Universal neonatal hearing screening: past, present, and future.

After a brief review of the history of newborn hearing screening including the Downs behavioral testing procedure, the Crib-o-gram and similar devices, and the use of auropalpebral reflex and otoacoustic emissions, there is a discussion of key issues that need to be resolved before universal hearing screening is introduced. Included are questions regarding the target population(s) of screening programs, well baby versus NICU screening, dealing with false-positives and the effects on parent-child relationships, and finally, the availability of resources for screening and follow-up. The results of a recent study in the United Kingdom that assessed the current state of audiology services and found there is a difference between existing standards and what is actually being done in practice, are presented and considered in terms of current trends in the United States to move ahead with universal screening without a solid database of information regarding the preparedness of clinical centers to deal with the need for services that will result from the initiation of universal programs. Caution is urged.

Universal newborn screening: a dream realized or a nightmare in the making?

There is a very strong movement to develop universal newborn hearing screening. This effort is the end product of a long international research effort to determine the most effective means to screen newborns. Now that OAE and ABR together offer a superior mechanism to achieve universal screening, problems related to middle ear effusion, non-high-risk children and adequate resources for all aspects of identification, diagnosis and treatment have come to the fore. Further, what to do in the developing world is also a major problem as audiology embarks on this exciting new frontier. This paper discusses some of the issues, raises some concerns and offers a few small solutions.

Intensive surveillance for cocaine use in obstetric patients.

OBJECTIVE: To determine the value of intensive surveillance for cocaine use in pregnancy and also determine the prevalence of cocaine use in our institution. METHODS: Among 124 consecutive new obstetrical clinic patients, urine specimens were collected anonymously at the first prenatal visit, in each subsequent trimester of pregnancy, and on labor and delivery. Corresponding newborn urine and meconium were also collected for these patients. 324 urine specimens and 49 meconium specimens were obtained. A local private group also collected first prenatal visit urine from an additional 104 patients. Urine specimens were analyzed for cocaine metabolites by fluorescent polarization immunoassay with confirmation of positive results by gas chromatography/mass spectrophotometry. RESULTS: One clinic patient had a positive cocaine screen. All other urine and meconium screens were negative. CONCLUSION: Intensive surveillance did not increase the detection rate for cocaine abuse in our obstetric population. We also found that the prevalence of cocaine abuse among obstetrical patients at our institution is low (< 1%). These data reconfirm that resource allocation for drug treatment centers should be based on prevalence data specific to an area or institution.