Auditory neural responses to click stimuli of different rates in the brainstem of very preterm babies at term

Auditory neural responses to acoustic stimuli of different rates were studied by analyzing changes in brainstem auditory evoked responses (BAER) with increasing repetition rate of clicks, or rate-dependent changes, in 62 very preterm babies (gestation 24-32 wk). None had perinatal asphyxia or major complications at the time of testing (37-42 wk postconceptional age) to exclude their possible effects on the recorded BAER. As the rate of clicks was increased from 21/s to 51/s and 91/s, I-V interpeak interval in these babies increased similarly to that in normal term neonates. The rate-dependent change decreased significantly in I-III interval, but increased significantly in III-V intervals and III-V/ I-III interval ratio (all p < 0.01). At all three rates of clicks, the I-V interval, the most commonly used BAER variable, tended to increase slightly but did not differ significantly from the term neonates. The I-III interval decreased significantly at higher click rates (ANOVA p < 0.05 at 51/s and < 0.001 at 91/s), whereas the III-V interval and III-V/I-III interval ratio increased significantly at all 21/s. 51/s, and particularly 91/s (p < 0.01-0.001). No abnormalities were found in wave V amplitude at any rates. These results suggest that very preterm babies have an advanced peripheral development of the brainstem auditory pathway but a retarded central development or central impairment. A nearly normal I-V interval does not exclude a possible abnormality in its subcomponents (I-III and III-V intervals). In babies who have a normal BAER at a conventionally used low rate of clicks, we cannot exclude an abnormal BAER at higher rates.