The interaction between illness perception and intrinsic capacity during hospital-to-home transition in older adults with COPD and diabetes: a prospective cohort study.

Survival among infants requiring neonatal intensive care has improved substantially over the past several decades. However, neonatal intensive care unit (NICU) admission remains associated with an increased risk of long-term neurodevelopmental impairment (NDI), particularly among infants born very preterm or with severe neonatal illness (). In contemporary cohorts of extremely preterm infants assessed in early childhood, moderate-to-severe NDI has been reported in approximately 10%–26% of survivors, with rates exceeding 40% among those born before 25 weeks’ gestation in some studies (). Even among children without severe disability, meta-analyses demonstrate persistent differences in cognitive ability, executive functioning, and processing speed compared with term-born peers (). These findings underscore the need for early, clinically accessible markers of neurodevelopmental vulnerability in NICU populations. Current clinical markers are insufficient as NDI is often not identified until early childhood. Hearing loss represents one of the most clinically significant sensory complications in NICU survivors. Permanent childhood hearing loss, even when mild, can disrupt early speech and language acquisition and has lasting consequences for educational attainment, social participation, and employment opportunities (; ). The introduction of universal newborn hearing screening (UNHS) has enabled earlier detection in many countries. Population estimates suggest that permanent bilateral hearing loss (BHL) occurs in approximately 1.3 per 1,000 live birth; however, prevalence is substantially higher in NICU populations, with estimates up to tenfold greater than in the general population, reflecting different inclusion criteria, higher-risk clinical profiles and increased exposure to neonatal risk factors (; ). Expanded genomic sequencing combined with hearing screening may be effective at detecting hearing loss among NICU cases (). Despite advances in early detection and intervention, children with hearing loss remain at increased risk of broader developmental difficulties (). The mechanisms linking NICU admission and hearing loss are complex and multifactorial. Established risk factors include congenital infection, genetic conditions, and structural anomalies affecting the auditory system, as well as postnatal exposures such as hypoxic–ischaemic injury, severe infection, prolonged respiratory support, exposure to ototoxic medications (; ) and metabolic instability during critical periods of brain maturation (; ; ; ; ; ; ). Importantly, many of these exposures are also recognised as risk factors for broader NDI in NICU survivors. Conditions such as intraventricular haemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and systemic infection are consistently associated with adverse cognitive and behavioural outcomes in early childhood (; ; ; ).