Effective screening in child health

In Britain today two neonatal screening programmes—for phenylketonuria and congenital hypothyroidism—are working well and preventing brain damage and severe intellectual impairment from these conditions. But for many of the other child health problems discussed last month at a meeting on systematic reviews of screening in child health organised by the National Screening Committee and the Royal College of Paediatrics and Child Health there are doubts either about the value of early detection or about the most effective method for doing it. Each year in the United Kingdom about 700 children are born with severely impaired hearing, and identifying them is important because early treatment improves their language development and emotional well being. The traditional distraction test of hearing at 8 months is failing them: the mean age for detecting severe deafness is 18 months. The evidence reviewed at the meeting shows clearly that universal (rather than targeted) electronic screening of newborn infants is more reliable, cheaper, and leads to hearing aids being fitted at a mean age below 4 months. For other conditions future policy looks less clear. The list of inborn errors of metabolism which could be detected in the newborn …