Prolonged use of pancuronium bromide and sensorineural hearing loss in childhood survivors of congenital diaphragmatic hernia

Sensorineural hearing loss (SNHL) is a significant neurologic morbidity in survivors of neonatal congenital diaphragmatic hernia (CDH), with a reporte d incidence of up to 60%. In a historical cohort study of 37 neonates with CDH, we investigated the use of pancuronium bromide (PB) and common ototoxi c drugs during the neonatal period and their relationship to SNHL in childh ood survivors. Survivors with SNHL (n = 23) had significantly higher cumula tive dose of PB administered during the neonatal illness than survivors wit hout SNHL (n = 14). The cumulative dose and duration of PB use significantl y correlated (r = 0.66-0.81) and independently predicted (adjusted r(2) = 0 .42-0.64) the greatest intensity (in decibels) and the widest band (lowest frequency in hertz) loss of SNHL. No differences were identified between su rvivors with and without SNHL regarding demographic and neonatal characteri stics (including oxygenation and ventilation variables and the cumulative d ose and duration of therapy with aminoglycosides, vancomycin, and furosemid e), although survivors with SNHL had received a modestly higher cumulative dose of ethacrynic acid than survivors without SNHL. Although we show that prolonged administration of PB during the neonatal period is associated wit h SNHL in childhood survivors of CDH, further multicenter studies are requi red to investigate the possible etiologies of SNHL in this high-risk popula tion.