Neonatal Hearing Screening Parental Perspective: AABR Vs OAE, Attitudes and Anxiety by Pak Ng Duchess of Kent Children’s Hospital Advances 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

AABROAE Sensitivity84-98% (depends on quote) 80-98% (depends on quote) Specificity90-98%88-90% False positive results (48 hrs after birth) Less proneMore prone Literature review by Thompson et al (2001)

Attitudes and preference Watkin % considered worthwhile Hergils % positive attitude Bailey et al only 0.4% refused screening Ng et al % 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

PreferenceAnswersResponses (%) UNHSPrior to hospital discharge 5-30 days back to hospital 5-30 days at local MCHC Others Screening at a later age At or after 3 mths at MCHC At 3 yrs at nursery At 6 yrs at primary school Others (Ng et al 2004, n=347)

Responses (%) Hospital-based (n=35) MCHC-based (n=57) Satisfied with present arrangement 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 Knowledge Score (Max score 10) Hospital-based (n = 35) MCHC-based (n = 57) Control (n = 42) 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