PubMed · 11062821
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A Vogel. 2000-09-22. Pacifier use and morbidity.. https://pubmed.ncbi.nlm.nih.gov/11062821/
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AIM: The aim of this study was to elucidate the role of health surveillance for infants during the first year of life in detecting severe health problems. Two central questions were addressed: (1) what health problems were detected by routine health examinations at the Child Health Centre at the 2-, 6- and 12-month check-ups by a physician and at the 9-month check-up by a nurse; and (2) to what extent did the health examinations contribute to early identification of children with following key abnormalities: congenital heart disease, congenital dislocation of the hip, abnormalities as registered at the habilitation centre and severe hearing impairments? MATERIAL AND INCLUSION CRITERIA: The study population included all children in Uppsala county, born January 1995 to October 1996, who had participated in at least one of the four health check-ups. There were 3107-3487 children in the respective check-ups. METHOD: Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. Data on children with key abnormalities were obtained from specialist units. RESULTS: The rate of suspected new health problems varied between 1.9% and 2.8% at the respective check-ups. Of the new problems detected by the physician, 21%-36% were false-positive, 34%-44% were minor and 10%-15% were moderate. Only two severe health problems were detected among all the children during the four check-ups. Of all key abnormalities, 20% were detected by way of child health surveillance during the first year of life. IMPLICATIONS: Severe health problems and key abnormalities in infants were detected only to a limited extent through routine health examinations at 2, 6, 9 and 12 months of age. The minor and moderate problems detected justify a health surveillance programme, but the organization and content of the programme could be reconsidered.
OBJECTIVE: To estimate the cost and cost-effectiveness of universal newborn hearing screening. STUDY DESIGN AND SETTING: Decision analysis model utilizing the hospital perspective. This model evaluated 4 distinct protocols for screening a fixed and defined hypothetical cohort of newborn infants. OUTCOME MEASURES: Cost of screening and the number of infants with hearing loss identified through universal screening. RESULTS: Otoacoustic emissions testing at birth followed by repeat testing at follow up demonstrated the lowest cost ($13 per infant) and had the lowest cost-effectiveness ratio ($5100 per infant with hearing loss identified). Screening auditory brainstem evoked response testing at birth with no screening test at follow-up was the only protocol with greater effectiveness, but it also demonstrated the highest cost ($25 per infant) and highest cost-effectiveness ratio ($9500 per infant with hearing loss identified). These findings were robust to sensitivity analysis, including best-case and worst-case estimation. The prevalence of hearing loss and the fraction of infants returned for follow-up testing had a large impact on the absolute level, but not relative level of protocol cost and cost-effectiveness. CONCLUSION: The otoacoustic emissions testing protocol should be selected by screening programs concerned with cost and cost-effectiveness, although there are certain caveats to consider. SIGNIFICANCE: The most significant barriers to implementation of universal newborn hearing screening programs have been financial, and this study compares the most common protocols currently in use. This study can assist program directors not only in the decision to initiate universal screening but also in their choice of screening protocol.
The terms 'sensitivity' and 'specificity' are defined and some of the factors that determine their values are discussed in the context of screening for permanent childhood hearing loss. There is a need to distinguish between the values observed in 'simple experiments' and those that may be obtained under more realistic 'field' conditions. It is not feasible to give a meta-analytic overview of published data because of the variety of methods and objectives used in those studies published in the literature. However, a qualitative synthesis of the data is possible. This suggests that most proposed neonatal hearing screening tests, when implemented in accordance with a programme of quality assurance, can be reasonably accurate at a modest cost. However, the optimal combination of tests and test parameters for given populations has not yet been fully researched. The infant distraction test screen has a lower sensitivity than neonatal hearing screening tests, particularly for moderate impairments, accompanied by a fairly low specificity.