TABLE 2

Studies of Potential Adverse Effects of Screening

Source (Quality)Study DesignSubjectsScreeningSettingResults
Kennedy et al,49 1999 (fair)Retrospective cohortParents of average-risk newborns: 100 passed UNHS and 100 did not pass; subset of Wessex TrialOAE and ABRUnited Kingdom; 2–12 mo after UNHSNo differences in scores on the Spielberger State-Trait Anxiety Inventory and Attitudes Toward the Baby Scale between parents of newborns who passed UNHS versus not passed
Weichbold and Welzl-Mueller,50 2001 (fair)Prospective cohort85 mothers whose newborns failed first and/or second screening testsOAE; 2 timesInnsbruck, Austria59% of mothers whose newborns failed the first screen were not concerned, 27% were slightly concerned, and 14% were highly concerned; in an additional sample of 43 mothers whose newborns failed the second screening, 42% were not concerned, 37% were slightly concerned, and 21% were highly concerned; differences in proportions between groups were not statistically significant
Poulakis et al,51 2003 (poor)Case controlParents of infants: 108 at risk for hearing impairment; 64 control subjects for at risk infants; 103 failed distraction test; 53 control subjects for infants failing the testDistraction testAustraliaParent concerns about language development, general development, and perceived vulnerability to ill health did not differ among the 4 groups; ∼18% of parents continued to feel worried 6 mo after the definitive hearing testing; 6% rated the test procedures as somewhat difficult or unpleasant; parents of children who failed the distraction test reported more negative emotions (anger, sadness, upset, worry, and confusion) after their child's definitive hearing test than parents of children considered at risk (P < .05)
Crockett et al,52 2006Survey (questionnaire)Parents of 722 screened newborns (53% response rate); 103 with 1 or 2 negative tests; 81 with third negative test; 105 with third test positive in 1 ear; 55 with third test positive in both earsOAE; ABR final testUnited Kingdom; 3 wk and 6 mo postscreeningSignificant trends for increased anxiety (P < .05), increased worry (P < .001), and decreased certainty (P < .001) as the number of tests increased; parents in group 4 who understood test implications had lower anxiety (P = .01) and lower worry (P < .01) versus those who did not
de Uzcategui and Yoshinaga-ltano, 199753Survey (questionnaire)Parents of 201 screened newborns who were referred for further testing (51% response rate)Not reportedColorado; 2 university hospitals78% of parents were not angry, 81% felt informed, 38% did not feel comforted by hospital staff; 14% had negative emotions, half had a child with a confirmed hearing loss; parents of children with confirmed hearing losses had a higher level of frustration, anger, depression, and confusion versus other parents; 25% of the sample did not return for follow-up testing after a referral was indicated
Hergils and Hergils,54 2000Survey (questionnaire)Parents of 83 screened newborns (95% response rate)OAELinkoping, Sweden; well-infant visit, 5–6 mo of age76 were satisfied with screening, 3 neutral, 3 dissatisfied, 1 did not know; screening raised questions for 28 and no questions for 44; 79 were positive about the test and 4 were negative; information on the test was sufficient for 64 and insufficient for 9; the majority of parents were positive about the screening; most felt early detection was good, test was easy and did not bother their infant; negative comments included the test being too demanding, test took too long, clearing the ear canal would be difficult for newborns; complaints included getting information about the test earlier and test methodology; parents of 6 of the 10 infants needing retesting reported anxiety
Russ et al,55 2004Survey (questionnaire)Parents of 134 hearing impaired children after hearing aid fitting (61% response rate)ABR; distraction testVictoria, AustraliaThemes analysis showed parents had generally positive responses to ABR screening and mixed response to the distraction test; denial and shock at diagnosis; frustrations in delays in diagnosis; and communication difficulties with providers; difficulty testing children with other medical and development problems was also reported
Vohr et al,56 2001Survey (interview)Mothers of 307 screened newborns (85% response rate); mothers of 40 newborns needing rescreening (90% response rate)OAERhode IslandSignificantly more mothers with infants who were rescreened worried about the test results compared with mothers with infants undergoing only 1 screening (P < .001); for mothers of infants requiring rescreening, the degree of worry at the time of the rescreening was significantly greater than at the first screen (P < .001); greater worry at the initial screening was seen in mothers with less than high school education (P = .003) and who were bilingual (P = .006), nonmarried (P = .02), and nonwhite race (P = .005); learning about screening during hospitalization versus before arriving was also associated with greater worry (P = .012)