The impact of prematurity and neonatal complications on hearing function in children born to HIV-Positive mothers: A secondary data analysis in the South African context.

BACKGROUND: Children born to HIV-positive mothers are at increased risk for a range of neonatal complications that may negatively impact auditory development. In low- and middle-income countries (LMICs) like South Africa, where both HIV exposure and adverse neonatal outcomes are prevalent, understanding the relationship between early clinical risk factors and hearing loss is critical for informing early hearing detection and intervention (EHDI) strategies. METHODS: This study aimed to examine the association between neonatal complications-such as prematurity, low birth weight, hyperbilirubinemia, neonatal intensive care unit (NICU) admission, and ototoxic drug exposure-and hearing outcomes in children born to HIV-positive mothers in a South African tertiary care setting. A retrospective secondary data analysis was conducted on medical records of 85 children aged 0-5 years who were born to HIV-positive mothers and assessed at an Academic Hospital in Johannesburg, South Africa. Demographic, clinical, and audiological data were extracted and analysed using descriptive statistics, chi-square tests, and logistic regression to identify significant associations and predictors of hearing loss. RESULTS: The cohort demonstrated a balanced gender distribution, with most children between 2 and 5 years old. Low birth weight (58.8%), prematurity (44.7%), and NICU admission (49.4%) were the most prevalent neonatal risk factors. Hearing loss was identified in 17.6% of the sample, with sensorineural hearing loss (SNHL) accounting for the majority of cases (11.8%). Significant associations were found between hearing loss and prematurity (p = 0.042), low birth weight (p = 0.031), hyperbilirubinemia (p = 0.016), NICU admission (p = 0.028), and ototoxic drug exposure (p = 0.012). Logistic regression analysis revealed that hyperbilirubinemia (OR = 4.12, p = 0.005) and ototoxic drug exposure (OR = 5.19, p = 0.002) were the strongest independent predictors of hearing loss. CONCLUSIONS: Neonatal complications are key contributors to hearing loss among HIV-exposed children in South Africa. These findings, particularly the identification of hyperbilirubinemia and ototoxic exposure as the strongest predictors, highlight the urgent need for risk-based EHDI approaches, routine audiological follow-up for at-risk neonates, and integration of hearing health services into existing maternal and child health frameworks. Strengthening early identification efforts in LMICs is essential to reducing preventable hearing loss and promoting equitable developmental outcomes.