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Neonatal Hearing Screening Parental Perspective: AABR Vs OAE, Attitudes and Anxiety

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. Successful UNHS programmes. Parents. Medical staff, equipment, protocol, settings, etc. Infant.

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Neonatal Hearing Screening Parental Perspective: AABR Vs OAE, Attitudes and Anxiety

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  1. Neonatal Hearing ScreeningParental Perspective:AABR Vs OAE, Attitudes and Anxiety by Pak Ng Duchess of Kent Children’s Hospital Advances in Deafness Management 8-9 October, 2005

  2. Successful UNHS programmes Parents Medical staff, equipment, protocol, settings, etc Infant

  3. Parental perspective • Focus on universal neonatal hearing screening (UNHS) • Acceptability of screening techniques and protocols • Attitudes and preference • Anxiety due to false positive screens

  4. 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

  5. Literature review by Thompson et al (2001)

  6. 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

  7. 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

  8. (Ng et al 2004, n=347)

  9. Questionnaires given to cases referred for diagnostic test

  10. 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

  11. 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)

  12. 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

  13. 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

  14. Local pilot study (contd) • Parameters • Anxiety/ negative emotions score • Knowledge on hearing developmental milestones/ hearing loss score • First baby? • Parental education level

  15. 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

  16. Sample questions (Anxiety) contd • E.g. You did not feel like eating; your appetite was poor • E.g. Your sleep was restless

  17. 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”

  18. Sample questions (Knowledge) contd • E.g. List one possible reason why a normal ear may fail the hearing screening.

  19. Results

  20. 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

  21. 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

  22. 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

  23. Thank you

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