Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024

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Vilela-Estrada" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Sensorineural hearing loss in children, when associated with specific risk factors, can negatively affect language development, which in turn impacts their quality of life as well as their family and social environment. Objective To determine the association between risk factors for severe-to-profound sensorineural hearing loss and auditory performance in post–cochlear implant patients at Instituto Nacional de Salud del Niño, San Borja, during the period from 2021 to 2024. Methods An analytical cross-sectional study was conducted. Data collection was performed through a review of medical records; information was obtained from children treated between 2021 and 2024, including sociodemographic and clinical characteristics of post–cochlear implant patients. Auditory performance was assessed using the PEACH test. Results Medical records from 100 children who underwent cochlear implant surgery were reviewed. Preterm children showed poorer auditory performance (52.8%) compared with those born at term (70.5%). Children with low birth weight recorded a PEACH score of 51.4%, whereas those with normal birth weight reached higher values (71.8%). Additionally, children implanted before their first year of life presented a lower rate of suboptimal performance (40%), while those implanted after the age of three reached 56.5% performance. Analysis of risk factors associated with auditory outcomes revealed that prematurity, low birth weight, severe asphyxia, and hydrocephalus were significantly associated with poorer auditory performance. Conclusions There is a significant association between risk factors and reduced auditory performance in children with sensorineural hearing loss who underwent cochlear implant surgery, particularly among those born prematurely, with low birth weight, severe asphyxia, or hydrocephalus. 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F1000Research 2026, 15 :159 ( https://doi.org/10.12688/f1000research.173575.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] Diego Marin Marín https://orcid.org/0000-0002-1913-328X 1 , Leydy Kelly Cordero Tito 1,2 , Liseth Melissa Montañez Córdova 1 , Felix Cordero-Pinedo 1 , Martín A. Vilela-Estrada https://orcid.org/0000-0002-1494-952X 1 Diego Marin Marín https://orcid.org/0000-0002-1913-328X 1 , Leydy Kelly Cordero Tito 1,2 , [...] Liseth Melissa Montañez Córdova 1 , Felix Cordero-Pinedo 1 , Martín A. Vilela-Estrada https://orcid.org/0000-0002-1494-952X 1 PUBLISHED 31 Jan 2026 Author details Author details 1 Lima, Instituto Nacional de Salud del Niño San Borja, Lima, San Borja, 15037, Peru 2 Universidad Nacional Federico Villarreal, San Miguel, Lima Region, Peru Diego Marin Marín Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Leydy Kelly Cordero Tito Roles: Conceptualization, Data Curation, Investigation, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Liseth Melissa Montañez Córdova Roles: Conceptualization, Investigation, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Felix Cordero-Pinedo Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Martín A. Vilela-Estrada Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Sensorineural hearing loss in children, when associated with specific risk factors, can negatively affect language development, which in turn impacts their quality of life as well as their family and social environment. Objective To determine the association between risk factors for severe-to-profound sensorineural hearing loss and auditory performance in post–cochlear implant patients at Instituto Nacional de Salud del Niño, San Borja, during the period from 2021 to 2024. Methods An analytical cross-sectional study was conducted. Data collection was performed through a review of medical records; information was obtained from children treated between 2021 and 2024, including sociodemographic and clinical characteristics of post–cochlear implant patients. Auditory performance was assessed using the PEACH test. Results Medical records from 100 children who underwent cochlear implant surgery were reviewed. Preterm children showed poorer auditory performance (52.8%) compared with those born at term (70.5%). Children with low birth weight recorded a PEACH score of 51.4%, whereas those with normal birth weight reached higher values (71.8%). Additionally, children implanted before their first year of life presented a lower rate of suboptimal performance (40%), while those implanted after the age of three reached 56.5% performance. Analysis of risk factors associated with auditory outcomes revealed that prematurity, low birth weight, severe asphyxia, and hydrocephalus were significantly associated with poorer auditory performance. Conclusions There is a significant association between risk factors and reduced auditory performance in children with sensorineural hearing loss who underwent cochlear implant surgery, particularly among those born prematurely, with low birth weight, severe asphyxia, or hydrocephalus. READ ALL READ LESS Keywords Risk Factors; Auditory Performance; Cochlear Implant; Auditory Therapy; Children. Corresponding Author(s) Diego Marin Marín ( [email protected] ) Close Corresponding author: Diego Marin Marín Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Marin Marín D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Marin Marín D, Cordero Tito LK, Montañez Córdova LM et al. Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :159 ( https://doi.org/10.12688/f1000research.173575.1 ) First published: 31 Jan 2026, 15 :159 ( https://doi.org/10.12688/f1000research.173575.1 ) Latest published: 31 Jan 2026, 15 :159 ( https://doi.org/10.12688/f1000research.173575.1 ) Introduction The World Health Organization estimates that approximately 430 million people worldwide experience some degree of disabling hearing loss requiring rehabilitation. 1 Among the genetically based risk factors are hereditary conditions such as Usher and Waardenburg syndromes, as well as neurofibromatosis type 2. Prenatal factors are also recognized—including infections such as rubella, cytomegalovirus, and toxoplasmosis—along with perinatal conditions such as prematurity and hypoxia, which may cause injury to the auditory nerve, leading to severe or profound hearing loss and negatively impacting language development. 2 – 5 It is projected that by the year 2050, more than 700 million people will be living with some form of hearing loss, highlighting the growing magnitude of this global health problem. 6 , 7 In the pediatric population, it is reported that between 1 and 3 per 1,000 newborns present with severe-to-profound sensorineural hearing loss; this number may increase to as many as 8 per 1,000 among neonates who required intensive care, given their increased exposure to risk factors during NICU admission. 8 , 9 Childhood hearing loss represents a major concern due to its impact on speech and language development, which can result in significant deterioration of cognitive, social, and emotional development if not detected and treated in a timely manner. 10 – 12 Cochlear implantation has proven to be an effective intervention for restoring auditory function in cases of severe or profound hearing loss, allowing for the progressive development of auditory and verbal skills through auditory rehabilitation. 13 – 15 However, functional outcomes may vary depending on the presence of associated risk factors, making it essential to evaluate how these conditions influence auditory performance following surgery. Despite the relevance of this topic, no studies have been identified in Peru that examine the relationship between risk factors and auditory performance in pediatric patients undergoing cochlear implantation. In this context, the need arises to address the following question: How do risk factors influence auditory performance after cochlear implantation in children? The objective of the present study was to determine the association between risk factors and auditory performance among cochlear implant recipients at Instituto Nacional de Salud del Niño, San Borja during the period 2021–2024. Methods Study design An analytical cross-sectional study was conducted between 2021 and 2024 at the Instituto Nacional de Salud del Niño–San Borja, including 100 postoperative cochlear implant recipients diagnosed with severe-to-profound bilateral sensorineural hearing loss. Primary data were obtained using the validated Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) scale, and secondary data were extracted from electronic medical records. 16 The sample size was calculated assuming a finite population of eligible patients and a 95% confidence level. 17 To reduce selection and information bias, standardized procedures were used for data abstraction, and two independent researchers cross-verified extracted information. Patients with conductive or mixed hearing loss, incomplete clinical documentation, or whose caregivers declined participation were excluded. Survey design A structured data extraction form was developed to retrieve demographic, perinatal, and clinical variables from the medical records. The PEACH scale—developed and validated by Teresa Ching and Mandy Hill—is publicly available at: https://outcomes.nal.gov.au/peach/ and consists of 13 items that assess auditory performance in quiet, noisy environments, and overall functioning. 18 Scores were converted into percentages for each domain (quiet/vowels, noise/consonants, and total performance) and categorized as high (≥75%), medium, or low performance. Because the PEACH is a previously validated instrument, no modifications or translations were applied. Parents were interviewed by trained audiology staff following a detailed standardized protocol to reduce interviewer variability. Clarification prompts were scripted to minimize subjective interpretation. The full PEACH questionnaire used in this study is included as Extended Data to ensure reproducibility. Data analysis Data were entered using a double-entry system in Microsoft Excel to ensure consistency, and discrepancies were resolved through manual inspection. All analyses were conducted using STATA version 19. Normality of continuous variables was assessed using the Shapiro–Wilk test. Due to non-normal distribution of PEACH scores, group comparisons were performed with non-parametric tests: Mann–Whitney U test for two-group comparisons (e.g., age at implantation) and Kruskal–Wallis test for comparisons involving more than two groups (e.g., type of labor, geographical origin). Categorical variables were expressed as frequencies and percentages, and differences between groups were evaluated using Chi-square tests. To identify factors associated with poor auditory performance (defined as PEACH <75%), crude prevalence ratios (RP) were obtained through bivariate analysis. Multivariable models were then fitted using logistic regression and Poisson regression with robust variance (FAM-Poisson), the latter chosen to avoid overestimation of associations in outcomes with high prevalence. Adjusted prevalence ratios (RPA) were calculated controlling for sex, geographical origin, and age at implantation. Statistical significance was set at p < 0.05, and 95% confidence intervals were reported. Sensitivity analyses were performed by reclassifying borderline PEACH scores to evaluate the robustness of the associations. Ethical statement This study was conducted for scientific purposes using anonymized secondary data obtained from medical records and standardized interviews with caregivers of children who underwent cochlear implantation between 2021 and 2024. All data were securely coded and stored to ensure strict confidentiality and compliance with ethical standards. The study adhered to the principles of beneficence, non-maleficence, autonomy, and justice, in accordance with the Declaration of Helsinki. 19 The research protocol was reviewed and approved by the Comité Institucional de Ética en Investigación del Instituto Nacional de Salud del Niño – San Borja, located at Av. Agustín de la Rosa Toro N.° 1399, Urb. Jacaranda II, San Borja, Lima, Perú (Tel. 2300600, Anexo 4012). Ethical approval was granted on February 10, 2025, under Approval Certificate No. 011-2025, signed by Dra. Emiliana Rizo-Patrón Terrero, President of the Institutional Research Ethics Committee. No additional approval from independent review boards was required. Written informed consent was obtained from all caregivers prior to data collection. This study was not pre-registered in any public research protocol registry, as national regulations do not mandate registration for observational studies involving anonymized secondary data. Results In the analysis of postoperative cochlear implant patients treated at the National Institute of Child Health–San Borja between 2021 and 2024, PEACH test scores varied according to perinatal characteristics and age at the time of assessment in Table 1 . When comparing mode of labor, children born by vaginal labor achieved an average PEACH total score of 68.2 ± 22.1, with performances of 70.5% in the vowel section and 65.8% in the consonant section. In contrast, those born by cesarean section showed slightly lower values, with a mean PEACH total score of 62.4 ± 24.8, 64.1% for vowels, and 60.7% for consonants. Although the mean values were higher in the vaginal labor group, these differences did not reach statistical significance (p = 0.08 for the total score and p = 0.12 for sections A and B) in Table 1 . Table 1. Auditory performance (PEACH) according to mode of labor and age at implantation. Group PEACH total (Mean ± SD) PEACH A% (Vowels) PEACH B% (Consonants) p-value (Kruskal–Wallis) Vaginal Labor (n = 60) 68.2 ± 22.1 70.5 ± 18.3 65.8 ± 20.7 0.08 Cesarean Section (n = 40) 62.4 ± 24.8 64.1 ± 21.2 60.7 ± 23.1 0.12 Age ≤3 years (n = 55) 72.6 ± 19.4 * 74.2 ± 16.8 * 71.0 ± 18.1 * 0.04 * Age >3 years (n = 45) 58.3 ± 25.7 60.1 ± 22.3 56.5 ± 24.9 — * Better performance in children implanted at ≤3 years (p < 0.05). With respect to age, more marked differences were observed. Children assessed before the age of three demonstrated significantly higher performance, with a PEACH total score of 72.6 ± 19.4, 74.2% for vowels, and 71.0% for consonants. Conversely, those older than three years obtained an average PEACH total score of 58.3 ± 25.7, with 60.1% for vowels and 56.5% for consonants. Comparison between both groups revealed statistically significant differences (p = 0.04), indicating that younger age at assessment is associated with better auditory performance following cochlear implantation in Table 1 . The analysis showed that prematurity was associated with a 3.1-fold higher crude risk (95% CI: 1.4–6.8) compared with term births, and this association persisted in the adjusted model, yielding an OR of 2.8 (95% CI: 1.2–6.5; p = 0.01). Likewise, low birth weight was an important risk factor, with a crude OR of 3.8 (95% CI: 1.7–8.5) and an adjusted OR of 3.5 (95% CI: 1.5–8.1), confirming a statistically significant association (p = 0.003). Severe birth asphyxia was also linked to a greater risk of impaired auditory performance, with a crude OR of 3.6 (95% CI: 1.3–9.8) and an adjusted OR of 3.2 (95% CI: 1.1–9.1; p = 0.03). Similarly, meningitis represented the most impactful factor, with a crude OR of 5.0 (95% CI: 1.4–17.9) and an adjusted OR of 4.7 (95% CI: 1.3–17.0), indicating a markedly increased risk and strong statistical significance (p = 0.02) in Table 2 . Table 2. Association between neonatal complications and PEACH. Complication Crude OR (95% CI) Adjusted OR (95% CI) * p-value Prematurity 3.1 (1.4–6.8) 2.8 (1.2–6.5) 0.01 * Low birth weight 3.8 (1.7–8.5) 3.5 (1.5–8.1) 0.003 * Severe asphyxia 3.6 (1.3–9.8) 3.2 (1.1–9.1) 0.03 * Meningitis 5.0 (1.4–17.9) 4.7 (1.3–17.0) 0.02 * * Adjusted for age, sex, and place of origin. Dependent variable: Low PEACH (<75%). Patients from Metropolitan Lima achieved a median score of 80, with an interquartile range (IQR) of 65 to 90, representing the group with the highest outcomes. In contrast, patients from Provincial Lima had a median of 65 [50–75], whereas those from coastal provinces reached a median of 70 [55–85]. Meanwhile, patients from the central region showed a median of 60 [40–75], and those from the southern region recorded the lowest values, with a median of 55 [30–70]. Statistical comparison using the Kruskal–Wallis test yielded a p-value of 0.02, indicating that these differences were statistically significant in Table 3 . Table 3. Differences in PEACH scores according to geographic origin. Geographic origin n Total PEACH (Median [IQR]) p-value (Kruskal–Wallis) Metropolitan Lima 45 80 [65–90] 0.02 * Lima Provinces 15 65 [50–75] Coastal Provinces 20 70 [55–85] Central Provinces 15 60 [40–75] Southern Provinces 5 55 [30–70] * Significant differences were found (p < 0.05), with better performance observed in Metropolitan Lima. The findings showed that a history of exposure to ototoxic medications was present in 26% of children with low PEACH scores, compared with only 8% of those with high scores; this difference was statistically significant (p = 0.007). Likewise, an extended stay in the Intensive Care Unit (>48 hours) had a negative impact on auditory performance: 45% of children with low PEACH scores experienced this condition, whereas it was observed in 22% of those with high scores, representing a significant difference (p = 0.01). Similarly, the requirement for mechanical ventilation for more than five days was also associated with poorer auditory performance; 31% of children with low PEACH scores were exposed to this factor compared with 12% of those with high scores, demonstrating a statistically significant difference (p = 0.02) in Table 4 . Table 4. Ototoxic agents and ICU stay in relation to PEACH scores. Variable High PEACH (n = 58) Low PEACH (n = 42) p-value Use of ototoxic agents 8% 26% 0.007 * (Chi 2 ) ICU stay >48 h 22% 45% 0.01 * (Chi 2 ) Mechanical ventilation >5 days 12% 31% 0.02 * (Chi 2 ) * Higher prevalence of low PEACH scores among patients exposed to these factors. In an analysis of 100 postoperative cochlear implant recipients treated at the National Institute of Child Health–San Borja during 2021–2024, the mean age at implantation was 4.2 ± 3.1 years, with no statistically significant difference between the high auditory performance group (PEACH ≥75%) and the low performance group (PEACH <75%)—3.8 ± 2.5 vs. 4.7 ± 3.8 years, respectively (p = 0.15). Regarding sex, 52% of patients were male, with similar distribution across groups (55% in the high PEACH group vs. 48% in the low PEACH group; p = 0.47). Likewise, place of residence was not associated with performance: 45% resided in Metropolitan Lima (50% among high PEACH vs. 38% among low PEACH; p = 0.22) in Table 5 . Table 5. Risk factors associated with auditory performance (PEACH) in postoperative cochlear implant recipients (2015–2024). Variable Total (n = 100) High PEACH (≥75%) (n = 58) Low PEACH (<75%) (n = 42) p value Age at implantation (years) 4.2 ± 3.1 3.8 ± 2.5 4.7 ± 3.8 0.15 (MW) Sex (Male) 52% 55% 48% 0.47 (χ 2 ) Residence (Metropolitan Lima) 45% 50% 38% 0.22 (χ 2 ) Prematurity (<37 weeks) 38% 24% 57% 0.001 * (χ 2 ) Low birth weight 32% 19% 48% 0.003 * (χ 2 ) Severe perinatal asphyxia 18% 10% 29% 0.02 * (χ 2 ) Meningitis 12% 5% 21% 0.01 * (χ 2 ) * Statistically significant (p < 0.05). Analysis of perinatal conditions and clinical history identified significant associations. Prematurity (<37 weeks) was present in 38% of the sample and was more frequent in the low PEACH group (57%) than in the high PEACH group (24%), a statistically significant difference (p = 0.001). Similarly, low birth weight was recorded in 32% of patients and was more common among those with low PEACH (48%) compared with those with high PEACH (19%; p = 0.003). Severe perinatal asphyxia was reported in 18% overall, with a predominance in the low PEACH group (29% vs. 10%; p = 0.02). Finally, meningitis was a antecedent in 12% of children and was more prevalent among those with low PEACH (21%) than among those with high PEACH (5%; p = 0.01) in Table 5 . The results show that prematurity (<37 weeks) was present in 63.2% of cases with low auditory performance, and was associated with a significantly increased crude risk (PR: 2.8; 95% CI: 1.6–4.9; p < 0.001). In multivariate analysis this factor remained an independent predictor, with an adjusted risk of 2.5 (95% CI: 1.4–4.4) in the logistic model and 2.6 (95% CI: 1.5–4.5) in the Poisson model with robust variance in Table 6 . Table 6. Factors associated with auditory performance (PEACH) — Bivariate and multivariate analysis. Variable PEACH low (<75%) n (%) Bivariate PR (95% CI) p-value Multivariate (Logistic) aPR (95% CI) Multivariate (Poisson, robust) aPR (95% CI) Premature (<37 weeks) 24/38 (63.2%) 2.8 (1.6–4.9) <0.001 2.5 (1.4–4.4) * 2.6 (1.5–4.5) * Low birth weight 20/32 (62.5%) 2.6 (1.5–4.5) 0.001 2.3 (1.3–4.1) * 2.4 (1.4–4.2) * Severe perinatal asphyxia 11/18 (61.1%) 2.4 (1.2–4.8) 0.01 2.1 (1.0–4.3) 2.2 (1.1–4.5) * Meningitis 9/12 (75.0%) 3.5 (1.6–7.6) 0.002 3.1 (1.4–6.9) * 3.2 (1.5–7.0) * Age > 3 years at implantation 28/45 (62.2%) 1.8 (1.1–3.0) 0.02 1.6 (0.9–2.8) 1.7 (1.0–2.9) * Models adjusted for sex, place of origin and age at implantation. Poisson (robust variance): Poisson model with robust variance to avoid overestimation in frequent binary outcomes. Similarly, low birth weight was associated with poorer performance in 62.5% of patients, yielding a crude risk of 2.6 (95% CI: 1.5–4.5; p = 0.001). This association remained significant after adjustment in both the logistic model (aPR: 2.3; 95% CI: 1.3–4.1) and the Poisson model (aPR: 2.4; 95% CI: 1.4–4.2) in Table 6 . Severe perinatal asphyxia was observed in 61.1% of patients with low PEACH scores, with a crude risk of 2.4 (95% CI: 1.2–4.8; p = 0.01). In adjusted analysis this factor showed borderline significance (aPR: 2.1; 95% CI: 1.0–4.3 in the logistic model; aPR: 2.2; 95% CI: 1.1–4.5 in the Poisson model) in Table 6 . Meningitis had the largest impact: 75.0% of affected patients had low auditory performance, with a crude risk of 3.5 (95% CI: 1.6–7.6; p = 0.002) and a similarly significant adjusted risk in both models (logistic: aPR: 3.1; 95% CI: 1.4–6.9; Poisson: aPR: 3.2; 95% CI: 1.5–7.0) in Table 6 . Finally, age greater than 3 years at implantation was associated in the bivariate analysis (PR: 1.8; 95% CI: 1.1–3.0; p = 0.02), but lost statistical significance in multivariate analysis, remaining only as a trend toward higher risk (logistic: aPR: 1.6; 95% CI: 0.9–2.8; Poisson: aPR: 1.7; 95% CI: 1.0–2.9) in Table 6 . Discussion In this cohort of 100 postoperative cochlear implant recipients treated at the National Institute of Child Health–San Borja between 2021 and 2024, auditory performance as measured by the PEACH scale was significantly influenced by perinatal and early developmental factors. These findings are consistent with those reported by Díaz et al., 20 who highlighted the relevance of early-life complications on long-term auditory outcomes. Prematurity and low birth weight were among the strongest predictors of reduced auditory performance. In the present study, 63.2% of premature children and 62.5% of those with low birth weight showed low PEACH scores, with adjusted prevalence ratios ranging from 2.3 to 2.6 across multivariate models. This suggests that preterm birth and intrauterine growth restriction can compromise auditory processing pathways through mechanisms such as delayed neurosensory maturation, chronic hypoxia, and myelination deficits—processes that are critical for effective auditory encoding and cortical integration. Similar findings were described by Boboshko, Savenko et al., and Aldè et al., 21 – 23 who proposed that neonatal hypoxic–ischemic injury and immature neural synchronization contribute to the vulnerability of the auditory cortex in preterm infants. Age at implantation also played a decisive role in auditory outcomes. Children implanted before the age of three demonstrated significantly higher PEACH scores (72.6 ± 19.4) compared with those implanted later (58.3 ± 25.7; p = 0.04). This agrees with the observations of Wahyu et al. and Culbertson et al., 24 , 25 who emphasized that earlier auditory stimulation through cochlear implantation promotes optimal neural plasticity and language acquisition. During the first three years of life, synaptic density and cortical mapping remain highly adaptable; therefore, earlier activation of the auditory pathway enhances the establishment of functional auditory–linguistic networks. Among the clinical conditions analyzed, meningitis emerged as the most detrimental factor, with affected patients exhibiting a threefold higher adjusted risk of poor auditory performance (aPR = 3.1–3.2, p < 0.01). The pathophysiological mechanisms underlying this association are well recognized—post-meningitic cochlear ossification, spiral ganglion neuron loss, and central auditory sequelae can all limit the effectiveness of electrical stimulation. 26 Our results parallel those reported by Singhal et al., 26 who demonstrated significantly lower speech perception and auditory comprehension among post-meningitic implant recipients. These findings underscore the importance of rapid surgical intervention following meningitis to prevent cochlear fibrosis and optimize postoperative outcomes. 27 In addition, exposure to ototoxic agents and prolonged mechanical ventilation were significantly associated with lower PEACH scores ( p 48 h) and mechanical ventilation (>5 days) were also linked to reduced auditory outcomes (45% and 31%, respectively, in the low PEACH group). These findings are consistent with the evidence presented by Naik et al. and other authors, 20 , 28 , 29 who recommend systematic audiologic monitoring for patients exposed to aminoglycosides, loop diuretics, or prolonged hypoxic conditions during intensive care, given their potential to cause irreversible cochlear or neural damage. Overall, the present findings indicate that auditory performance following cochlear implantation is determined not only by surgical and technological variables but also by early perinatal risk factors that influence auditory plasticity. Early diagnosis, timely intervention, and continuous auditory rehabilitation are therefore critical to maximizing post-implant outcomes. In line with Naik et al., 29 comprehensive management should include structured family counseling and long-term audiologic follow-up to strengthen auditory–linguistic development and social integration in affected children. Conclusion In this study, a significant association was found between several risk factors and poorer auditory performance in hearing-impaired children who underwent cochlear implantation. The most strongly associated factors were prematurity, low birth weight, severe perinatal asphyxia, and hydrocephalus, all of which were linked to less favorable auditory and language development outcomes following surgery. Data availability The data underlying this study are available in Figshare at https://doi.org/10.6084/m9.figshare.31118719 . 30 The dataset includes the raw, unprocessed data supporting all analyses reported in the article, including values underlying descriptive statistics (means, standard deviations and other measures), data used to construct tables and figures, and a data dictionary describing all study variables (e.g., age, sex/gender, occupation, and other relevant variables). All datasets have been fully anonymized to protect participant confidentiality. Extended data The full PEACH questionnaire used in this study, together with supplementary tables and supporting methodological documents, are available in the Figshare repository at https://doi.org/10.6084/m9.figshare.31118719 . 30 All extended data and associated materials are shared under the Creative Commons Attribution 4.0 International (CC BY 4.0) license, in accordance with the license specified in the repository. This license permits use, distribution, and reproduction in any medium, provided that appropriate credit is given to the original authors and source. References 1. World Health Organization: WHO warns that 1 in 4 people are projected to have hearing problems by 2050.2021 [cited 2025 Oct 14]. Reference Source 2. Narváez AM, Pacheco-Calderón MC, Centeno-Mora Ó: Risk factors for hearing loss associated with auditory alterations in neonates admitted to the Intensive Care Unit of Dr. Rafael Ángel Calderón Guardia Hospital, San José, Costa Rica, 2018–2019. 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Vilela Estrada A: Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024. Dataset. figshare. 2026. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Jan 2026 ADD YOUR COMMENT Comment Author details Author details 1 Lima, Instituto Nacional de Salud del Niño San Borja, Lima, San Borja, 15037, Peru 2 Universidad Nacional Federico Villarreal, San Miguel, Lima Region, Peru Diego Marin Marín Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Leydy Kelly Cordero Tito Roles: Conceptualization, Data Curation, Investigation, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Liseth Melissa Montañez Córdova Roles: Conceptualization, Investigation, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Felix Cordero-Pinedo Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Martín A. Vilela-Estrada Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 31 Jan 2026, 15:159 https://doi.org/10.12688/f1000research.173575.1 Copyright © 2026 Marin Marín D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Marin Marín D, Cordero Tito LK, Montañez Córdova LM et al. Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :159 ( https://doi.org/10.12688/f1000research.173575.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 31 Jan 2026 Views 0 Cite How to cite this report: Kacker S and Saboo N. Reviewer Report For: Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :159 ( https://doi.org/10.5256/f1000research.191405.r461815 ) The direct URL for this report is: https://f1000research.com/articles/15-159/v1#referee-response-461815 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Mar 2026 Sudhanshu Kacker , Rajasthan University of Health Sciences, Jaipur, Rajasthan, India Neha Saboo , PHYSIOLOGY, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.191405.r461815 The manuscript's topic is clinically relevant and addresses an important pediatric otology issue, particularly in low‑ and middle-income settings where early detection and management of hearing loss remain challenging. particularly given the limited research focusing exclusively on ... Continue reading READ ALL The manuscript's topic is clinically relevant and addresses an important pediatric otology issue, particularly in low‑ and middle-income settings where early detection and management of hearing loss remain challenging. particularly given the limited research focusing exclusively on “ Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery. ” However, the authors must put more effort into rewriting and paraphrasing sentences The title should be simplified to align with the study methodology Abstract The statistical approach used for evaluating associations (for example, logistic regression or Poisson regression) is not mentioned and could be briefly indicated. Results section, numerical effect estimates (such as odds ratios or prevalence ratios with confidence intervals) would strengthen the scientific value of the abstract. Conclusion may benefit from a slightly more balanced tone by highlighting the clinical implications of management of risk factors in improving auditory outcomes. Introduction: Overall, the introduction is not influential. This portion needs to be rewritten. The introduction could be strengthened by presenting more recent epidemiological statistics on paediatric hearing loss to contextualize the study within the current global health landscape. Additionally, while the rationale for examining risk factors is described, the knowledge gap could be articulated more explicitly by highlighting the gap and explaining the need for the study; the authors should clearly demonstrate that it is scientifically justified. Add recently published key international studies addressing similar questions. Methods: Specify the eligibility criteria. Inclusion & Exclusion could be presented more clearly to ensure reproducibility. What are the strategies for contact, and screening of parents Sampling strategy and sample size calculation should be explained in greater detail, including assumptions used for determining the final sample of 100 participants. Need more details on whether parents were interviewed by trained audiology staff following a detailed standardized protocol to reduce interviewer variability? Total duration of the interview, including any intra- or inter-observer variations? A more detailed explanation of how data abstraction and verification were performed would strengthen the methodological transparency Statistical analysis: Add details if any multicollinearity diagnostics were performed prior to regression modelling The manuscript should consistently report confidence intervals alongside effect estimates in both tables and text to enhance interpretability. Results: First, the narrative description occasionally repeats information already presented in tables, which could be streamlined to improve readability. Second, the order of presentation could be slightly reorganized so that baseline characteristics are clearly described before analytical comparisons. A summary figure or flow diagram illustrating the patient selection process and distribution of auditory performance categories. Discussion The discussion is poorly written. Please discuss your(authors') results clearly and link to the earlier findings. The author rewrites the discussion and compares it with relevant studies. Discussion would benefit from a more detailed examination of potential mechanisms underlying the observed associations The conclusion should be based on the study results. Delete fact hypothetically. The conclusion could be strengthened by avoiding repetition of detailed results and instead focusing on broader clinical and public health implications The manuscript should include a clear limitations subsection All references are checked in accordance with the journal's guidelines. Ensure uniform formatting of journal abbreviations. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Noncommunicable disease,life style modifications, Neonatal hearing loss,BERA,Physical fitness,VO2 Max We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kacker S and Saboo N. Reviewer Report For: Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :159 ( https://doi.org/10.5256/f1000research.191405.r461815 ) The direct URL for this report is: https://f1000research.com/articles/15-159/v1#referee-response-461815 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Jan 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 31 Jan 26 read Sudhanshu Kacker , Rajasthan University of Health Sciences, Jaipur, India Neha Saboo , Rajasthan University of Health Sciences, Jaipur, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Kacker S et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Mar 2026 | for Version 1 Sudhanshu Kacker , Rajasthan University of Health Sciences, Jaipur, Rajasthan, India Neha Saboo , PHYSIOLOGY, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India 0 Views copyright © 2026 Kacker S et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript's topic is clinically relevant and addresses an important pediatric otology issue, particularly in low‑ and middle-income settings where early detection and management of hearing loss remain challenging. particularly given the limited research focusing exclusively on “ Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery. ” However, the authors must put more effort into rewriting and paraphrasing sentences The title should be simplified to align with the study methodology Abstract The statistical approach used for evaluating associations (for example, logistic regression or Poisson regression) is not mentioned and could be briefly indicated. Results section, numerical effect estimates (such as odds ratios or prevalence ratios with confidence intervals) would strengthen the scientific value of the abstract. Conclusion may benefit from a slightly more balanced tone by highlighting the clinical implications of management of risk factors in improving auditory outcomes. Introduction: Overall, the introduction is not influential. This portion needs to be rewritten. The introduction could be strengthened by presenting more recent epidemiological statistics on paediatric hearing loss to contextualize the study within the current global health landscape. Additionally, while the rationale for examining risk factors is described, the knowledge gap could be articulated more explicitly by highlighting the gap and explaining the need for the study; the authors should clearly demonstrate that it is scientifically justified. Add recently published key international studies addressing similar questions. Methods: Specify the eligibility criteria. Inclusion & Exclusion could be presented more clearly to ensure reproducibility. What are the strategies for contact, and screening of parents Sampling strategy and sample size calculation should be explained in greater detail, including assumptions used for determining the final sample of 100 participants. Need more details on whether parents were interviewed by trained audiology staff following a detailed standardized protocol to reduce interviewer variability? Total duration of the interview, including any intra- or inter-observer variations? A more detailed explanation of how data abstraction and verification were performed would strengthen the methodological transparency Statistical analysis: Add details if any multicollinearity diagnostics were performed prior to regression modelling The manuscript should consistently report confidence intervals alongside effect estimates in both tables and text to enhance interpretability. Results: First, the narrative description occasionally repeats information already presented in tables, which could be streamlined to improve readability. Second, the order of presentation could be slightly reorganized so that baseline characteristics are clearly described before analytical comparisons. A summary figure or flow diagram illustrating the patient selection process and distribution of auditory performance categories. Discussion The discussion is poorly written. Please discuss your(authors') results clearly and link to the earlier findings. The author rewrites the discussion and compares it with relevant studies. Discussion would benefit from a more detailed examination of potential mechanisms underlying the observed associations The conclusion should be based on the study results. Delete fact hypothetically. The conclusion could be strengthened by avoiding repetition of detailed results and instead focusing on broader clinical and public health implications The manuscript should include a clear limitations subsection All references are checked in accordance with the journal's guidelines. Ensure uniform formatting of journal abbreviations. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Noncommunicable disease,life style modifications, Neonatal hearing loss,BERA,Physical fitness,VO2 Max We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (0) Kacker S and Saboo N. Peer Review Report For: Risk Factors for Severe and Profound Sensorineural Hearing Loss and Auditory Performance in Children After Cochlear Implant Surgery at Instituto Nacional de Salud del Niño, San Borja, Lima, 2021–2024 [version 1; peer review: 1 approved with reservations] . F1000Research 2026, 15 :159 ( https://doi.org/10.5256/f1000research.191405.r461815) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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