Title

Gentamicin use and hearing loss in children of peri areas of Karachi : a cohort study

Date of Award

2010

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Background: Neonatal sepsis is the cause of 20-36 % of 4 million yearly neonatal deaths worldwide. In Pakistan an estimated 110/1000 live births suffer from sepsis in the first two months of their life mainly because of exposure to unhygienic conditions during home delivery. Hospitalization and parenteral treatment with injection gentamicin and penicillin is the recommended treatment for neonatal sepsis. However, these home delivered sick babies quite often do not reach hospital because of socioeconomic, logistic or social constraints and are often managed at home. Few studies show the effectiveness of gentamicin use at the community level for treatment of neonatal sepsis but data regarding its side effects in neonates (ototoxicity and nephrotoxicity) is lacking. If gentamicin is ototoxic in neonates, its community level use for the management of neonatal sepsis could expose a large proportion of neonates to hearing loss. Our study aims to determine the risk of hearing loss associated with gentamicin exposure in first 60 days of life in children of 6-36 months of age in pen urban communities of Karachi. Methods: This was a retrospective cohort study. Exposed group consisted of those children who were given intramuscular gentamicin for at least 5 days in their first 60 days of life. Non-exposed group consisted of children who had never received gentamicin. Outcome was hearing loss which was detected through Brainstem Evoked Response Audiometry (BERA) conducted after six months of gentamicin exposure. Exposed and non —exposed children were recruited from the records of neonatal sepsis management programme of Aga Khan University. A structured questionnaire was administered to the care takers of study participants and hearing ability of children in both the groups was assessed by BERA. Results: 125 children in gentamicin exposed group and 130 in gentamicin non-exposed group participated in the study. BERA was performed on 97 children in gentamicin exposed group and 105 children in gentamicin non-exposed group. 30(30.9%) children in gentamicin exposed and 33(31.4 %) children in gentamicin non-exposed were found to have hearing loss. Relative risk of hearing loss in gentamicin exposed vs. gentamicin non-exposed is 0.99 [95% CI: 0.60-1.61]. History of previous ear discharge and family history of hearing loss were found to be associated with hearing loss in children. Relative risk of hearing loss in children with previous ear discharge vs. no ear discharge is 1.79[95% CI: 1.08- 2.98] while Relative risk of hearing loss in children with family history of hearing loss in immediate relative or maternal relative vs. no family history of hearing loss is 2.00[95°A CI: 1.02-3.95] and 2.79 [1.27-5.87] respectively. Conclusion: Study results failed to show any association of hearing loss with the use of gentamicin for the treatment of sepsis in Pakistani neonates. Study results also showed a high frequency of hearing loss in children of gentamicin non-exposed group as well. Further research is recommended to find other risk factors of hearing loss Pakistani children.

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