ABSTRACT As a major objective test for auditory function, the brainstem auditory evoked response (BAER), also called brainstem auditory evoked potential (BAEP) or auditory brainstem response (ABR), has been the focus of non-invasive electrophysiological examinations of the functional integrity of the auditory system. It is particularly suitable in very young infants and sick children. The nature of the BAER has led to its wide use in neonatal neurology to assess the functional integrity and development of the brainstem and the auditory system in infants and children. It has been documented to be an important tool and adjunct to detect neuropathology that involves the brainstem auditory pathway in a wide range of pediatric, particularly neonatal, diseases. Conventional BAER, i.e. the BAER recorded and analysed using conventional averaging techniques, has some limitation in the detection of neuropathology. It has only modest associations with neurological status and false negative results are not uncommon. In the last decade, the maximum length sequence (MLS) has been introduced to record and analyse the BAER. Recent studies have shown that this relatively new technique improves the detection of neuropathology that affects the auditory brainstem in a range of major neonatal problems. It is particularly valuable in the detection of some early or subtle degrees of neuropathology that may not be detected by conventional BAER and other examinations. This article reviews the recent advances in the application of BAER in neonates with brain damage due to a range of major perinatal problems or conditions, including hypoxia-ischemia or asphyxia, low Apgar score, neonatal chronic lung disease or bronchopulmonary dysplasia, hyperbilirubinemia and necrotizing enterocolitis. Some methodological or technical issues for the use of BAER in neurological examination are also discussed. Particular attention is paid to the recent studies and application of MLS BAER in detection of neonatal brain damage and central auditory impairment.
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