Newborn hearing screening in youth health care in the Netherlands: National results of implementation and follow-up.

OBJECTIVE: The aim of this study is to investigate whether the quality of the Dutch, community based, universal newborn hearing screening programme is consistent over time. DESIGN: Universal newborn hearing screening data from three cohorts are compared on a number of quality targets concerning the outcome of the screening and the process of the screening in a three stage, community based, hearing screening programme. STUDY SAMPLE: A total of 552 820 children entered the study (189 794 in 2002-2006; 181 574 in 2008, and 181 452 in 2009). RESULTS: Participation in the programme is high from implementation onwards and increases over time for all screen stages to percentages above 99%. Refer rates are within quality targets and they are consistent over time. The screening is completed within 42 days of birth for 91.5% of the children in the last cohort. Of all children screened, 0.29% to 0.30% are referred to a speech and hearing centre. Participation in diagnostic testing is 93.3% to 95.2%. Of all referred children 77% to 85% receive a diagnosis within 122 days of birth. CONCLUSIONS: A good quality neonatal hearing screening programme in youth health care has been established in the Netherlands. However, both participation in diagnostic testing after a positive screen result and the timing of the diagnostic testing can still be improved.

Risk indicators for hearing loss in infants treated in different neonatal intensive care units.

AIM: To assess which infants' characteristics and specialized procedures are risk indicators for unilateral or bilateral hearing loss (HL) and to evaluate whether these risk indicators are associated with variation in prevalence of HL between Neonatal Intensive Care Units (NICUs). METHODS: For 2002-2005, data from the NICU hearing screening database in the Netherlands were matched with the national neonatology database in which all NICU infants with their patient characteristics and specialized procedures are registered. Multivariate logistic regression analyses were performed to assess risk indicators for HL and to explain differences in prevalence rates between NICUs. RESULTS: A total of 10 830 infants were available for analyses. The prevalence of HL was 1.8% and ranged from 0.7 to 3.7% between NICUs. Infants' characteristics that significantly increased the risk of HL were the presence of craniofacial anomalies, chomosomal/syndromal anomalies, central nervous system conditions, circulatory system conditions and intra-uterine infections. The specialized procedures involving > or =12 days of intensive care and high frequency oxygenation ventilation were independent risk indicators for HL. Approximately 20% of the variance can be explained by the studied risk indicators. Differences in prevalence rates between NICUs were slightly reduced after adjustment for these risk indicators. NICUs with the highest prevalence rates of HL were situated in the largest cities in the Netherlands with a mixed population because of immigration. Therefore, ethnicity may be a risk indicator. CONCLUSIONS: Several independent risk indicators for HL were found, but they could not explain all differences in prevalence rates of HL between NICUs.

Prevention of adolescents' music-induced hearing loss due to discotheque attendance: a Delphi study.

Noise-induced hearing loss is a significant social and public health problem, which is found in increasing numbers of adolescents. Young people are particularly likely to expose themselves to potentially damaging loud sounds during leisure activities. Visiting discotheques is one of the most popular leisure activities of young people. Only a few minutes exposure to the sound levels played in discotheques can cause permanent hearing loss. Since little is known about what constitutes effective prevention strategies, we explored the opinions and ideas of 30 experts in a qualitative study consisting of a three-round web-based Delphi study. The main parties involved in the prevention of music-induced hearing loss due to discotheque attendance are as follows: the adolescents themselves, followed by the government, discotheque owners, decorators of discotheques and disk jockeys (DJs). None of the identified protective behaviors of adolescents was considered to be feasible. Five environmental interventions were identified as being both relevant and feasible; of these, the most important were that loudspeakers must be placed further away from the visitors and that discotheques have attractive, low-volume and clearly indicated 'chill-out rooms'. Effective prevention strategies to avoid music-induced hearing loss among adolescents due to discotheque attendance need to be taken primarily by discotheque owners and disk jockeys.

[Foetal Rhesus-D typing added to antenatal screening for infectious diseases and erythrocyte immunisation]. / Foetale resus-D-typering toegevoegd aan prenatale screening op infectieziekten en erytrocytenimmunisatie.

OBJECTIVE: Investigation of the accuracy and national implementation of foetal Rhesus-D typing (fRhD), introduced in 2011 for RhD-negative pregnant women. DESIGN: Descriptive, national study. METHOD: Results of fRhD in pregnant women in the first year after implementation were compared to results from cord blood RhD typing of the child. RESULTS: 0.05% of the fRhD results was false negative (9/18.383; 95% CI: 0.02-0.09), and 0.85% was false positive (157/18.383; 95% CI: 0.73-1.00). fRhD was incorrectly omitted in fewer than 1% of pregnant women. In 96.1% of the pregnant women, antenatal administration of anti-D prophylaxis was recorded. Recording of postnatal anti-D administration turned out to be lower (92%), but locally recorded data showed that postnatal anti-D was omitted in fewer than 2% of cases. CONCLUSION: The percentage of false negative fRhD was statistically significantly lower (p < 0.05) than the critical limit of 0.25% determined beforehand by the Programme Committee of the Dutch Antenatal Screening Programme for Infectious Diseases and Erythrocyte Immunisation. The percentage of false positive fRhD was considered acceptable, and implementation of fRhD was more or less complete. Routine RhD-typing on cord blood was therefore omitted from January 2013. Antenatal and postnatal anti-D administration is now specifically indicated for RhD-negative pregnant women when fRhD is positive, thus saving about 10,000 unnecessary antenatal anti-D administrations per year. RhD-typing on cord blood is now performed only if the RhD blood type of the child of a RhD-negative mother is unknown at delivery, if a positive fRhD was found for multiple births, and in exceptional situations, e.g. if fRhD typing is not possible due to a rare genetic variation.

Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data.

BACKGROUND: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. METHODS: We used primary data to compare cost-effectiveness of four screening strategies for NBSCF, i.e. immunoreactive trypsinogen-testing followed by pancreatitis-associated protein-testing (IRT-PAP), IRT-DNA, IRT-DNA-sequencing, and IRT-PAP-DNA-sequencing, each compared to no-screening. A previously developed decision analysis model for NBSCF was fed with model parameters mainly based on a study evaluating two novel screening strategies among 145,499 newborns in The Netherlands. RESULTS: The four screening strategies had cost-effectiveness ratios varying from €23,600 to €29,200 per life-year gained. IRT-PAP had the most favourable cost-effectiveness ratio. Additional life-years can be gained by IRT-DNA but against higher costs. When treatment costs reduce with 5% due to early diagnosis, screening will lead to financial savings. CONCLUSION: NBSCF is as an economically justifiable public health initiative. Of the four strategies tested IRT-PAP is the most economic and this finding should be included in any decision making model, when considering implementation of newborn screening for CF.

[Increased risk of hepatitis B due to incomplete or untimely immunisation in one-quarter of infants of hepatitis-B-virus carriers]. / Verhoogd risico op hepatitis B door onvolledige of ontijdige immunisatie bij een kwart van de zuigelingen van hepatitis-B-virusdraagsters.

OBJECTIVE: To determine the frequency of an increased risk of infection in children of hepatitis-B-virus carriers due to incomplete or untimely hepatitis-B immunisation. DESIGN: Descriptive. METHOD: Dates of birth and hepatitis-B immunisations were collected for all documented children of hepatitis-B-virus carriers in the vaccination registers, born in 2000 in The Netherlands. To assess the possible increased risk of infection, criteria were drawn up for the completeness and timeliness of the immunisations and on the basis of these the number of children who possibly had an increased risk of infection was determined. RESULTS: In total, 731 of the 769 children (95%) had received hepatitis-B immunoglobulins and at least 3 vaccinations. For 200 children (26%) the deviation from the immunisation schedule was so great that the child was possibly (temporarily) inadequately protected. CONCLUSION: A quarter of the children of hepatitis-B-virus carriers were immunised incompletely or at the wrong time. This calls for an adjustment of the immunisation schedule and national guidelines in which the responsibilities and tasks are clearly defined.

[Antenatal screening in the Netherlands for HIV, hepatitis B and syphilis is effective]. / Prenatale screening op hiv, hepatitis B en syfilis in Nederland effectief.

OBJECTIVE: Evaluation of the effectiveness of antenatal screening in the Netherlands for HIV, hepatitis B virus (HBV) and syphilis, in preventing mother-to-child transmission. DESIGN: Descriptive. METHODS: The results of antenatal screening in the period 2006-2008 were compared with data from pregnant women and newborns from other data sources. RESULTS: Each year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. Prior to the introduction of screening, 5-10 children were born with HIV annually. After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening. CONCLUSION: The screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically.

Examination of long-lasting parental concern after false-positive results of neonatal hearing screening.

OBJECTIVE: To investigate whether false-positive outcomes on neonatal hearing screening cause long-lasting parental concerns. METHODS: A general population of parents whose children had participated in the universal neonatal hearing screening (UNHS) programme were examined. Parents filled out a questionnaire 6 months after UNHS. Outcomes were compared for all parents whose child tested positive or inconclusive in at least one of three tests but afterwards proved not to have hearing impairment (cases, n = 154) and a random sample of parents whose child passed the first test (controls, n = 288). Parental anxiety as measured with the State-Trait Anxiety Inventory (STAI), attitude towards the child (child health rating and experienced problems) and sensitivity to hearing problems were measured. RESULTS: Median STAI score was equal for cases and controls. Parental attitudes toward the child also did not differ. The difference in the proportion of parents who worried about their child's hearing was statistically significant between cases and controls (p = 0.001) and varied with the number of screens; 4% of controls were worried about the child's hearing, as compared to 10% of cases whose children were tested twice, and 15% of cases whose children were tested three times. CONCLUSIONS: False-positive UNHS test results do not cause long-term general parental anxiety. However, 6 months after screening, a considerable proportion of parents continued to experience hearing-specific worries regarding their child.