Neonatal Hearing ScreeningParental Perspective:

AABR Vs OAE, Attitudes and Anxiety

by Pak Ng

Duchess of Kent Children’s HospitalAdvances in Deafness Management

8-9 October, 2005

Parents

Infant

Medical staff, equipment, protocol, settings, etc

Successful UNHS programmes

Parental perspective Focus on universal neonatal hearing

screening (UNHS) Acceptability of screening techniques and

protocols Attitudes and preference Anxiety due to false positive screens

Acceptability of screening techniques and protocols AABR, OAE Two-stage screening approach Results 100% accurate? Results sensitive to equipment, tester’s

training and ongoing quality control

AABR OAE

Sensitivity 84-98% (depends on quote)

80-98% (depends on quote)

Specificity 90-98% 88-90%

False positive results (48 hrs after birth)

Less prone More prone

Literature review by Thompson et al (2001)

Attitudes and preference Watkin 1998 --- 97% considered

worthwhile Hergils 2000 --- 95% positive attitude Bailey et al 2002 --- only 0.4% refused

screening Ng et al 2004 --- 91% considered desirable

UNHS in Hong Kong Hospital-based

Pilot in several hospitals 2 stage, AABR, first screening before hospital

discharge

Maternal and Child Health Centre-based (MCHC-based) Service covered all MCHC 2 stage, OAE, first screening within the first month

of age

Preference Answers Responses (%)

UNHS Prior to hospital discharge

5-30 days back to hospital

5-30 days at local MCHC

Others

43.8

37.9

17.7

0.6

Screening at a later age

At or after 3 mths at MCHC

At 3 yrs at nursery

At 6 yrs at primary school

Others

83.3

3.3

0

13.4

(Ng et al 2004, n=347)

Responses (%)

Hospital-based (n=35)

MCHC-based (n=57)

Satisfied with present arrangement

85.8 83.2

Questionnaires given to cases referred for diagnostic test

Parental anxiety/ negative emotions Positive predictive value: 2.2 to 11.7% (US

Preventive Task Force Review on UNHS Literature 2000)

High false positive rate causing parental anxiety/ negative emotions

Findings from studies mixed Newborn screening of phenylketonuria,

hypothyroidism, Duchenne muscular dystrophy and cystic fibrosis indicated prolonged parental anxiety (Fyro 1987, Smith 1990, Tluczek et al 1992)

Tharpe 1999, reported no differences in parental stress (control and referred gp)

Findings from studies mixed Kennedy 1999, reported similar anxiety

(screened and not screened gp) Clemens et al 2000, reported 3-13% having

residual negative effects Weichbold et al 2001, 14% of families

reported some concern Poulakis et al 2003, some mild anxiety

remained even after a final normal result

Local pilot study Questionnaires given to parents prior to

diagnostic hearing test Results eventually found to be false positive Three Categories

Hospital-based n=35 MCHC-based n=57 Control n=42, passed hearing screening at hospital,

and questionnaires reply through phone interviews

Local pilot study (contd)

Parameters Anxiety/ negative emotions score Knowledge on hearing developmental

milestones/ hearing loss score First baby? Parental education level

Sample questions (Anxiety) 10 questions (Ref: PSI, Abidin 1995) Parents indicated how frequently each

statement occurred on a 6-pt scale from “never” to “constantly” after screen fails

E.g. You were anxious about child’s hearing.

E.g. You were bothered by things usually that didn’t bother you

Sample questions (Anxiety) contd E.g. You did not feel like eating; your

appetite was poor E.g. Your sleep was restless

Sample questions (Knowledge) 10 questions Scored one pt if answered correctly E.g. By what age do you think a baby will

quiet and listen to familiar voice? E.g. By what age do you think a baby will

respond to simple words, such as his or her name, “bye-bye”, and “no”

Sample questions (Knowledge) contd E.g. List one possible reason why a normal

ear may fail the hearing screening.

Mean Anxiety Score (Max score 50)

Mean KnowledgeScore (Max score 10)

Hospital-based(n = 35)

17.91 5.11

MCHC-based(n = 57)

16.56 4.67

Control(n = 42)

11.40 4.55

Results

Results contd Correlation significant (p<0.05) between Anxiety

Score and Knowledge Score for both Hospital- and MCHC-based Groups

Anxiety Score of Hospital-based Group significantly higher (p<0.05) than that of Control

Anxiety Score of MCHC-based Group significantly higher (p<0.05) than that of Control

No difference between Anxiety Scores of Hospital- and MCHC-based Group

Results contd Correlation significant (p<0.05) between

Anxiety Score and whether child is first baby

No correlation among Anxiety Score, Knowledge Score and Parental Education Level

Summary Both AABR and OAE acceptable to parents in 2-

stage UNHS Parental attitudes positive to UNHS Both Hospital-based and MCHC-based settings

acceptable to parents in Hong Kong? Further study suggested

Findings from studies evaluated parental anxiety/negative emotions mixed, further study suggested

Thank you