Maternal perception and acceptability of systematic echocardiography of newborns

Abstract Introduction We included 27,000 newborns in a population-based cohort study mapping newborn cardiac function using echocardiography, ECG, and pulse oximetry, enabling lifelong follow-up. The study offers valuable insights, but population studies may raise parental concerns, especially when detecting false positives or findings of uncertain clinical significance. Purpose To assess maternal experience, satisfaction, and concerns regarding systematic neonatal echocardiography in a cohort vs. controls and to evaluate concerns related to normal, false positive (FP), and true positive (TP) findings. METHOD We included 2,000 mothers from the cohort and 350 controls. Controls were recruited from the same hospitals post-inclusion or a neighboring hospital during inclusion. The Pulse Oximetry Study Acceptability Questionnaire was adapted for echocardiography and Danish context. Mothers completed baseline questionnaires shortly after birth and at follow-up two months later. Questions were categorized into Anxiety, Depression, Illness Perception, and Optimism. Results At baseline, 2,001 mothers in the inclusion group and 359 in the control group completed the questionnaire; at follow-up, 1,296 (64.8%) and 274 (76.3%) responded, respectively. 6.8% (n=136) of the included newborns had a TP finding and 1.8% (n=36) had a FP finding. Compared to the control group, depression scores were significantly lower in the inclusion group at baseline (1 IQR 1-2 vs. 1 IQR 1-2, p0.001) and follow-up (1 IQR 1-2 vs. 1 IQR 1-2, p0.001). Illness perception scores were higher at baseline (5 IQR 4-5 vs. 4 IQR 4-5, p0.001) and follow-up (5 IQR 4-5 vs. 5 IQR 4-5, p0.001). Optimism scores were higher at baseline (4 IQR 3-4 vs. 3 IQR 2-4, p0.001) and follow-up (4 IQR 4-4 vs. 3 IQR 2-4, p0.001). Anxiety did not differ significantly (baseline; 2 IQR 1-3 vs. 2 IQR 1-3, p=0.951 and follow-up; 2 IQR 1-3 vs. 2 IQR 1-3, p=0.762). The inclusion group found the examination more important than the control group (5 IQR 4-5 vs. 3 IQR 2-4, p0.001). The inclusion group were generally satisfied with the pre-test information (4 IQR 3-5), the examination (5 IQR 4-5), and the test results (5 IQR 4-5). When comparing included newborns with normal findings with TP- and FP findings, we did not observe any significant difference in the level of illness perception, anxiety, depression or optimism at baseline or at follow-up. Conclusion Participation in this study was associated with lower maternal depression levels, greater illness perception and optimism. Anxiety was similar for both groups. Mothers to newborns with positive, either true positive or false positive findings on echocardiography, did not differ in scores for depression, anxiety, optimism and illness perception from mothers to newborns with normal findings. These findings suggest that systematic echocardiographic screening is well-received and does not induce unnecessary concern.Table 1 Demographics