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Perinatal
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| 1 |
Family history of early, progressive, or delayed onset permanent childhood hearing loss |
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| 2 |
Neonatal intensive care of more than 5 days |
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| 3 |
Hyperbilirubinemia |
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| 4 |
Aminoglycoside administration for more than 5 days |
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| 5 |
Asphyxia or Hypoxic Ischemic Encephalopathy |
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| 6 |
Extracorporeal membrane oxygenation (ECMO) |
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| 7 |
In utero infections, such as herpes, rubella, syphilis, and toxoplasmosis |
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| 8 |
Certain birth conditions or findings:
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Craniofacial malformations including microtia/atresia, ear dysplasia, oral facial clefting, white forelock, and microphthalmia
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Congenital microcephaly, congenital or acquired hydrocephalus
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Temporal bone abnormalities
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| 9 |
Syndrome: _____________________________________ |
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Perinatal or Postnatal
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| 10 |
Infections associated with sensorineural hearing loss, including meningitis or encephalitis |
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| 11 |
Events associated with hearing loss:
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Significant head trauma especially basal skull/temporal bone fractures
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| 12 |
Caregiver concern regarding hearing, speech, language, development delay and/or development regression |
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Emerging factors from LMICs
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| 13 |
Maternal hypertensive disorders in pregnancy |
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| 14 |
Non-elective caesarean delivery |
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| 15 |
Unskilled attendant at delivery |
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| 16 |
Undernutrition |
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Possible risk-factor for the Pacific Islands
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| 17 |
Gestational diabetes |
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