1. Esther Pugh Melanie Rosenblatt
Speech-evoked Complex Auditory Brainstem Response (cABR) and Frequency Following Response (FFR) in the Neonatal Intensive Care Unit (NICU)
Esther Pugh
Melanie Rosenblatt

2. Newborn infants in NICU at risk of auditory impairment
Common risk factors
Prematurity, low birth weight, and hyperbilirubinemia (Akinpelu et al., 2013)
Hyperbilirubinemia
Significant increase in serum bilirubin
Can result in multiple neurological impairments and deficits
Most common condition in neonates that require assessment and management
May lead to neurotoxicity (Shapiro, 2003)
Risk factor for newborn hearing loss (JCIH, 2007)
Early identification and early evaluation
Key to reducing the risk of kernicterus (Bhutani et al., 2011)
Interventions and monitoring for neural deficits that follow

3. Newborn infants in NICU at risk of auditory impairment
Auditory neural pathway
Sensitive to bilirubin-induced neurotoxicity (Shapiro & Popelka, 2011)
Integrity of the pathway
Evaluated by Auditory Brainstem Response (ABR)
Conventional ABR
Click, tone burst, and chirps
Widely used in newborns
Estimate type and severity of hearing loss
Sensory and neural loss
e.g. ANSD (Berlin, et al., 2010)
Limitations
Detecting early or subtle neural damage and neural impairment (Jiang & Wilkinson, 2014)

4. Frequency Following Response and Complex ABR
Auditory brainstem responses elicited by speech stimuli
Response waveform has periodicity that follows stimulus frequency
Similar setup with conventional ABR
One channel recording
Commercially available
Complex stimuli
cABR
/da/: Transient + steady-state
FFR
Speech sound, usually a syllable, with pitch changes
Multiple quantitative indexes
Response magnitude, peak latency, pitch strength, pitch accuracy, etc.

5. Frequency Following Response and Complex ABR
FFR and cABR
Quantifies complex sound coding and processing
In quiet and background noise (Anderson et al., 2012)
In preschool and school aged children (Kraus et al., 2011)
In adults and the elderly (Anderson et al., 2014)
Central auditory processing deficits (Kraus et al., 2009)
Neuroplasticity
Short-term and long-term music training (Musacchia et al., , 2008)
Language background (Krishnan et al., 2004; Jeng & Hu, )
Influence of language development (Hu & Jeng, 2011)
In adults and the elderly in specific language environments (Wang & Hu, 2017)

6. Frequency Following Response and Complex ABR
FFR and cABR
Neuroplasticity
Short-term and long-term music training (Musacchia et al., , 2008)

7. Frequency Following Response and Complex ABR
FFR and cABR
Neuroplasticity
Influence of language development (Hu & Jeng, 2011)

8. FFR and cABR in NICU FFR and cABR in NICU? Purpose
Feasible in NICU setting?
Sensitive in detecting and reflecting subtle changes?
E.g. hyperbilirubinemia
Purpose
Feasibility in NICU
Response compared to adults
Fidelity of responses with bilirubin level changes

9. 19 full term newborn infants in NICU
Method
19 full term newborn infants in NICU
Data obtained from NMCHH
Diagnosed with hyperbilirubinemia
Transcutaneous total bilirubin level
200 umol/L (11.7 mg/dL)
No other known pathology
Passed newborn hearing screening
AABR and OAE
One channel recording
Fz – M2 – Fpz
Natural sleeping
Monaural stimulation to the right
70 dB SPL
Calibrated in 2cc coupler, corrected to infant canal size

10. Method Quantitative indexes cABR FFR Spectral energy at f0 region
Latencies of peaks
FFR
Pitch strength

11. Intelligent Hearing Systems
Method
Stimuli
cABR
/da/, synthesized
Five formant, 40 ms with initial 10 ms burst
F0 around 100 Hz
FFR
/i/, recorded Mandarin syllable
250 ms
Falling pitch change, f0: Hz
Intelligent Hearing Systems
Artifact rejection
Shielded ER3A
Study approved by the IRB board of University of the Pacific and NMCHH

12. Results
Feasibility and responses compared to adults
cABR

13. Results
Feasibility and responses compared to adults
FFR

14. Results
Feasibility and responses compared to adults
FFR

15. Results
Response fidelity and bilirubin levels
cABR

16. Results
Response fidelity and bilirubin levels
FFR

17. Discussion
Auditory brainstem responses elicited by speech stimuli can be reliably recorded from NICU
Responses obtained from newborns with hyperbilirubinemia were weaker compared to adults, as expected
Correlations between f0 amplitude and pitch strength, and transcutaneous bilirubinometry
Suggests the potential for detecting more subtle neural impairment
Central auditory processing abnormalities that gross evoked potentials fail to detect

18. The presenters thank Thank you
Dr. Jiong Hu, Co-director, AEP lab at UOP
Dr. Gabriella Musacchia, Co-director, AEP lab at UOP
Mr. Griffin Talan, lab manager, AEP lab at UOP
Dr. Meiling Tong, Director, Neonatology, NMCHH
Dr. Matthew Fitzgerald, Chief Audiologist, Stanford University
Dr. Rosalie Saxman, CAA CEU Chairperson
Audience at CAA 2017

19. References
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