Screening infants for neuroblastoma: the parents' perspective

Six month impact of false positives in an Australian infant hearing screening programme

AIMS

To assess short and longer term parent reported impacts of false positive referrals in the Victorian Infant Hearing Screening Program (VIHSP).

METHODS

Mailed retrospective case-control survey of infants consecutively referred to VIHSP between December 1998 and April 1999 for whom audiology did not confirm permanent hearing loss, comprising 137 infants screened with a neonatal risk factor questionnaire and 148 older infants screened with two consecutive behavioural (distraction) tests. The two control groups comprised non-referred screened infants matched by domicile, age, and gender. Main outcome measures were parent reported emotions experienced before and after child's audiology test, parent estimated impact of hearing loss, the Child Vulnerability Scale, audiology assessment satisfaction questionnaire, and questions relating to their child's hearing and language development.

RESULTS

Final sample: at risk cases (AR) 108 (79% response), at risk controls 64 (51%); distraction test cases (DT) 103 (70%), distraction test controls 53 (41%). Parents across all groups believed that hearing loss would have major effects on a child's language (91-96%), schooling (81-91%), and employment opportunities (67-75%). Before audiology, 71% (AR) and 72% (DT) of case parents were anxious/worried, falling to 4% and 15% afterwards. After the test 82% (AR) and 79% (DT) reported relief, but 19% and 18% continued to feel worried. Ongoing concerns about hearing, language, development, and general health were comparable for AR cases compared to controls, and for DT cases compared to controls.

CONCLUSIONS

Hearing screening tests are generally well received. Parents are realistic about the impact of childhood hearing loss and report a range of negative emotions when a false positive hearing screen requires referral. Although most are reassured by a normal test, a substantial number report continuing concern.

Maternal concern about positive test results in universal newborn hearing screening

OBJECTIVE

A positive test result from universal newborn hearing screening (UNHS) has been suspected to cause maternal concern. However, findings so far are inconclusive. Against the background of a 2-stage UNHS protocol, we investigated the extent of maternal concern in 2 different situations: 1) mothers' immediate reactions after a positive result at the first-stage test and 2) maternal concern during a 1-month period while waiting for the infant's hearing assessment after the infant also failed the retest (ie, the screening). In addition, we checked whether mothers who are informed by an audiologist about the low predictive validity of positive test results in hearing screening are less concerned about a positive result than mothers who are not informed.

METHODS

A prospective study was conducted over a 1-year period, in which all mothers whose infants tested positive in the first stage or failed the screening were questioned about their level of concern attributable to the positive test result.

RESULTS

Of 85 mothers whose infants tested positive in the first-stage test (situation 1), 34 (40%) did not know the result. Of the remaining 51 mothers, 59% were not at all concerned and 27% were only slightly concerned about the result, whereas 14% stated that they were highly concerned. In an additional sample of 43 mothers whose infants failed the screening (situation 2), 42% reported not being worried and 37% only slightly worried, whereas 21% were highly concerned about the positive screening result. No effect of information about the low predictive validity of positive test results on the extent of maternal concern could be ascertained.

CONCLUSIONS

The results of this study contradict the findings of some previous surveys that reported considerably higher levels of maternal concern after a positive test in UNHS. The failure to demonstrate the impact of information on maternal concern might be attributable to the fact that the number of uninformed mothers was too small to affect our results perceptibly.

Compliance in a screening program for neuroblastoma

BACKGROUND

The Quebec Screening Program for neuroblastoma was undertaken to determine if routine screening of infants for neuroblastoma would decrease the mortality rate from this cancer. All 476,603 children born in Quebec during a 5-year period (1989 to 1994) were offered this screening at ages 3 weeks and 6 months. Through various strategies, an attempt was made to attain the highest level of voluntary compliance possible.

METHODS

Each screening consisted of the analysis of the catecholamine metabolites vanillylmandelic acid and homovanillic acid on a dry, urine-saturated filter paper mailed to a central laboratory by the parents. The strategies employed to optimize compliance consisted of increasing the awareness of the parents, health professionals, and the public about neuroblastoma and the screening program.

RESULTS

The population responded well to this public health measure, with a 91% compliance rate at 3 weeks and a 74% compliance rate at 6 months.

CONCLUSIONS

A well-informed population accustomed to voluntary screening for metabolic disease in infants responds well to screening for cancer.