen and the hearing disorders (ABR test), and those who needed oxygen showed greater hearing disorders. This finding has been less well-considered in similar studies; the cause of this issue can be of a different therapeutic nature and different types of treatment for patients treated in different studies. However, these findings are consistent with the results reported by Umehara et al. The results of their study showed that the factors contributing to the elevation of ABR threshold were oxygen administration (22). There was a statistically significant relationship between the two variables of OAE and ABR in the study, and the participants, who were diagnosed with hearing disorder via the ABR test, also failed their OAE test.
This direct relationship between the two tests may indicate that persons hospitalized and treated in NICUs need both tests (ABR and OAE) at birth to make a definitive diagnosis of hearing disorders. This finding was also mentioned in the study carried out by Di Stadio et al. (24). In their study, 95.3% of the participants had a healthy hearing, and based on the results, 4% of study participants had hearing disorders. They also showed disorder in both ears, and 4.7% of participants in the study had mild to severe hearing disorder. This finding is in line with some similar studies (9,25). It is recommended that programs be designed and implemented to inform ad follow up parents on the subject of hearing loss.

 

Conclusion

Two main dietary patterns (i.e., the DASH-style dietary pattern and the modern dietary pattern) were dominant in the nutrition patterns of patients with hypertension. The results showed that the modern dietary pattern was associated with higher SBP and, interestingly, that the DASH-style dietary pattern was not associated with lower levels of SBP or DBP. Hypertensive patients in both identified dietary patterns consumed more sodium and less potassium, calcium, and magnesium than expressed in the DASH recommendations. The evidence in this study suggests that following a healthy diet and achieving the recommended intake of effective nutrients such as calcium, magnesium, potassium, and sodium is necessary to reach beneficial outcomes. Another indirect but important finding of this study was that many hypertensive people receiving treatment for hypertension did not comply with the recommended healthy diet to control their high blood pressure. Hypertension with the high prevalence and incidence is known as a public health problem globally. The key role of a healthy diet (including micronutrients) in controlling high blood pressure, and the insufficient information available about the dominant diet in hypertensive people show that there is still room to conduct further research to address these issues. Future research to replicate the present findings using a prospective design is recommended.

Acknowledgements

This article results from the research design and financial support of the Vice President of Research and Technology of Hamadan University of Medical Sciences, so thanks for their support. Also, we would like to thank all the parents of the newborns for their contribution to this study.

 

Conflicts of Interest

Authors declared no conflict of interests.