Conrad J. Clemens

The False-Positive in Universal Newborn Hearing Screening

Objectives. Concern has been raised about the frequency and subsequent emotional effect of a false-positive result during universal newborn hearing screening (UNHS). This study describes: 1) the results of 1 UNHS program and a potential method to significantly reduce the false-positive rate, and 2) the effect a false-positive result has on lasting maternal anxiety toward their children as well as their views toward UNHS in general. Methods. A retrospective analysis was conducted using data from 5010 infants screened with an automated auditory brainstem response (ABR) at the Womens Hospital of Greensboro (WHOG) from July 6, 1998 to June 30, 1999. In addition, a structured telephone survey was given to mothers of infants who had failed the initial hearing screen (stage 1) and who had completed an outpatient rescreen (stage 2). Results. Confirmed hearing loss occurred in non-neonatal intensive care unit infants at a rate of 1.8/1000. A false-positive rate of 1.9% occurred during stage 1 of UNHS (screening before newborn discharge). We attribute this relatively low rate to rescreening of 51% of those newborns who failed the initial screen before hospital discharge. Eighty percent of these rescreened infants passed, thus needing no additional follow-up. If we had rescreened all infants before discharge, the false-positive rate would have approached .5%. Results of the survey were reassuring with regard to lasting emotional effects of false-positive tests. Only 9% of mothers said they “treated their child differently” before outpatient rescreening, and only 14% reported any lasting anxiety after their child passed the outpatient repeat screen. Although none reached statistical significance, potential risk factors for lasting anxiety include more educated mothers, lack of understanding of UNHS, and a false-positive result in both stage 1 and stage 2. Over 90% of all mothers believed that UNHS was a good idea. Conclusions. By rescreening all infants before hospital discharge, the false-positive rate of UNHS performed using automated ABR can be reduced to <1%. However, for the false-positive results that do occur, any long-lasting and detrimental emotional impact between mother and infant seems to be small and could be reduced even more with improved understanding about UNHS.

Kindergarten Health Assessment Reports: What Do Schools Really Learn from Them?

The kindergarten health assessment report (KHAR), mandated by most states, is used to identify children at school entry with any health problems that may interfere with school performance. The objective of this study was to review the completeness and accuracy of the reports that schools receive from health care providers. By analyzing 3,952 KHARs of children enrolled in the Guilford County (North Carolina) Public Schools during the 1999-2000 school year we found that only 20% were fully completed and only 32% recorded results of all 6 required screening tests. Results of the 3 screening tests most applicable to school readiness: vision, hearing, and developmental screening, were documented only 55% of the time. Providers failed to properly classify 75% of children who were either underweight or overweight. Abnormal vision screening results were noted in 485 (14.2%) children, of whom only 38% were recommended for follow-up. Results of vision and hearing screening were recorded in only 50% of children noted to have developmental concerns. The information recorded on the kindergarten health assessment forms is incomplete and frequently inaccurate. These findings arouse concern, given that these forms constitute the basis for school districts to identify those children who may have medical problems.