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.
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.
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.
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.
We would like to address to Dr. Miller's comment "Universal newborn hearing screen: is lack of maternal concern a cause for concern" on our article "Maternal Concern About Positive Test Results in Universal Newborn Hearing Screening", published in the current issue of Pediatrics.
We fully agree with Dr. Miller that causing too little anxiety may be unfavorable to screening or treatment programs. For this purpose, we proposed in our article that the optimal level of parental concern caused by screening programs would be "mild" or "slight." However, additional research is needed to determine whether degree of concern is linked to returning rate and whether optimization of parental compliance is possible through creating "mild" concerns.
In our study, the lack of concern in mothers whose infants failed the screening, seemed to come from a particular strategy of managing the uncertainty about the baby's hearing. Mothers reported that, through the positive tests, they became sensitized to the question of whether the infant is hearing impaired. In consequence, they actively looked for evidence against hearing impairment. When they found clues for normal hearing, eg, the infant's reacting to sounds, they relied on them as a means of reassurance. Hence, the parents' searching for evidence that their infant is not hearing impaired, served as a protective factor against concern when their infant falsely failed the screening. In this regard, the low number of highly concerned mothers does not reflect a lack of parental compliance, but rather an effect of a self- reassuring strategy against undue concern.
With kind regards,
Dr. Viktor Weichbold Dr. Kunigunde Welzl-Mueller
The finding that very few mothers whose infants screened positive for hearing loss showed concern is both reassuring and concerning. Screening- related stress and anxiety are adverse effects of any screening program, and if these are minimal, so much the better. However, one wonders about the lack of concern of mothers whose infants failed second stage screening. Specifically, if the infants are confirmed to have hearing loss, will these parents be sufficiently concerned and motivated at that point to comply with treatment recommendations?