significant effect on out-come at 2 years of age [12]. However, the children are still young and their outcome should be re-assessed at school age. We also found that the severity of anaemia does not influence the need for intensive care treatment in the neonatal period. Moreover, we also found that there was no significant difference in survival between patients with an initial Hb concentration ≤3.0 mmol/l versus patients with an initial Hb concentration between 3.1 and 6.0 mmol/l. There was also no increased need for respiratory or circulatory support in the infants with more severe anaemia. However, the degree of organ fail-ure and especially the degree of encephalopathy scored clinically or with aEEG and the presence of seizure activ-ity and severe injury on MRI were correlated with mor-tality and/or redirection of care.LimitationsThis retrospective study has several limitations. First, Hb concentrations were not assessed within a predefined time after birth. However, all Hb measurements were per-formed within 6 h after birth, indicating severe neonatal anaemia. Second, MRI imaging was initially restricted to infants with a clinical indication, although MRI was also performed in patients with anaemia without serious co-morbidity. Although this may have caused a potential bias, clinical characteristics in infants with and without MRI data were not different. Third, a full neurodevelop-mental assessment was not performed routinely. It would therefore be desirable to have a follow-up in these patients at school age to study whether the white matter lesions are associated with school performance, as has previously been shown in survivors with white matter injury in the context of hypoxic ischaemic encephalopathy [13]. More insight in the association between patterns of damage and possible pathophysiological mechanisms, combined with neurological outcome, will hopefully provide more in-sight in how to predict future disabilities during the new-born period.Conclusion Severe neonatal anaemia is associated with high neo-natal mortality and neonatal morbidity. Those who sur-vive perform relatively well when assessed at approxi-mately 2 years of age. MRI shows abnormalities in the basal ganglia and thal-ami in severely affected infants, and white matter lesions in most patients. However, it is difficult to distinguish between damage due to anaemia only and damage due to associated perinatal asphyxia. Due to the retrospective setup of this study and miss-ing data, results should be interpreted with caution. Pro-spectively collected data with a longer follow-up period are needed. About 1 in 500 infants is born with or develops hearing loss during early childhood. Hearing loss has many causes: some are genetic (that is, caused by a baby’s genes) or non-genetic (such as certain infections the mother has during pregnancy, or infections the newborn baby has). A combination of genetic and non-genetic factors also can cause hearing loss. For many babies, the cause of hearing loss is unknown. This booklet answers many of the questions that families have about the causes of hearing loss, including genetic causes. For some of the topics, more extensive details are given in the shaded boxes. 2 About The Causes of Hearing Loss What are the types of hearing loss? There are many different ways to talk about the different types of hearing loss. o One way is based on whether or not a baby is born with hearing loss. If the baby is born with hearing loss it is called congenital. If the hearing loss occurs after the baby is born it is called acquired. o Another way depends on whether or not the hearing loss gets worse over time. Hearing loss that gets worse over time is called progressive. Hearing loss that does not change is called non-progressive. o A third way depends on whether or not other symptoms are present; that is, is it syndromic or non-syndromic. o A fourth way depends on whether or not hearing loss runs in the family. If it does, it is called familial; if it does not it is sporadic o A fifth way is based on where in the ear the hearing loss occurs. If the loss occurs in the outer or middle ear it is conductive. If it occurs in the inner ear it is sensorineural. If the loss occurs in both areas it is mixed. Drawing by: S. Blatrix © Centre Régional d’Imagerie Cellulaire. Used with persmission. m A Diagram of the External (E), Middle (M), and Inner (I) Ear 3 One way to describe hearing loss is as “congenital” or “acquired”. Congenital means that a person was born with the hearing loss. Babies born with hearing loss can be identified through a newborn hearing screening test. The test often is done before a baby leaves the hospital in which he or she was born. The screening test does not tell the cause of the baby’s hearing loss. It can tell only whether the baby might have a hearing loss. Acquired hearing loss means that a person could hear when he or she was born, but developed hearing loss later in life. Acquired hearing loss also can be described by the age at which it starts. If hearing loss starts before the age when children usually begin talking, it is called “prelingual”, which means “before speaking”. If hearing loss starts after the age when children begin talking, it is called “postlingual”, which means “after speaking”. If the hearing loss gets worse over time, it is called “progressive”. If the hearing loss does not change over time, it is “nonprogressive” or stable. “Syndromic” means that a person has other symptoms besides hearing loss. For example, some people with hearing loss also are blind. There are many different syndromes that have hearing loss as one of the symptoms. “Nonsyndromic” means that the person does not have any other symptoms. If more than one person in a family has hearing loss, it is said to be “familial”. That is, it runs in the family. If only one person in the family has hearing loss, it is called “sporadic”. That is, it does not run in the family. The middle ear contains small bones that help send sound from the air to the inner ear. The inner ear changes these sounds into nerve signals that go to the brain. “Conductive” hearing loss is caused by problems in the outer or middle ear.