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Bush LW, Levy HL. Past as Prologue: Predicting Potential Psychosocial-Ethical Burdens of Positive Newborn Screens as Conditions Propagate. Int J Neonatal Screen 2024; 10:12. [PMID: 38390976 PMCID: PMC10885124 DOI: 10.3390/ijns10010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/16/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
We look to the past as prologue for guidance in predicting and circumventing potential psychosocial-ethical challenges, including those that may influence the attachment process for some parents. We consider the evolution of bioethics and developmental psychology as they intersect with newborn screening while exploring potential implications of positive findings, be they false positives, true positives, or secondary as well as incidental findings. We reflect on navigating the complex landscape that may be significantly impacted by variable phenotypes, the age of onset, and uncertain prognoses, mindful of the diagnostic odyssey continuum. We explore select facets of ethical and psychological challenges encountered with positive newborn screening findings by highlighting enduring debates to improve the policy process in public health and medicine. We believe substantive empirical research is needed, including long-term follow-up, routine prenatal assessment of tolerance for uncertainties, and especially innovative methodologies to better evaluate potential psychological distress that may be present in some at-risk individuals during the perinatal period preceding and following reports of positive findings. Mitigation strategies building on lessons learned from NBS and clinical follow-up should be implemented and studied. We conclude by pondering why we remain far afield from providing these services. Research directed towards understanding the implications of positive NBS findings will further reduce the burdens on families and care providers alike and should lead to improved communication.
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Affiliation(s)
- Lynn W. Bush
- Department of Medicine, Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA;
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Harvey L. Levy
- Department of Medicine, Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, USA;
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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2
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Messina M, Arena A, Iacobacci R, La Spina L, Meli C, Raudino F, Ruggieri M. Butyrylcarnitine Elevation in Newborn Screening: Reducing False Positives and Distinguishing between Two Rare Diseases through the Evaluation of New Ratios. Biomedicines 2023; 11:3247. [PMID: 38137468 PMCID: PMC10741594 DOI: 10.3390/biomedicines11123247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
One of the main challenges of newborn screening programs, which screen for inherited metabolic disorders, is cutting down on false positives (FPs) in order to avoid family stresses, additional analyses, and unnecessary costs. False positives are partly caused by an insubstantial number of robust biomarkers in evaluations. Another challenge is how to distinguish between diseases which share the same primary marker and for which secondary biomarkers are just as highly desirable. Focusing on pathologies that involve butyrylcarnitine (C4) elevation, such as short-chain acylCoA dehydrogenase deficiency (SCADD) and isobutyrylCoA dehydrogenase deficiency (IBDD), we investigated the acylcarnitine profile of 121 newborns with a C4 increase to discover secondary markers to achieve two goals: reduce the FP rate and discriminate between the two rare diseases. Analyses were carried out using tandem mass spectrometry with whole blood samples spotted on filter paper. Seven new biomarkers (C4/C0, C4/C5, C4/C5DC\C6OH, C4/C6, C4/C8, C4/C14:1, C4/C16:1) were identified using a non-parametric ANOVA analysis. Then, the corresponding cut-off values were found and applied to the screening program. The seven new ratios were shown to be robust (p < 0.001 and p < 0.01, 0.0937 < ε2 < 0.231) in discriminating between FP and IBDD patients, FP and SCADD patients, or SCADD and IBDD patients. Our results suggest that the new ratios are optimal indicators for identifying true positives, distinguishing between two rare diseases that share the same primary biomarker, improving the predictive positive value (PPV) and reducing the false positive rate (FPR).
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Affiliation(s)
- MariaAnna Messina
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Alessia Arena
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Riccardo Iacobacci
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Luisa La Spina
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Concetta Meli
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Federica Raudino
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
| | - Martino Ruggieri
- Expanded Newborn Screening Laboratory, Newborn Screening and Metabolic Diseases Unit, University-Polyclinic “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.A.); (R.I.); (L.L.S.); (C.M.); (F.R.); (M.R.)
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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3
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Chen T, Fan C, Huang Y, Feng J, Zhang Y, Miao J, Wang X, Li Y, Huang C, Jin W, Tang C, Feng L, Yin Y, Zhu B, Sun M, Liu X, Xiang J, Tan M, Jia L, Chen L, Huang H, Peng H, Sun X, Gu X, Peng Z, Zhu B, Zou H, Han L. Genomic Sequencing as a First-Tier Screening Test and Outcomes of Newborn Screening. JAMA Netw Open 2023; 6:e2331162. [PMID: 37656460 PMCID: PMC10474521 DOI: 10.1001/jamanetworkopen.2023.31162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023] Open
Abstract
Importance Newborn screening via biochemical tests is in use worldwide. The availability of genetic sequencing has allowed rapid screening for a substantial number of monogenic disorders. However, the outcomes of this strategy have not been evaluated in a general newborn population. Objective To evaluate the outcomes of applying gene panel sequencing as a first-tier newborn screening test. Design, Setting, and Participants This cohort study included newborns who were prospectively recruited from 8 screening centers in China between February 21 and December 31, 2021. Neonates with positive results were followed up before July 5, 2022. Exposures All participants were concurrently screened using dried blood spots. The screen consisted of biochemical screening tests and a targeted gene panel sequencing test for 128 conditions. The biochemical and genomic tests could both detect 43 of the conditions, whereas the other 85 conditions were screened solely by the gene panel. Main Outcomes and Measures The primary outcomes were the number of patients detected by gene panel sequencing but undetected by the biochemical test. Results This study prospectively recruited 29 601 newborns (15 357 [51.2%] male). The mean (SD) gestational age was 39.0 (1.5) weeks, and the mean (SD) birth weight was 3273 (457) g. The gene panel sequencing screened 813 infants (2.7%; 95% CI, 2.6%-2.9%) as positive. By the date of follow-up, 402 infants (1.4%; 95% CI, 1.2%-1.5%) had been diagnosed, indicating the positive predictive value was 50.4% (95% CI, 50.0%-53.9%). The gene panel sequencing identified 59 patients undetected by biochemical tests, including 20 patients affected by biochemically and genetically screened disorders and 39 patients affected by solely genetically screened disorders, which translates into 1 out of every 500 newborns (95% CI, 1/385-1/625) benefiting from the implementation of gene panels as a first-tier screening test. Conclusions and Relevance In this cohort study, the use of gene panel sequencing in a general newborn population as a first-tier screening test improved the detection capability of traditional screening, providing an evidence-based suggestion that it could be considered as a crucial method for first-tier screening.
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Affiliation(s)
- Ting Chen
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research & Center for Clinical Innovation and Research, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chunna Fan
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Yonglan Huang
- Guangzhou Newborn Screening Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jizhen Feng
- Department of Genetics, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, Hebei, China
| | - Yinhong Zhang
- Department of Medical Genetics, NHC Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jingkun Miao
- Department of Pediatrics, Chongqing Health Center for Women and Children & Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaohua Wang
- Department of Genetics, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, Inner Mongolia, China
| | - Yulin Li
- Neonatal Disease Screening Center, Jinan Maternity and Child Health Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Cidan Huang
- Neonatal Disease Screening Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | - Weiwei Jin
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
- Tianjin Medical Laboratory, BGI-Tianjin, BGI-Shenzhen, Tianjin, China
| | - Chengfang Tang
- Guangzhou Newborn Screening Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lulu Feng
- Department of Genetics, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, Hebei, China
| | - Yifan Yin
- Department of Pediatrics, Chongqing Health Center for Women and Children & Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Zhu
- Department of Genetics, Inner Mongolia Maternity and Child Health Care Hospital, Hohhot, Inner Mongolia, China
| | - Meng Sun
- Neonatal Disease Screening Center, Jinan Maternity and Child Health Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiulian Liu
- Neonatal Disease Screening Center, Hainan Women and Children’s Medical Center, Haikou, Hainan, China
| | | | - Minyi Tan
- Guangzhou Newborn Screening Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liyun Jia
- Department of Genetics, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, Hebei, China
| | - Lei Chen
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Hui Huang
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | | | - Xin Sun
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research & Center for Clinical Innovation and Research, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research & Center for Clinical Innovation and Research, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiyu Peng
- BGI Genomics, BGI-Shenzhen, Shenzhen, China
| | - Baosheng Zhu
- Department of Medical Genetics, NHC Key Laboratory of Preconception Health Birth in Western China, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Hui Zou
- Neonatal Disease Screening Center, Jinan Maternity and Child Health Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lianshu Han
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research & Center for Clinical Innovation and Research, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Caglayan M, Gonel A, Tayman C, Cakir U, Koyuncu I, Temiz E, Sert Y. Investigation of the effect of vitamin K1 prophylaxis on newborn screenings tests in newborns. J Med Biochem 2023; 42:376-382. [PMID: 37814616 PMCID: PMC10560507 DOI: 10.5937/jomb0-40162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/22/2022] [Indexed: 10/11/2023] Open
Abstract
Background Routine screening for hereditary disorders in newborns includes screening for treatable metabolic and endocrine disorders, such as biotidinase deficiency, galactosemia, maple syrup urine disease, hypothyroidism, and cystic fibrosis. Incorrect test results may be encountered due to the use of vitamin K1. To investigate the interference effect of vitamin K1 on neonatal screening tests and to raise awareness of erroneous measurements. Methods Heel blood samples were taken from 25 newborns born in a neonatal intensive care unit. Dry blood C0, C2, C3, C4, C4DC, C5:1, C5OH, C5DC, C6, C6DC, C8, C8:1, C8DC, C10, C10:1, C10DC, C12, C14, C14:1, C14:2, C16, C16:1, C18, C18:1, C18:2, C18:OH, methylglutaryl, valine, leucine/isoleucine, methionine, phenylalanine, argininosuccinic acid, aspartate, alanine, arginine, citrulline, glycine, ornithine, and glutamate tests were studied using the tandem mass spectrometry (MS) method. The results of the heel blood samples obtained before and after the application of vitamin K1 (Phyto menadione) were compared. Results In two studies conducted with in vitro and in vivo tests, C0, C2, C3, C4, C4DC, C5, C5OH, C6, C8, C10, C10:1, C14, C16, C16:1, C18, C18:1, methylglutaryl, phenylalanine, argininosuccinic acid, tyrosine, aspartate, arginine, citrulline, glycine, and glutamine were all significantly elevated (p < 0.05). Conclusions Heel blood samples may yield false results due to vitamin K1 administration. In the case of doubtful results, a new sample should be taken and the measurement should be repeated.
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Affiliation(s)
- Murat Caglayan
- Health Science University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Medical Biochemistry, Ankara, Turkey
| | - Ataman Gonel
- Hasan Kalyoncu University, Faculty of Health Science, Medical Park Gaziantep Hastanesi, Department of Nutrition and Dietetics, Gaziantep, Turkey
| | - Cuneyt Tayman
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Cankaya, Ankara, Turkey
| | - Ufuk Cakir
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Cankaya, Ankara, Turkey
| | - Ismail Koyuncu
- Harran University, Medicine Faculty, Department of Medical Biochemistry, Sanliurfa, Turkey
| | - Ebru Temiz
- Harran University, Health Services Vocational School, Program of Medical Promotion and Marketing, Sanliurfa, Turkey
| | - Yasemin Sert
- Ankara City Hospital, Department of Gynecology Obstetrics, Ankara, Turkey
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Sebaa R, AlMalki RH, Alseraty W, Abdel Rahman AM. A Distinctive Metabolomics Profile and Potential Biomarkers for Very Long Acylcarnitine Dehydrogenase Deficiency (VLCADD) Diagnosis in Newborns. Metabolites 2023; 13:725. [PMID: 37367883 DOI: 10.3390/metabo13060725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Very long-chain acylcarnitine dehydrogenase deficiency (VLCADD) is a rare inherited metabolic disorder associated with fatty acid β-oxidation and characterized by genetic mutations in the ACADVL gene and accumulations of acylcarnitines. VLCADD, developed in neonates or later adults, can be diagnosed using newborn bloodspot screening (NBS) or genetic sequencing. These techniques have limitations, such as a high false discovery rate and variants of uncertain significance (VUS). As a result, an extra diagnostic tool is needed to deliver improved performance and health outcomes. As VLCADD is linked with metabolic disturbance, we postulated that newborn patients with VLCADD could display a distinct metabolomics pattern compared to healthy newborns and other disorders. Herein, we applied an untargeted metabolomics approach using liquid chromatography-high resolution mass spectrometry (LC-HRMS) to measure the global metabolites in dried blood spot (DBS) cards collected from VLCADD newborns (n = 15) and healthy controls (n = 15). Two hundred and six significantly dysregulated endogenous metabolites were identified in VLCADD, in contrast to healthy newborns. Fifty-eight and one hundred and eight up- and down-regulated endogenous metabolites were involved in several pathways such as tryptophan biosynthesis, aminoacyl-tRNA biosynthesis, amino sugar and nucleotide sugar metabolism, pyrimidine metabolism and pantothenate, and CoA biosynthesis. Furthermore, biomarker analyses identified 3,4-Dihydroxytetradecanoylcarnitine (AUC = 1), PIP (20:1)/PGF1alpha) (AUC = 0.982), and PIP2 (16:0/22:3) (AUC = 0.978) as potential metabolic biomarkers for VLCADD diagnosis. Our findings showed that compared to healthy newborns, VLCAADD newborns exhibit a distinctive metabolic profile, and identified potential biomarkers that can be used for early diagnosis, which improves the identification of the affected patients earlier. This allows for the timely administration of proper treatments, leading to improved health. However, further studies with large independent cohorts of VLCADD patients with different ages and phenotypes need to be studied to validate our potential diagnostic biomarkers and their specificity and accuracy during early life.
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Affiliation(s)
- Rajaa Sebaa
- Department of Medical Laboratories, College of Applied Medical Sciences, Shaqra University, Al-Dawadmi 17472, Saudi Arabia
| | - Reem H AlMalki
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
| | - Wafaa Alseraty
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Al-Dawadmi 17472, Saudi Arabia
| | - Anas M Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
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6
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Sebaa R, AlMogren M, Alseraty W, Abdel Rahman AM. Untargeted Metabolomics Identifies Biomarkers for MCADD Neonates in Dried Blood Spots. Int J Mol Sci 2023; 24:ijms24119657. [PMID: 37298607 DOI: 10.3390/ijms24119657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is the most common inherited mitochondrial metabolic disease of fatty acid β-oxidation, especially in newborns. MCADD is clinically diagnosed using Newborn Bloodspot Screening (NBS) and genetic testing. Still, these methods have limitations, such as false negatives or positives in NBS and the variants of uncertain significance in genetic testing. Thus, complementary diagnostic approaches for MCADD are needed. Recently, untargeted metabolomics has been proposed as a diagnostic approach for inherited metabolic diseases (IMDs) due to its ability to detect a wide range of metabolic alterations. We performed an untargeted metabolic profiling of dried blood spots (DBS) from MCADD newborns (n = 14) and healthy controls (n = 14) to discover potential metabolic biomarkers/pathways associated with MCADD. Extracted metabolites from DBS samples were analyzed using UPLC-QToF-MS for untargeted metabolomics analyses. Multivariate and univariate analyses were used to analyze the metabolomics data, and pathway and biomarker analyses were also performed on the significantly identified endogenous metabolites. The MCADD newborns had 1034 significantly dysregulated metabolites compared to healthy newborns (moderated t-test, no correction, p-value ≤ 0.05, FC 1.5). A total of 23 endogenous metabolites were up-regulated, while 84 endogenous metabolites were down-regulated. Pathway analyses showed phenylalanine, tyrosine, and tryptophan biosynthesis as the most affected pathways. Potential metabolic biomarkers for MCADD were PGP (a21:0/PG/F1alpha) and glutathione, with an area under the curve (AUC) of 0.949 and 0.898, respectively. PGP (a21:0/PG/F1alpha) was the first oxidized lipid in the top 15 biomarker list affected by MCADD. Additionally, glutathione was chosen to indicate oxidative stress events that could happen during fatty acid oxidation defects. Our findings suggest that MCADD newborns may have oxidative stress events as signs of the disease. However, further validations of these biomarkers are needed in future studies to ensure their accuracy and reliability as complementary markers with established MCADD markers for clinical diagnosis.
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Affiliation(s)
- Rajaa Sebaa
- Department of Medical Laboratories, College of Applied Medical Sciences, University of Shaqra, Al-Dawadmi 17472, Saudi Arabia
| | - Maha AlMogren
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
| | - Wafaa Alseraty
- Department of Nursing, College of Applied Medical Sciences, University of Shaqra, Al-Dawadmi 17472, Saudi Arabia
| | - Anas M Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, Saudi Arabia
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
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7
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Lee CS, Ni YH, Chen HL, Wu JF, Hsu HY, Chien YH, Lee NC, Hwu WL, Yen TA, Chua HH, Chen YJ, Wang YL, Chang MH. A Pilot Study of Biliary Atresia Newborn Screening Using Dried Blood Spot Matrix Metalloproteinase-7. J Pediatr Gastroenterol Nutr 2023; 76:418-423. [PMID: 36946999 DOI: 10.1097/mpg.0000000000003701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Timely diagnosis is a critical challenge and is associated with improved survival of biliary atresia (BA) patients. We aimed to measure matrix metalloproteinase-7 (MMP-7) levels in BA patients within 3 days of birth using the dried blood spot (DBS) method and evaluate its potential as a screening tool. METHODS The study enrolled 132 patients, including 25 patients diagnosed with BA and 107 non-BA patients with other congenital or perinatal conditions from the National Taiwan University Children Hospital. The stored DBS samples collected from 48 to 72 hours of life were retrieved from newborn screening centers. MMP-7 on the DBS was quantified using a sensitive sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS The MMP-7 levels of BA patients on the DBS were significantly higher than those of non-BA patients (19.2 ± 10.4 vs 5.6 ± 2.7 ng/mL, P value < 0.0001). MMP-7 levels in non-BA patients, including 5 patients with hepatobiliary structural anomaly, 9 patients with intrahepatic cholestasis, and 93 patients with other perinatal diseases, were 11.6 ± 4.2 ng/mL, 6.9 ± 3.0 ng/mL, and 5.2 ± 2.1 ng/mL, respectively. The DBS MMP-7 level showed good accuracy for identifying BA, with an area under the curve of 93.7% [95% confidence interval (CI): 87.7%-99.7%]. The MMP-7 cutoff at 8.0 ng/mL showed a sensitivity of 92.0% (95% CI: 75.0%-98.6%) and specificity of 92.5% (95% CI: 85.9%-96.1%) for detecting BA from other congenital or perinatal diseases. CONCLUSIONS MMP-7 DBS analysis can be used to distinguish BA from other conditions as early as 3 days of age.
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Affiliation(s)
- Chee-Seng Lee
- From the Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Hsuan Ni
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huey-Ling Chen
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- the Department and Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jia-Feng Wu
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Yuan Hsu
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yin-Hsiu Chien
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- the Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ni-Chung Lee
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- the Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- the Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-An Yen
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Huey-Huey Chua
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ju Chen
- Institute of Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Lin Wang
- Institute of NanoEngineering and MicroSystems, National Tsing Hua University, Hsinchu, Taiwanthe
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Mei-Hwei Chang
- the Department of Pediatrics, National Taiwan University Hospital and Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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8
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Kingsmore SF, Smith LD, Kunard CM, Bainbridge M, Batalov S, Benson W, Blincow E, Caylor S, Chambers C, Del Angel G, Dimmock DP, Ding Y, Ellsworth K, Feigenbaum A, Frise E, Green RC, Guidugli L, Hall KP, Hansen C, Hobbs CA, Kahn SD, Kiel M, Van Der Kraan L, Krilow C, Kwon YH, Madhavrao L, Le J, Lefebvre S, Mardach R, Mowrey WR, Oh D, Owen MJ, Powley G, Scharer G, Shelnutt S, Tokita M, Mehtalia SS, Oriol A, Papadopoulos S, Perry J, Rosales E, Sanford E, Schwartz S, Tran D, Reese MG, Wright M, Veeraraghavan N, Wigby K, Willis MJ, Wolen AR, Defay. T. A genome sequencing system for universal newborn screening, diagnosis, and precision medicine for severe genetic diseases. Am J Hum Genet 2022; 109:1605-1619. [PMID: 36007526 PMCID: PMC9502059 DOI: 10.1016/j.ajhg.2022.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 12/31/2022] Open
Abstract
Newborn screening (NBS) dramatically improves outcomes in severe childhood disorders by treatment before symptom onset. In many genetic diseases, however, outcomes remain poor because NBS has lagged behind drug development. Rapid whole-genome sequencing (rWGS) is attractive for comprehensive NBS because it concomitantly examines almost all genetic diseases and is gaining acceptance for genetic disease diagnosis in ill newborns. We describe prototypic methods for scalable, parentally consented, feedback-informed NBS and diagnosis of genetic diseases by rWGS and virtual, acute management guidance (NBS-rWGS). Using established criteria and the Delphi method, we reviewed 457 genetic diseases for NBS-rWGS, retaining 388 (85%) with effective treatments. Simulated NBS-rWGS in 454,707 UK Biobank subjects with 29,865 pathogenic or likely pathogenic variants associated with 388 disorders had a true negative rate (specificity) of 99.7% following root cause analysis. In 2,208 critically ill children with suspected genetic disorders and 2,168 of their parents, simulated NBS-rWGS for 388 disorders identified 104 (87%) of 119 diagnoses previously made by rWGS and 15 findings not previously reported (NBS-rWGS negative predictive value 99.6%, true positive rate [sensitivity] 88.8%). Retrospective NBS-rWGS diagnosed 15 children with disorders that had been undetected by conventional NBS. In 43 of the 104 children, had NBS-rWGS-based interventions been started on day of life 5, the Delphi consensus was that symptoms could have been avoided completely in seven critically ill children, mostly in 21, and partially in 13. We invite groups worldwide to refine these NBS-rWGS conditions and join us to prospectively examine clinical utility and cost effectiveness.
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Affiliation(s)
- Stephen F. Kingsmore
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Keck Graduate Institute, Claremont, CA 91711, USA,Corresponding author
| | - Laurie D. Smith
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Matthew Bainbridge
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Sergey Batalov
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Wendy Benson
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Eric Blincow
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Sara Caylor
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | | | - David P. Dimmock
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Yan Ding
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Katarzyna Ellsworth
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Annette Feigenbaum
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Erwin Frise
- Fabric Genomics, Inc., Oakland, CA 94612, USA
| | - Robert C. Green
- Mass General Brigham, Broad Institute, Ariadne Labs and Harvard Medical School, Boston, MA 02115, USA
| | - Lucia Guidugli
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Christian Hansen
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Charlotte A. Hobbs
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Mark Kiel
- Genomenon Inc., Ann Arbor, MI 48108, USA
| | - Lucita Van Der Kraan
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Yong H. Kwon
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Lakshminarasimha Madhavrao
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Jennie Le
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Rebecca Mardach
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | | | - Danny Oh
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Mallory J. Owen
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Gunter Scharer
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Mari Tokita
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Albert Oriol
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - James Perry
- Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Edwin Rosales
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Erica Sanford
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Duke Tran
- Illumina, Inc., San Diego, CA 92122, USA
| | | | - Meredith Wright
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Narayanan Veeraraghavan
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Kristen Wigby
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Mary J. Willis
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Thomas Defay.
- Alexion, Astra Zeneca Rare Disease, Boston, MA 02210, USA
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9
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Lee K, Al Jumaily K, Lin M, Siminoski K, Ye C. Dual-energy x-ray absorptiometry scanner mismatch in follow-up bone mineral density testing. Osteoporos Int 2022; 33:1981-1988. [PMID: 35614236 DOI: 10.1007/s00198-022-06438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED Scanner mismatch occurs frequently with follow-up dual-energy x-ray absorptiometry (DXA) scans. Nearly one-in-five follow-up DXA scans were conducted on non-cross-calibrated scanners (scanner mismatch) and more than a quarter of patients who had a follow-up DXA scan had experienced scanner mismatch. INTRODUCTION Detecting significant changes in bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) scanners relies on the least significant change (LSC). Results from two different DXA scanners can only be compared, albeit with decreased sensitivity for change, if the LSC between the two scanners has been directly determined through cross-calibration. Performing follow-up DXA scans on non-cross-calibrated scanners (scanner mismatch) has safety and economic implications. This study aims to determine the proportion of scanner mismatch occurring at a population level. METHODS All patients who completed at least two DXA scans between 1 April 2009 and 31 December 2018 in the province of Alberta, Canada, were identified using population-based health services databases. Scanner mismatch was defined as a follow-up DXA scan completed on a DXA scanner that differed from and was not cross-calibrated to the previous DXA scanner. Multivariate logistic regression models were used to assess predictive factors that may contribute to scanner mismatch. RESULTS A total of 264,866 patients with 470,641 follow-up DXA scans were identified. Scanner mismatch occurred in 18.9% of follow-up DXA scans; 28.7% of patients experienced at least one scanner mismatch. Longer duration between scans (OR 1.25, 95% CI 1.24-1.26) and major osteoporotic fracture history before index scan (OR 1.06, 95% CI 1.03-1.08) increased risk of scanner mismatch. Osteoporosis medication use before index scan (OR 0.89; 95% CI 0.88-0.91), recency of follow-up scans (OR 0.98, 95% CI 0.73-0.98), female sex (OR 0.97, 95% CI 0.94-1.00), and age at last scan (OR 0.99, 95% CI 0.99-1.00) were associated with lower risk of scanner mismatch. CONCLUSION Scanner mismatch is a common problem, occurring in one-in-five follow-up DXA scans and affecting more than a quarter of patients. Interventions to reduce this large proportion of scanner mismatch are necessary.
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Affiliation(s)
- K Lee
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Core Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Al Jumaily
- Division of Core Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Lin
- Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - K Siminoski
- Dpartment of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Ye
- Division of Rheumatology, Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2G3, Canada.
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10
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Semeraro D, Verrocchio S, Di Dalmazi G, Rossi C, Pieragostino D, Cicalini I, Ferrante R, Di Michele S, Stuppia L, Rizzo C, Lepri FR, Novelli A, Dionisi-Vici C, De Laurenzi V, Bucci I. High Incidence of Partial Biotinidase Deficiency in the First 3 Years of a Regional Newborn Screening Program in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138141. [PMID: 35805799 PMCID: PMC9265859 DOI: 10.3390/ijerph19138141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
Biotinidase deficiency (BD) is an autosomal recessive inherited disorder in which the enzyme biotinidase is totally or partially defective and the vitamin biotin is not recycled. BD meets the major criteria for a population screening program. Newborn bloodspot screening (NBS) allows early diagnosis of BD, thus preventing the high morbidity and mortality associated with untreated disease. Both profound and partial BD variant can be detected by NBS test, and serum enzyme activity and/or mutational analysis are required for definitive diagnosis. In Italy, BD is included in the screening panel for inborn errors of metabolism (IEMs) that has been declared mandatory in 2016. We analyzed the data of the first 3 years of the NBS for BD in our region (Abruzzo, Italy), with the aim to describe the outcomes of this recently introduced screening program. In over 26,393 newborns screened, we found 2 carriers and 16 cases with genotype associated with partial BD. Since the serum biotinidase assay has been recently introduced in our algorithm, only three of our newborns met the criteria of genetic and biochemical confirmation, with an incidence of 1:8797, which is in the high range of what has been reported in the literature. All affected infants carried the 1330G>C (D444H) variant in compound heterozygosis, with variants known to be associated with profound BD. A variant previously not described and likely pathogenic was found in one newborn. None of the infants had signs or symptoms. The study of the distribution of the enzyme activity in our population allowed us to validate the adopted cutoff with which the program has a positive predictive value of 18% and to analyze some preanalytical factors influencing biotinidase activity: A correlation of the enzyme activity with gestational age and time at specimen collection was found. Lower mean values of enzyme activity were found in infants born in the summer.
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Affiliation(s)
- Daniela Semeraro
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Medicine and Aging Science, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sara Verrocchio
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Medicine and Aging Science, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Di Dalmazi
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Medicine and Aging Science, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Claudia Rossi
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Damiana Pieragostino
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ilaria Cicalini
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Rossella Ferrante
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Silvia Di Michele
- Department of Pediatrics, “Spirito Santo” Hospital, 65124 Pescara, Italy;
| | - Liborio Stuppia
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Cristiano Rizzo
- Division of Metabolism, Bambino Gesù Children’s Research Hospital, 00165 Rome, Italy; (C.R.); (C.D.-V.)
| | - Francesca Romana Lepri
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.R.L.); (A.N.)
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.R.L.); (A.N.)
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children’s Research Hospital, 00165 Rome, Italy; (C.R.); (C.D.-V.)
| | - Vincenzo De Laurenzi
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ines Bucci
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.S.); (S.V.); (G.D.D.); (C.R.); (D.P.); (I.C.); (R.F.); (L.S.); (V.D.L.)
- Department of Medicine and Aging Science, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Correspondence:
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11
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Henderson MPA, McIntosh N, Chambers A, Desormeaux E, Kowalski M, Milburn J, Chakraborty P. Biotinidase Activity is Affected by Both Seasonal Temperature and Filter Collection Cards. Clin Biochem 2022; 115:129-136. [PMID: 35398329 DOI: 10.1016/j.clinbiochem.2022.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
This study set out to examine pre-analytical factors affecting the frequency of positive results in newborn screening for biotinidase deficiency. This investigation was prompted by an increase in the annual screen positive rate for biotinidase deficiency in Ontario from 2.65x10-4 in 2016 to 6.57x10-4 in 2017. Season and trend decomposition was used to separate seasonality from an underlying trend in the time series of biotindase activity measurements for the period 2014-01-12 to 2019-07-27 (n = 798,770). This analysis revealed a marked seasonal effect (winter = median + ⩽ 17 MRU, summer = mean - ⩽20 MRU) and a non-linear negative trend. Seasonal temperature was correlated with biotinidase results (Pearson's r = 0.79) but not with the observed negative trend (Pearson's r = 0.0025). Time series analysis of biotinidase results grouped by print lot of filter paper revealed that recently printed filter paper cards inhibit biotinidase and that this inhibition resolved over time. This study demonstrates that biotindase activity is inhibited by both increased seasonal temperature and collection on newly printed filter cards.
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Affiliation(s)
- Matthew P A Henderson
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada; Department of Medicine, University of Ottawa, Canada.
| | - Nathan McIntosh
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada
| | - Amy Chambers
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada
| | - Emily Desormeaux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada
| | - Michael Kowalski
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Canada; Department of Medicine, University of Ottawa, Canada
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12
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Held PK, Bialk ER, Lasarev MR, Allen DB. 21-Deoxycortisol is a Key Screening Marker for 21-Hydroxylase Deficiency. J Pediatr 2022; 242:213-219.e1. [PMID: 34780778 DOI: 10.1016/j.jpeds.2021.10.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess whether 21-deoxycortisol (21deoxy) can be used to predict 21-hydroxylase deficiency (21OHD) in newborns and to evaluate the influence of gestational age and the timing of collection on 21deoxy concentrations. STUDY DESIGN 17-hydroxyprogesterone (17OHP) and 21deoxy levels were measured in 906 newborn screening specimens (851 unaffected newborns, 55 confirmed cases of 21OHD) to compare their ability to identify babies with 21OHD. In addition, these 2 steroids were assessed in the unaffected cohort to determine the influence of gestational age (ranging from 23 to 42 weeks) and the timing of specimen collection on the measured concentrations. RESULTS The gestational age of the newborn impacted both 17OHP and 21deoxy concentrations, but the degree of influence was more substantial for 17OHP. Timing of collection did not affect 21deoxy concentration. Moreover, 21deoxy was a better predictor of 21OHD status compared with 17OHP, with little overlap in concentrations between the unaffected population and confirmed cases of 21OHD. A streamlined decision tree using solely 21deoxy (cutoff value, 0.85 ng/mL) yielded a 91.7% positive predictive value for 21OHD screening. CONCLUSIONS Our findings demonstrate that 21deoxy is a key disease marker of 21OHD and can be used to improve the accuracy of newborn screening for this disorder.
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Affiliation(s)
- Patrice K Held
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI; Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Eric R Bialk
- Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David B Allen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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13
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Gold NB, Harrison SM, Rowe JH, Gold J, Furutani E, Biffi A, Duncan CN, Shimamura A, Lehmann LE, Green RC. Low frequency of treatable pediatric disease alleles in gnomAD: An opportunity for future genomic screening of newborns. HGG ADVANCES 2022; 3:100059. [PMID: 35047849 PMCID: PMC8756496 DOI: 10.1016/j.xhgg.2021.100059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/20/2021] [Indexed: 01/18/2023] Open
Abstract
Hematopoietic stem cell transplant (HSCT) can prevent progression of several genetic disorders. Although a subset of these disorders are identified on newborn screening panels, others are not identified until irreversible symptoms develop. Genetic testing is an efficient methodology to ascertain pre-symptomatic children, but the penetrance of risk-associated variants in the general population is not well understood. We developed a list of 127 genes associated with disorders treatable with HSCT. We identified likely pathogenic or pathogenic (LP/P) and loss-of-function (LoF) variants in these genes in the Genome Aggregation Database (gnomAD), a dataset containing exome and genome sequencing data from 141,456 healthy adults. Within gnomAD, we identified 59 individuals with a LP/P or LoF variant in 15 genes. Genes were associated with bone marrow failure syndromes, bleeding disorders, primary immunodeficiencies, osteopetrosis, metabolic disorders, and epidermolysis bullosa. In conclusion, few ostensibly healthy adults had genotypes associated with pediatric disorders treatable with HSCTs. Given that most of these disorders do not have biomarkers that could be cheaply and universally assessed on a standard newborn screen, our data suggest that genetic testing may be a complementary approach to traditional newborn screening methodology that has the potential to improve mortality and is not expected to lead to a high burden of false-positive results.
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Affiliation(s)
- Nina B. Gold
- Massachusetts General Hospital for Children, Division of Medical Genetics and Metabolism, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jared H. Rowe
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
- Dana-Farber Cancer Institute Division of Pediatric Oncology, Boston, MA, USA
| | - Jessica Gold
- Department of Pediatrics, Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elissa Furutani
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
| | - Alessandra Biffi
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
- Dana-Farber Cancer Institute Division of Pediatric Oncology, Boston, MA, USA
| | - Christine N. Duncan
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
- Dana-Farber Cancer Institute Division of Pediatric Oncology, Boston, MA, USA
| | - Akiko Shimamura
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
- Dana-Farber Cancer Institute Division of Pediatric Oncology, Boston, MA, USA
| | - Leslie E. Lehmann
- Harvard Medical School, Boston, MA, USA
- Boston Children’s Hospital, Division of Hematology and Oncology, Boston, MA, USA
- Dana-Farber Cancer Institute Division of Pediatric Oncology, Boston, MA, USA
| | - Robert C. Green
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Ariadne Labs, Boston, MA, USA
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Godler DE, Ling L, Gamage D, Baker EK, Bui M, Field MJ, Rogers C, Butler MG, Murgia A, Leonardi E, Polli R, Schwartz CE, Skinner CD, Alliende AM, Santa Maria L, Pitt J, Greaves R, Francis D, Oertel R, Wang M, Simons C, Amor DJ. Feasibility of Screening for Chromosome 15 Imprinting Disorders in 16 579 Newborns by Using a Novel Genomic Workflow. JAMA Netw Open 2022; 5:e2141911. [PMID: 34982160 PMCID: PMC8728620 DOI: 10.1001/jamanetworkopen.2021.41911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Newborn screening for Angelman syndrome (AS), Prader-Willi syndrome (PWS), and chromosome 15 duplication syndrome (Dup15q) may lead to benefit from early diagnosis and treatment. OBJECTIVE To examine the feasibility of newborn screening for these chromosome 15 imprinting disorders at population scale. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, the validation data set for the first-tier SNRPN test, called methylation-specific quantitative melt analysis (MS-QMA), included 109 PWS, 48 AS, 9 Dup15q, and 1190 population control newborn blood spots (NBS) and peripheral tissue samples from participants recruited from January 2000 to December 2016. The test data set included NBS samples from 16 579 infants born in 2011. Infants with an NBS identified as positive for PWS, AS, or Dup15q by the first-tier test were referred for droplet digital polymerase chain reaction, real-time polymerase chain reaction, and low-coverage whole-genome sequencing for confirmatory testing. Data analyses were conducted between February 12, 2015, and August 15, 2020. RESULTS In the validation data set, the median age for the 77 patients with PWS was 3.00 years (IQR, 0.01-44.50 years); for the 46 patients with AS, 2.76 years (IQR, 0.028 to 49.00 years); and for the 9 patients with Dup15q, 4.00 years (IQR, 1.00 to 28.00 years). Thirty-eight patients (51.4%) in the PWS group, 20 patients (45.5%) in the AS group, and 6 patients (66.7%) in the Dup15q group who had sex reported were male. The validation data set showed MS-QMA sensitivity of 99.0% for PWS, 93.8% for AS, and 77.8% for Dup15q; specificity of 100% for PWS, AS, and Dup15q; positive predictive and negative predictive values of 100% for PWS and AS; and a positive predictive value of 87.5% and negative predictive value of 100% for Dup15q. In the test data set of NBS samples from 16 579 infants, 92 had a positive test result using a methylation ratio cut-off of 3 standard deviations from the mean. Of these patients, 2 were confirmed to have PWS; 2, AS; and 1, maternal Dup15q. With the use of more conservative PWS- and AS-specific thresholds for positive calls from the validation data set, 9 positive NBS results were identified by MS-QMA in this cohort. The 2 PWS and 2 AS calls were confirmed by second-tier testing, but the 1 Dup15q case was not confirmed. Together, these results provided prevalence estimates of 1 in 8290 for both AS and PWS and 1 in 16 579 for maternal Dup15q, with positive predictive values for first-tier testing at 67.0% for AS, 33.0% for PWS, and 44.0% for combined detection of chromosome 15 imprinting disorders for the validation data set. CONCLUSIONS AND RELEVANCE The findings of this diagnostic study suggest that it is feasible to screen for all chromosome 15 imprinting disorders using SNRPN methylation analysis, with 5 individuals identified with these disorders out of 16 579 infants screened.
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Affiliation(s)
- David E. Godler
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- E.D.G. Innovations and Consulting, St Kilda, Victoria, Australia
| | - Ling Ling
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
| | - Dinusha Gamage
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
| | - Emma K. Baker
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Michael J. Field
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, New South Wales, Australia
| | - Carolyn Rogers
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, New South Wales, Australia
| | - Merlin G. Butler
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, University of Kansas Medical Centre, Kansas City, Kansas
| | - Alessandra Murgia
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Emanuela Leonardi
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Roberta Polli
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Charles E. Schwartz
- Center for Molecular Studies, J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, South Carolina
| | - Cindy D. Skinner
- Center for Molecular Studies, J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, South Carolina
| | - Angelica M. Alliende
- Cytogenetics and Molecular Laboratory, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
- Centre for Diagnosis and Treatment of Fragile X Syndrome (CDTSXF), INTA University of Chile, Santiago, Chile
| | - Lorena Santa Maria
- Cytogenetics and Molecular Laboratory, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
- Centre for Diagnosis and Treatment of Fragile X Syndrome (CDTSXF), INTA University of Chile, Santiago, Chile
| | - James Pitt
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Ronda Greaves
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - David Francis
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Min Wang
- Translational Bioinformatics, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Cas Simons
- Translational Bioinformatics, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - David J. Amor
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
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McCandless SE, Wright EJ. Mandatory newborn screening in the United States: History, current status, and existential challenges. Birth Defects Res 2021; 112:350-366. [PMID: 32115905 DOI: 10.1002/bdr2.1653] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/12/2020] [Accepted: 01/17/2020] [Indexed: 01/09/2023]
Abstract
Beginning in the 1960s, mandatory newborn screening (NBS) of essentially all infants has been a major public health success story. NBS is not just a blood test, rather, it is a complex, integrated system that begins with timely testing, scrupulous follow up of patients, tracking of outcomes, quality improvement of all aspects of the process, and education of providers, staff, and parents. In the past, expansion of NBS programs has been driven by new testing technology, but now is increasingly driven by the development of novel therapeutics and political advocacy. Each state determines how the NBS system will be structured in that state, but there is increasing oversight and support for harmonization at a federal level. Several recent initiatives, together with the increased number of conditions screened and the concomitant increase in burdensome false-positive tests, are creating new scrutiny of NBS systems, and potentially pose an existential risk to the public acceptance of mandatory NBS. The history, current state and challenges for NBS are explored in this issue, with some suggestions as to how to address them.
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Affiliation(s)
- Shawn E McCandless
- Department of Pediatrics, Section of Genetics and Metabolism, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erica J Wright
- Department of Pediatrics, Section of Genetics and Metabolism, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Shum BOV, Bennett G, Navilebasappa A, Kumar RK. Racially equitable diagnosis of cystic fibrosis using next-generation DNA sequencing: a case report. BMC Pediatr 2021; 21:154. [PMID: 33789612 PMCID: PMC8011156 DOI: 10.1186/s12887-021-02609-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cystic Fibrosis (CF) is one of the most prevalent autosomal recessive inherited disease in Caucasians. Rates of CF were thought to be negligible in non-Caucasians but growing epidemiological evidence shows CF is more common in Indian, African, Hispanic, Asian, and other ethnic groups than previously thought. Almost all second-tier molecular diagnostic tools currently used to confirm the diagnosis of CF consist of panels of the most common CF-causing DNA variants in Caucasians. However non-Caucasian individuals with CF often have a different spectrum of pathogenic variants than Caucasians, limiting the clinical utility of existing molecular diagnostic panels in this group. As a consequence of racially inequitable CF testing frameworks, non-Caucasians with CF encounter greater delays in diagnosis and associated harms than Caucasians. An unbiased approach of detecting CF-causing DNA variants using full gene sequencing could potentially address racial inequality in current CF testing. Case presentation We present the case of a female baby from rural India who had a borderline first-tier newborn screening result for CF. Instead of choosing a targeted CF panel for second-tier testing, we used next-generation DNA sequencing to comprehensively analyze the cystic fibrosis transmembrane conductance regulator gene as an unbiased approach for molecular confirmation of CF. Sequencing identified two pathogenic variants that cause CF. One variant (c.1521_1523delCTT) is the most common cause of CF, while the other variant (c.870-1G > C) is absent from all population allele databases and has not been found in the Indian population previously. The rare variant would not have been detected by all currently available targeted CF panels used for second- or third-tier molecular CF testing. Conclusions Our use of full gene sequencing as a second-tier CF test in a non-Caucasian patient avoided the problems of missed diagnosis from using Caucasian-biased targeted CF panels currently recommended for second-tier testing. Full gene sequencing should be considered as the standard methodology of second-tier CF testing to enable equal opportunity for CF diagnosis in non-Caucasians.
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Affiliation(s)
- Bennett O V Shum
- Preventive Health Division, Genepath, 302B 7 Help St, Chatswood, NSW, Australia. .,EMBL Australia Node in Single Molecule Science, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
| | - Glenn Bennett
- Preventive Health Division, Genepath, 302B 7 Help St, Chatswood, NSW, Australia
| | | | - R Kishore Kumar
- Cloudnine Hospitals, 1533, 3rd Block, Jayanagar, Bengaluru, Karnataka, India
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17
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Lin D, Yang SW, Hsieh CL, Hsu KJ, Gong T, Wu Q, Qiu S, Feng S, Kong KV. Tandem Quantification of Multiple Carbohydrates in Saliva Using Surface-Enhanced Raman Spectroscopy. ACS Sens 2021; 6:1240-1247. [PMID: 33560111 DOI: 10.1021/acssensors.0c02533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The detection of carbohydrates in human body fluids is critical for disease diagnosis and healthy monitoring. Despite recent advances in glucose sensing, multiplex detection of different carbohydrates within a single assay that is capable of efficiently providing richer health information remains challenging. Herein, we report a versatile surface-enhanced Raman spectroscopy-based platform for the quantitative detection of monosaccharides (glucose, fructose, and galactose) in one test using a displace-and-trap mechanism. Moreover, due to the use of multiple optical interference-free (1800-2200 cm-1) signal-independent Raman probes, the detection range of this platform (0.125-7 mg/dL) perfectly covers physiological concentrations, enabling the quantitative detection of glucose and galactose in clinical human saliva samples. This work provides a noninvasive and high-efficiency potential tool for the screening of clinical diabetes and other carbohydrate-related diseases.
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Affiliation(s)
- Duo Lin
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Digital Fujian Internet-of-Things Laboratory of Environment Monitoring, Fujian Normal University, Fuzhou 350007, China
| | - Shang-Wei Yang
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Chang-Lin Hsieh
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Keng-Jia Hsu
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
| | - Tianxun Gong
- State Key Laboratory of Electronic Thin Films and Integrated Devices, School of Electronic Science and Engineering (National Exemplary School of Microelectronics), University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Qiong Wu
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Digital Fujian Internet-of-Things Laboratory of Environment Monitoring, Fujian Normal University, Fuzhou 350007, China
| | - Sufang Qiu
- Department of Radiation Oncology, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou 350014, China
| | - Shangyuan Feng
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Digital Fujian Internet-of-Things Laboratory of Environment Monitoring, Fujian Normal University, Fuzhou 350007, China
| | - Kien Voon Kong
- Department of Chemistry, National Taiwan University, Taipei 10617, Taiwan
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De Bruyne S, Speeckaert MM, Van Biesen W, Delanghe JR. Recent evolutions of machine learning applications in clinical laboratory medicine. Crit Rev Clin Lab Sci 2020; 58:131-152. [PMID: 33045173 DOI: 10.1080/10408363.2020.1828811] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Machine learning (ML) is gaining increased interest in clinical laboratory medicine, mainly triggered by the decreased cost of generating and storing data using laboratory automation and computational power, and the widespread accessibility of open source tools. Nevertheless, only a handful of ML-based products are currently commercially available for routine clinical laboratory practice. In this review, we start with an introduction to ML by providing an overview of the ML landscape, its general workflow, and the most commonly used algorithms for clinical laboratory applications. Furthermore, we aim to illustrate recent evolutions (2018 to mid-2020) of the techniques used in the clinical laboratory setting and discuss the associated challenges and opportunities. In the field of clinical chemistry, the reviewed applications of ML algorithms include quality review of lab results, automated urine sediment analysis, disease or outcome prediction from routine laboratory parameters, and interpretation of complex biochemical data. In the hematology subdiscipline, we discuss the concepts of automated blood film reporting and malaria diagnosis. At last, we handle a broad range of clinical microbiology applications, such as the reduction of diagnostic workload by laboratory automation, the detection and identification of clinically relevant microorganisms, and the detection of antimicrobial resistance.
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Affiliation(s)
- Sander De Bruyne
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | | | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Joris R Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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19
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Rozmarič T, Mitulović G, Konstantopoulou V, Goeschl B, Huemer M, Plecko B, Spenger J, Wortmann SB, Scholl-Bürgi S, Karall D, Greber-Platzer S, Zeyda M. Elevated Homocysteine after Elevated Propionylcarnitine or Low Methionine in Newborn Screening Is Highly Predictive for Low Vitamin B12 and Holo-Transcobalamin Levels in Newborns. Diagnostics (Basel) 2020; 10:diagnostics10090626. [PMID: 32846920 PMCID: PMC7555675 DOI: 10.3390/diagnostics10090626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022] Open
Abstract
Early diagnostics and treatment of vitamin B12 deficiency (B12D) in infants, mainly maternally conditioned, is crucial in preventing possible developmental delay and neurological deficits. Currently, B12D is rarely listed in regular newborn screening panels and mostly regarded as an incidental finding. The aim of this study was to evaluate a targeted newborn screening strategy for detection of suspected B12D. A decision strategy based on the primary parameters propionylcarnitine and methionine for selection of samples to be analyzed for total homocysteine by mass spectrometry was established. Therefore, 93,116 newborns were initially screened. Concentrations of vitamin B12 and holotranscobalamin in serum were obtained from clinical follow-up analyses of recalled newborns. Moreover, an extremely sensitive mass spectrometric method to quantify methylmalonic acid from the dried blood spots was developed. Overall, 0.15% of newborns were screened positive for suspected B12D, of which 64% had vitamin B12 concentrations below 148 pM. We also determined a cutoff value for methylmalonic acid in dried blood spots indicative for B12D in infants. Overall, we calculated a prevalence of 92/100,000 for suspected B12D in the Austrian newborns. In conclusion, we present a screening algorithm including second-tier measurement of total homocysteine that allows detection of low B12 serum concentrations with a high detection rate and low false-positive rate.
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Affiliation(s)
- Tomaž Rozmarič
- Austrian Newborn Screening, Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (V.K.); (B.G.); (S.G.-P.)
| | - Goran Mitulović
- Clinical Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Vassiliki Konstantopoulou
- Austrian Newborn Screening, Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (V.K.); (B.G.); (S.G.-P.)
| | - Bernadette Goeschl
- Austrian Newborn Screening, Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (V.K.); (B.G.); (S.G.-P.)
| | - Martina Huemer
- Department of Paediatrics, Landeskrankenhaus Bregenz, 6900 Bregenz, Austria;
- Division of Metabolism and Children’s Research Center, University Children’s Hospital, 8032 Zürich, Switzerland
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, University Childrens’ Hospital Graz, Medical University Graz, 8036 Graz, Austria;
| | - Johannes Spenger
- University Children’s Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (J.S.); (S.B.W.)
| | - Saskia B. Wortmann
- University Children’s Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (J.S.); (S.B.W.)
| | - Sabine Scholl-Bürgi
- Department of Pediatrics I (Inherited Metabolic Disorders), Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.S.-B.); (D.K.)
| | - Daniela Karall
- Department of Pediatrics I (Inherited Metabolic Disorders), Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.S.-B.); (D.K.)
| | - Susanne Greber-Platzer
- Austrian Newborn Screening, Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (V.K.); (B.G.); (S.G.-P.)
| | - Maximilian Zeyda
- Austrian Newborn Screening, Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (V.K.); (B.G.); (S.G.-P.)
- Correspondence: ; Tel.: +43-1-40400-32050
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20
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Demirelce Ö, Aksungar FB, Saral NY, Kilercik M, Serteser M, Unsal I. Institutional experience of newborn screening for inborn metabolism disorders by tandem MS in the Turkish population. J Pediatr Endocrinol Metab 2020; 33:703-711. [PMID: 32469332 DOI: 10.1515/jpem-2019-0571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/07/2020] [Indexed: 12/26/2022]
Abstract
Background The tandem mass spectrometry method in the screening of congenital metabolic disorders is not included in routine national newborn screening programmes in Turkey. To evaluate the distribution of acylcarnitines and amino acid levels in normal newborns, establish acylcarnitine and amino acid cut-off levels and further preliminary results of inherited metabolic disorders inferentially in the Turkish population. Methods Newborn screening tests performed by tandem MS from 2016 to 2018 were retrospectively reviewed. The study group included 17,066 newborns born in our hospitals located in various regions of Turkey. Blood samples were obtained from infants older than 24 h of age. Among the 17,066 newborns, the metabolic screening data of 9,994 full-term newborns (>37 weeks) were employed to obtain the percentile distribution of the normal population. The study group (17,066) was screened for 26 types of inborn error of metabolism. Results Our established cut-offs, were compared with the cut-offs determined by Region for Stork Study and Centers for Disease Control. Among the 26 screened disorders, a total of 12 cases (8 amino acid metabolism disorders, 1 urea cycle defect, 2 organic acidaemias and 1 fatty acid oxidation disorder) were identified. Conclusions Because of the high rate of consanguineous marriages in Turkey, the development of a nationwide screening panel is necessary for early detection and management of potentially treatable inherited metabolic disorders.
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MESH Headings
- Amino Acid Metabolism, Inborn Errors/blood
- Amino Acid Metabolism, Inborn Errors/diagnosis
- Amino Acid Metabolism, Inborn Errors/epidemiology
- Consanguinity
- Early Diagnosis
- Female
- Humans
- Infant
- Infant, Newborn
- Lipid Metabolism, Inborn Errors/blood
- Lipid Metabolism, Inborn Errors/diagnosis
- Lipid Metabolism, Inborn Errors/epidemiology
- Male
- Metabolism, Inborn Errors/blood
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/epidemiology
- Neonatal Screening/methods
- Retrospective Studies
- Tandem Mass Spectrometry
- Turkey/epidemiology
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Affiliation(s)
- Özlem Demirelce
- Clinical Biochemistry Specialist, Acibadem Labmed Clinical Laboratories, Acibadem University, İçerenköy Mah. Kayışdağı Cad. N0:32-36/B, 34752, Ataşehir, İstanbul, Turkey
| | - Fehime Benli Aksungar
- Department of Metabolism, Acibadem Labmed Clinical Laboratories, İstanbul, Turkey
- Department of Biochemistry, School of Medicine, Acibadem University, İstanbul, Turkey
| | | | - Meltem Kilercik
- Department of Biochemistry, School of Medicine, Acibadem University, İstanbul, Turkey
- Department of Biochemistry, Acibadem Universitesi, İstanbul, Turkey
| | - Mustafa Serteser
- Department of Biochemistry, School of Medicine, Acibadem University, İstanbul, Turkey
- Medical Biochemistry, School of Medicine, Acibadem University, İstanbul, Turkey
| | - Ibrahim Unsal
- Medical Biochemistry, School of Medicine, Acibadem University, İstanbul, Turkey
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21
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Harpavat S, Garcia-Prats JA, Anaya C, Brandt ML, Lupo PJ, Finegold MJ, Obuobi A, ElHennawy AA, Jarriel WS, Shneider BL. Diagnostic Yield of Newborn Screening for Biliary Atresia Using Direct or Conjugated Bilirubin Measurements. JAMA 2020; 323:1141-1150. [PMID: 32207797 PMCID: PMC7093763 DOI: 10.1001/jama.2020.0837] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Treating biliary atresia in newborns earlier can delay or prevent the need for liver transplant; however, treatment typically occurs later because biliary atresia is difficult to detect during its early stages. OBJECTIVE To determine the diagnostic yield of newborn screening for biliary atresia with direct or conjugated bilirubin measurements and to evaluate the association of screening implementation with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional screening study of 124 385 infants born at 14 Texas hospitals between January 2015 and June 2018; and a pre-post study of 43 infants who underwent the Kasai portoenterostomy as treatment for biliary atresia at the region's largest pediatric hepatology center before (January 2008-June 2011) or after (January 2015-June 2018) screening implementation. Final follow-up occurred on July 15, 2019. EXPOSURES Two-stage screening with direct or conjugated bilirubin measurements. In stage 1, all newborns were tested within the first 60 hours of life, with a positive screening result defined as bilirubin levels exceeding derived 95th percentile reference intervals. In stage 2, infants who had a positive screening result in stage 1 were retested at or before the 2-week well-child visit, with a positive screening result defined as bilirubin levels greater than the stage 1 result or greater than 1 mg/dL. MAIN OUTCOMES AND MEASURES The primary outcomes of the screening study were sensitivity, specificity, positive predictive value, and negative predictive value based on infants testing positive in both stages. The reference standard was biliary atresia diagnosed at the region's pediatric hepatology centers. The primary outcome of the pre-post study was the age infants underwent the Kasai portoenterostomy for treatment of biliary atresia. RESULTS Of 124 385 newborns in the screening study, 49.2% were female, 87.6% were of term gestational age, 70.0% were white, and 48.1% were Hispanic. Screening identified the 7 known infants with biliary atresia with a sensitivity of 100% (95% CI, 56.1%-100.0%), a specificity of 99.9% (95% CI, 99.9%-99.9%), a positive predictive value of 5.9% (95% CI, 2.6%-12.2%), and a negative predictive value of 100.0% (95% CI, 100.0%-100.0%). In the pre-post study, 24 infants were treated before screening implementation and 19 infants were treated after screening implementation (including 6 of 7 from the screening study, 7 from screening at nonstudy hospitals, and 6 from referrals because of clinical symptoms). The age infants underwent the Kasai portoenterostomy was significantly younger after screening was implemented (mean age, 56 days [SD, 19 days] before screening implementation vs 36 days [SD, 22 days] after screening implementation; between-group difference, 19 days [95% CI, 7-32 days]; P = .004). CONCLUSIONS AND RELEVANCE Newborn screening with direct or conjugated bilirubin measurements detected all known infants with biliary atresia in the study population, although the 95% CI around the sensitivity estimate was wide and the study design did not ensure complete ascertainment of false-negative results. Research is needed in larger populations to obtain more precise estimates of diagnostic yield and to better understand the clinical outcomes and cost-effectiveness of this screening approach.
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Affiliation(s)
- Sanjiv Harpavat
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Joseph A. Garcia-Prats
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Carlos Anaya
- University of Texas Rio Grande Valley School of Medicine and Doctors Hospital at Renaissance, Edinburg
| | - Mary L. Brandt
- Department of Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Philip J. Lupo
- Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | | | - Alice Obuobi
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Adel A. ElHennawy
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | | | - Benjamin L. Shneider
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
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Abstract
Newborn screening (NBS) for inborn metabolic disorders is a highly successful public health program that by design is accompanied by false-positive results. Here we trained a Random Forest machine learning classifier on screening data to improve prediction of true and false positives. Data included 39 metabolic analytes detected by tandem mass spectrometry and clinical variables such as gestational age and birth weight. Analytical performance was evaluated for a cohort of 2777 screen positives reported by the California NBS program, which consisted of 235 confirmed cases and 2542 false positives for one of four disorders: glutaric acidemia type 1 (GA-1), methylmalonic acidemia (MMA), ornithine transcarbamylase deficiency (OTCD), and very long-chain acyl-CoA dehydrogenase deficiency (VLCADD). Without changing the sensitivity to detect these disorders in screening, Random Forest-based analysis of all metabolites reduced the number of false positives for GA-1 by 89%, for MMA by 45%, for OTCD by 98%, and for VLCADD by 2%. All primary disease markers and previously reported analytes such as methionine for MMA and OTCD were among the top-ranked analytes. Random Forest's ability to classify GA-1 false positives was found similar to results obtained using Clinical Laboratory Integrated Reports (CLIR). We developed an online Random Forest tool for interpretive analysis of increasingly complex data from newborn screening.
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Karsli T, Jain VG, Mhanna M, Wu Q, Pepkowitz SH, Chandler DW, Shekhawat PS. Assessment of adrenal function at birth using adrenal glucocorticoid precursor to product ratios to predict short-term neonatal outcomes. Pediatr Res 2020; 87:767-772. [PMID: 31645056 DOI: 10.1038/s41390-019-0629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most neonatal outcomes in neonates are related to normal adrenal gland function. Assessment of adrenal function in a sick preterm neonate remains a challenge, thus we hypothesized that adrenal steroid precursors to their product ratios have a direct relationship with neonatal outcomes. METHODS We studied demographics of pregnancy and neonatal outcomes in 99 mother-infant pairs (24-41 weeks) and assayed 7 glucocorticoid precursors in the cortisol biosynthesis/degradation pathway. We correlated antenatal factors and short-term neonatal outcomes with these precursors and their ratios to assess maturity of individual enzymes. RESULTS We found no correlation between cortisol levels with antenatal factors and outcomes. Antenatal steroid use impacted several cortisol precursors. 17-OH pregnenolone-to-cortisol ratio at birth was the best predictor of short-term neonatal outcomes, such as hypotension, RDS, IVH and PDA. A cord blood 17-OH pregnenolone:cortisol ratio of <0.21 predicts which neonate will have a normal outcome with a high sensitivity and specificity. CONCLUSIONS Maternal factors and antenatal steroids impact neonatal adrenal function and leads to maturation of adrenal function. 17-OH pregnenolone:cortisol ratio and not cortisol is the best predictor of adrenal function. Adrenal function can be assessed by evaluating the profile of adrenal steroids.
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Affiliation(s)
- Tijen Karsli
- Department of Pediatrics (Neonatology), East Carolina University, Greenville, NC, USA
| | - Viral G Jain
- Perinatal Research Institute, Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Maroun Mhanna
- Department of Pediatrics (Neonatology), MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | | | | | - Prem S Shekhawat
- Department of Pediatrics (Neonatology), MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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Klug TL, Swartz LB, Washburn J, Brannen C, Kiesling JL. Lessons Learned from Pompe Disease Newborn Screening and Follow-up. Int J Neonatal Screen 2020; 6:11. [PMID: 33073009 PMCID: PMC7422965 DOI: 10.3390/ijns6010011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
In 2015, Pompe disease became the first lysosomal storage disorder to be recommended for universal newborn screening by the Secretary of the U.S. Department of Health and Human Services. Newborn screening for Pompe has been implemented in 20 states and several countries across the world. The rates of later-onset disease phenotypes for Pompe and pseudodeficiency alleles are higher than initially anticipated, and these factors must be considered during Pompe disease newborn screening. This report presents an overview of six years of data from the Missouri State Public Health Laboratory for Pompe disease newborn screening and follow-up.
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Affiliation(s)
- Tracy L. Klug
- Missouri Department of Health and Senior Services, P.O. Box 570, Jefferson City, MO 65102-0570, USA
| | - Lori B. Swartz
- Missouri Department of Health and Senior Services, P.O. Box 570, Jefferson City, MO 65102-0570, USA
| | - Jon Washburn
- Baebies, Inc., P.O. Box 14403, Durham, NC 27709, USA
| | | | - Jami L. Kiesling
- Missouri Department of Health and Senior Services, P.O. Box 570, Jefferson City, MO 65102-0570, USA
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Ismail IT, Showalter MR, Fiehn O. Inborn Errors of Metabolism in the Era of Untargeted Metabolomics and Lipidomics. Metabolites 2019; 9:metabo9100242. [PMID: 31640247 PMCID: PMC6835511 DOI: 10.3390/metabo9100242] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/30/2022] Open
Abstract
Inborn errors of metabolism (IEMs) are a group of inherited diseases with variable incidences. IEMs are caused by disrupting enzyme activities in specific metabolic pathways by genetic mutations, either directly or indirectly by cofactor deficiencies, causing altered levels of compounds associated with these pathways. While IEMs may present with multiple overlapping symptoms and metabolites, early and accurate diagnosis of IEMs is critical for the long-term health of affected subjects. The prevalence of IEMs differs between countries, likely because different IEM classifications and IEM screening methods are used. Currently, newborn screening programs exclusively use targeted metabolic assays that focus on limited panels of compounds for selected IEM diseases. Such targeted approaches face the problem of false negative and false positive diagnoses that could be overcome if metabolic screening adopted analyses of a broader range of analytes. Hence, we here review the prospects of using untargeted metabolomics for IEM screening. Untargeted metabolomics and lipidomics do not rely on predefined target lists and can detect as many metabolites as possible in a sample, allowing to screen for many metabolic pathways simultaneously. Examples are given for nontargeted analyses of IEMs, and prospects and limitations of different metabolomics methods are discussed. We conclude that dedicated studies are needed to compare accuracy and robustness of targeted and untargeted methods with respect to widening the scope of IEM diagnostics.
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Affiliation(s)
- Israa T Ismail
- National Liver Institute, Menoufia University, Shebeen El Kom 55955, Egypt.
- NIH West Coast Metabolomics Center, University of California Davis, Davis, CA 95616, USA.
| | - Megan R Showalter
- NIH West Coast Metabolomics Center, University of California Davis, Davis, CA 95616, USA.
| | - Oliver Fiehn
- NIH West Coast Metabolomics Center, University of California Davis, Davis, CA 95616, USA.
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Wisconsin's Screening Algorithm for the Identification of Newborns with Congenital Adrenal Hyperplasia. Int J Neonatal Screen 2019; 5:33. [PMID: 33072992 PMCID: PMC7510207 DOI: 10.3390/ijns5030033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/02/2019] [Indexed: 11/29/2022] Open
Abstract
Newborn screening for congenital adrenal hyperplasia (CAH) has one of the highest false positive rates of any of the diseases on the Wisconsin panel. This is largely due to the first-tier immune assay cross-reactivity and physiological changes in the concentration of 17-hydroxyprogesterone during the first few days of life. To improve screening for CAH, Wisconsin developed a second-tier assay to quantify four different steroids (17-hydroxyprogesterone, 21-deoxycortisol, androstenedione, and cortisol) by liquid chromatography-tandem mass spectrometry (LC-MSMS) in dried blood spots. From validation studies which included the testing of confirmed CAH patients, Wisconsin established its own reporting algorithm that incorporates steroid concentrations as well as two different ratios-the birth weight and the collection time-to identify babies at risk for CAH. Using the newly developed method and algorithm, the false positive rate for the CAH screening was reduced by 95%. Patients with both classical forms of CAH, salt-wasting and simple virilizing, were identified. This study replicates and expands upon previous work to develop a second-tier LC-MSMS steroid profiling screening assay for CAH. The validation and prospective study results provide evidence for an extensive reporting algorithm that incorporates multiple steroids, birth weight, and collection times.
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Including ELSI research questions in newborn screening pilot studies. Genet Med 2018; 21:525-533. [PMID: 30100612 DOI: 10.1038/s41436-018-0101-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The evidence review processes for adding new conditions to state newborn screening (NBS) panels rely on data from pilot studies aimed at assessing the potential benefits and harms of screening. However, the consideration of ethical, legal, and social implications (ELSI) of screening within this research has been limited. This paper outlines important ELSI issues related to newborn screening policy and practices as a resource to help researchers integrate ELSI into NBS pilot studies. APPROACH Members of the Bioethics and Legal Workgroup for the Newborn Screening Translational Research Network facilitated a series of professional and public discussions aimed at engaging NBS stakeholders to identify important existing and emerging ELSI challenges accompanying NBS. RESULTS Through these engagement activities, we identified a set of key ELSI questions related to (1) the types of results parents may receive through newborn screening and (2) the initiation and implementation of NBS for a condition within the NBS system. CONCLUSION Integrating ELSI questions into pilot studies will help NBS programs to better understand the potential impact of screening for a new condition on newborns and families, and make crucial policy decisions aimed at maximized benefits and mitigating the potential negative medical or social implications of screening.
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Cao J, Sonilal M, Roper SM, Ali M, Devaraj S. Evaluation of a multiplex liquid chromatography-tandem mass spectrometry method for congenital adrenal hyperplasia in pediatric patients. CLINICAL MASS SPECTROMETRY 2018. [DOI: 10.1016/j.clinms.2018.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
West syndrome (WS) is an early life epileptic encephalopathy associated with infantile spasms, interictal electroencephalography (EEG) abnormalities including high amplitude, disorganized background with multifocal epileptic spikes (hypsarrhythmia), and often neurodevelopmental impairments. Approximately 64% of the patients have structural, metabolic, genetic, or infectious etiologies and, in the rest, the etiology is unknown. Here we review the contribution of etiologies due to various metabolic disorders in the pathology of WS. These may include metabolic errors in organic molecules involved in amino acid and glucose metabolism, fatty acid oxidation, metal metabolism, pyridoxine deficiency or dependency, or acidurias in organelles such as mitochondria and lysosomes. We discuss the biochemical, clinical, and EEG features of these disorders as well as the evidence of how they may be implicated in the pathogenesis and treatment of WS. The early recognition of these etiologies in some cases may permit early interventions that may improve the course of the disease.
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Affiliation(s)
- Seda Salar
- Laboratory of Developmental EpilepsySaul R. Korey Department of NeurologyMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
| | - Solomon L. Moshé
- Laboratory of Developmental EpilepsySaul R. Korey Department of NeurologyMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
- Dominick P. Purpura Department of NeuroscienceMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
- Department of PediatricsMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
| | - Aristea S. Galanopoulou
- Laboratory of Developmental EpilepsySaul R. Korey Department of NeurologyMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
- Dominick P. Purpura Department of NeuroscienceMontefiore/Einstein Epilepsy CenterAlbert Einstein College of MedicineBronxNew YorkU.S.A.
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Winter T, Lange A, Hannemann A, Nauck M, Müller C. Contamination of dried blood spots – an underestimated risk in newborn screening. ACTA ACUST UNITED AC 2017; 56:278-284. [DOI: 10.1515/cclm-2017-0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Newborn screening (NBS) is an established screening procedure in many countries worldwide, aiming at the early detection of inborn errors of metabolism. For decades, dried blood spots have been the standard specimen for NBS. The procedure of blood collection is well described and standardized and includes many critical pre-analytical steps. We examined the impact of contamination of some anticipated common substances on NBS results obtained from dry spot samples. This possible pre-analytical source of uncertainty has been poorly examined in the past.
Methods:
Capillary blood was obtained from 15 adult volunteers and applied to 10 screening filter papers per volunteer. Nine filter papers were contaminated without visible trace. The contaminants were baby diaper rash cream, baby wet wipes, disinfectant, liquid infant formula, liquid infant formula hypoallergenic (HA), ultrasonic gel, breast milk, feces, and urine. The differences between control and contaminated samples were evaluated for 45 NBS quantities. We estimated if the contaminations might lead to false-positive NBS results.
Results:
Eight of nine investigated contaminants significantly altered NBS analyte concentrations and potentially caused false-positive screening outcomes. A contamination with feces was most influential, affecting 24 of 45 tested analytes followed by liquid infant formula (HA) and urine, affecting 19 and 13 of 45 analytes, respectively.
Conclusions:
A contamination of filter paper samples can have a substantial effect on the NBS results. Our results underline the importance of good pre-analytical training to make the staff aware of the threat and ensure reliable screening results.
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Affiliation(s)
- Theresa Winter
- Institute of Clinical Chemistry and Laboratory Medicine , University Medicine Greifswald , Greifswald , Germany
| | - Anja Lange
- Hospital for Paediatric and Adolescent Medicine, University Medicine Greifswald , Greifswald , Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine , University Medicine Greifswald , Greifswald , Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine , University Medicine Greifswald , Greifswald , Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald , Greifswald , Germany
| | - Cornelia Müller
- Institute of Clinical Chemistry and Laboratory Medicine , University Medicine Greifswald , Greifswald , Germany
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Mehran L, Khalili D, Yarahmadi S, Amouzegar A, Mojarrad M, Ajang N, Azizi F. Worldwide Recall Rate in Newborn Screening Programs for Congenital Hypothyroidism. Int J Endocrinol Metab 2017; 15:e55451. [PMID: 29201074 PMCID: PMC5702453 DOI: 10.5812/ijem.55451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Neonatal mass screening program for congenital hypothyroidism provides the best tool for prevention of its devastating effects on mental development. Despite the overall success of the screening programs in detecting congenital hypothyroidism and eliminating its sequelae and new developments made in the program design, high recall rate and false positive results impose a great challenge worldwide. Lower recall rate and false positive results may properly organize project expenses by reducing the unnecessary repeated laboratory tests, increase physicians and parents' assurance and cooperation, as well as reduce the psychological effects in families. EVIDENCE ACQUISITION In this review, we assessed the recall rate in different programs and its risk factors worldwide. METHODS Publications reporting the results of the CH screening program from 1997 to 2016 focusing on the recall rate have been searched. RESULTS Recall rates vary from 0.01% to 13.3% in different programs; this wide range may be due to different protocols of screening (use of T4 or TSH or both), different laboratory techniques, site of sample collection, recall cutoff, iodine status, human error, and even CH incidence as affected by social, cultural, and regional factors of the population. CONCLUSIONS It is suggested to implement suitable interventions to reduce the contributing factors by improving the quality of laboratory tests, selecting conservative cut off points, control iodine deficiency, use of iodine free antiseptic during delivery, and use of more specific markers or molecular tests. Applying an age dependent criteria for thyrotropin levels can be helpful in regions with a varied time of discharge after delivery or for preterm babies.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Shahin Yarahmadi
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Mojarrad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Ajang
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Fereidoun Azizi, Professor of Internal Medicine and Endocrinology, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-2122432503, Fax: +98-2122402463, E-mail:
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Yang L, Zhang Y, Yang J, Huang X. Effects of birth weight on profiles of dried blood amino-acids and acylcarnitines. Ann Clin Biochem 2017; 55:92-99. [PMID: 29064274 DOI: 10.1177/0004563216688038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Birth weight influences profiles of dried blood amino-acids and acylcarnitines in newborn screening. This study aimed to define a more appropriate cut-off value to reduce the false positive rate and the number of recalled patients in newborn screening. Methods All babies who underwent newborn screening in our center were included; they were divided into groups by birth weight: 2500–3999 g (comparator group), <1000 g (group 1), 1000–1499 g (group 2), 1500–2499 g (group 3), and >4000 g (group 4). The 0.5th and 99.5th percentiles were used as the cut-off values. Comparisons were done on amino acid and acylcarnitines concentrations between the groups. False positive rate, positive predictive value, corrected false positive rate by birth weights were determined. Results Data on a total of 578,287 newborn infants were included in the analysis. The total false positive rate was 0.75%, and positive predictive value 2.89%. The false positive rate was 0.69%, 0.54% and 5.31% in infants with normal birth weight, birth weight of >4000 (group 4) and low birth weight of < 2500 g (groups 1, 2 and 3), respectively. Low-birth weight infants had much higher phenylalanine, tyrosine, methionine, arginine, propionylcarnitine, isovalerylcarnitine and octadecanoylcarnitine concentrations. Free carnitines and palmitoylcarnitine concentrations were lower. After adjusting for birth weight, false positive rate of all indices decreased to 0.53%, and positive predictive value increased to 4.31%. Conclusions Amino acid and carnitine concentrations in low-birth weight newborn infants may differ from the normal term newborn infants. The cut-off values of individual metabolites should be adjusted based on birth weight, to reduce false positive rate and increase positive predictive value.
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Affiliation(s)
- Lili Yang
- Department of Genetics and Metabolism, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Zhang
- Department of Genetics and Metabolism, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbin Yang
- Department of Genetics and Metabolism, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinwen Huang
- Department of Genetics and Metabolism, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Neonatal screening for congenital adrenal hyperplasia in Southern Brazil: a population based study with 108,409 infants. BMC Pediatr 2017; 17:22. [PMID: 28095810 PMCID: PMC5240440 DOI: 10.1186/s12887-016-0772-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/30/2016] [Indexed: 12/01/2022] Open
Abstract
Background Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder associated with inborn errors of steroid metabolism. 21-hydroxylase enzyme deficiency occurs in 90 to 95% of all cases of CAH, with accumulation of 17 hydroxyprogesterone (17-OHP). Early diagnosis of CAH based on newborn screening is possible before the development of symptoms and allows proper treatment, correct sex assignment, and reduced mortality rates. This study describes the results obtained in the first year of a public CAH screening program in the state of Rio Grande do Sul, Brazil. Methods We reviewed the screening database in search of babies with suspected CAH, that is, altered birth-weight adjusted 17-OHP values at screening. The following data were analyzed for this population: screening 17-OHP values, retest 17-OHP values, serum 17-OHP values for those with confirmed CAH on retest, maternal and newborn data, and family history of CAH. For the screening program, 17-OHP levels are determined on dried blood spots obtained in filter paper with GSP solid phase time-resolved immunofluorescence. Results Of 108,409 newborns screened, eight were diagnosed with CAH (four males, four females). The incidence of CAH in the state was 1:13,551. Six cases were identified as classic salt-wasting CAH and two were cases of virilizing CAH. The positive predictive value (PPV) of the initial screening (before diagnostic confirmation) was 1.6%. The overall rate of false positive results was 0.47%. The number of false positive results was higher among newborns with birth weight < 2000 g. Conclusion The present results support the need for CAH screening by the public health care system in the state, and show that the strategy adopted is adequate. PPV and false positive results were similar to those reported for other states of Brazil with similar ethnic backgrounds.
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Kim B, Lee MN, Park HD, Kim JW, Chang YS, Park WS, Lee SY. Dried blood spot testing for seven steroids using liquid chromatography-tandem mass spectrometry with reference interval determination in the Korean population. Ann Lab Med 2016; 35:578-85. [PMID: 26354345 PMCID: PMC4579101 DOI: 10.3343/alm.2015.35.6.578] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/03/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Conventional screening for congenital adrenal hyperplasia (CAH) using immunoassays generates a large number of false-positive results. A more specific liquid chromatography-tandem mass spectrometry (LC-MS/MS) method has been introduced to minimize unnecessary follow-ups. However, because of limited data on its use in the Korean population, LC-MS/MS has not yet been incorporated into newborn screening programs in this region. The present study aims to develop and validate an LC-MS/MS method for the simultaneous determination of seven steroids in dried blood spots (DBS) for CAH screening, and to define age-specific reference intervals in the Korean population. Methods We developed and validated an LC-MS/MS method to determine the reference intervals of cortisol, 17-hydroxyprogesterone, 11-deoxycortisol, 21-deoxycortisol, androstenedione, corticosterone, and 11-deoxycorticosterone simultaneously in 453 DBS samples. The samples were from Korean subjects stratified by age group (78 full-term neonates, 76 premature neonates, 89 children, and 100 adults). Results The accuracy, precision, matrix effects, and extraction recovery were satisfactory for all the steroids at three concentrations; values of intra- and inter-day precision coefficients of variance, bias, and recovery were 0.7-7.7%, -1.5-9.8%, and 49.3-97.5%, respectively. The linearity range was 1-100 ng/mL for cortisol and 0.5-50 ng/mL for other steroids (R2>0.99). The reference intervals were in agreement with the previous reports. Conclusions This LC-MS/MS method and the reference intervals validated in the Korean population can be successfully applied to analyze seven steroids in DBS for the diagnosis of CAH.
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Affiliation(s)
- Borahm Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Na Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Waisbren SE, Weipert CM, Walsh RC, Petty CR, Green RC. Psychosocial Factors Influencing Parental Interest in Genomic Sequencing of Newborns. Pediatrics 2016; 137 Suppl 1:S30-5. [PMID: 26729701 PMCID: PMC9923974 DOI: 10.1542/peds.2015-3731g] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND When parents of newborns are presented with the hypothetical possibility of obtaining genomic sequencing (GS) for their newborn infants immediately after birth, they express substantial interest. This study examined associations between expressed interest in GS and demographic and psychosocial variables some months after birth. METHODS A total of 1096 parents were enrolled in a study on GS of newborns shortly after the birth of their infants, before discharge from the postpartum floor. Of these parents, 663 (60.5%) completed a follow-up survey 2 to 28 months later that queried their interest in GS for their infant and whether they received worrisome health information during pregnancy, labor, and delivery. They were also administered the Parenting Stress Index. Multivariate logistic regression was used to examine factors associated with interest in GS of newborns. RESULTS Of parents, 76.1% indicated at least some interest in GS. A 10-point increase on the Parenting Stress Index was associated with an increase in the odds of having some interest in GS (odds ratio: 1.15; 95% confidence interval: 1.01-1.32). Age, gender, race, ethnicity, marital status, education, anxiety, and whether this was the first biological child were not significantly associated with interest in GS. Receiving worrisome health information was associated with greater interest in GS but this did not reach significance (odds ratio: 1.42; 95% confidence interval: 0.95-2.12). CONCLUSIONS This hypothetical survey study suggests that previous experiences leading to worrisome health information and parenting stress need to be considered when GS is offered. Additional research, currently underway, is exploring factors associated with real-life parental choices around whether to obtain GS of their newborns.
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Affiliation(s)
- Susan E. Waisbren
- Boston Children’s Hospital;,Harvard Medical School; and,Address correspondence to Susan E. Waisbren, PhD, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:
| | - Caroline M. Weipert
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rebecca C. Walsh
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Robert C. Green
- Harvard Medical School; and,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Held PK, Shapira SK, Hinton CF, Jones E, Hannon WH, Ojodu J. Congenital adrenal hyperplasia cases identified by newborn screening in one- and two-screen states. Mol Genet Metab 2015; 116:133-8. [PMID: 26296712 PMCID: PMC4640991 DOI: 10.1016/j.ymgme.2015.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 11/28/2022]
Abstract
There is no clear consensus among state newborn screening programs on whether routine second screening of newborns identifies clinically relevant cases of congenital adrenal hyperplasia. This retrospective study evaluated laboratory practices, along with biochemical and medical characteristics of congenital adrenal hyperplasia (CAH) cases (1) detected on the first newborn screen in one-screen compared to two-screen states, and (2) detected on the first versus the second screen in the two-screen states, to determine the effectiveness of a second screen. A total of 374 confirmed cases of CAH from 2 one-screen states and 5 two-screen states were included in this study. Demographic data and diagnostic information on each reported case were collected and analyzed. Additionally, laboratory data, including screening methodologies and algorithms, were evaluated. The one-screen states reported 99 cases of CAH out of 1,740,586 (1 in 17,500) newborns screened: 88 (89%) identified on the first screen and 5 (5%) identified on the targeted second screen. The two-screen states reported 275 cases of CAH out of 2,629,627 (1 in 9500) newborns screened: 165 (60%) identified on the first screen and 99 (36%) identified on the second screen. Using a multivariate model, the only significant predictor of whether a case was identified on the first or the second screen in the two-screen states was the type of CAH. Compared with classical salt-wasting CAH, classical simple virilizing and non-classical CAH cases were less likely to be detected on the first versus the second screen. The routine second newborn screen is important for identifying children with CAH, particularly simple virilizing and non-classical forms, which might otherwise not be captured through a single screen.
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Affiliation(s)
- Patrice K Held
- Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, WI, USA.
| | - Stuart K Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia F Hinton
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Jones
- Newborn Screening and Genetics Program, Association of Public Health Laboratories, Silver Spring, MD, USA
| | - W Harry Hannon
- Division of Laboratory Sciences, Centers for Disease Control and Prevention (retired), Atlanta, GA, USA
| | - Jelili Ojodu
- Newborn Screening and Genetics Program, Association of Public Health Laboratories, Silver Spring, MD, USA
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Miller FA, Hayeems RZ, Bombard Y, Cressman C, Barg CJ, Carroll JC, Wilson BJ, Little J, Allanson J, Chakraborty P, Giguère Y, Regier DA. Public Perceptions of the Benefits and Risks of Newborn Screening. Pediatrics 2015; 136:e413-23. [PMID: 26169426 DOI: 10.1542/peds.2015-0518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Growing technological capacity and parent and professional advocacy highlight the need to understand public expectations of newborn population screening. METHODS We administered a bilingual (French, English) Internet survey to a demographically proportional sample of Canadians in 2013 to assess preferences for the types of diseases to be screened for in newborns by using a discrete choice experiment. Attributes were: clinical benefits of improved health, earlier time to diagnosis, reproductive risk information, false-positive (FP) results, and overdiagnosed infants. Survey data were analyzed with a mixed logit model to assess preferences and trade-offs among attributes, interaction between attributes, and preference heterogeneity. RESULTS On average, respondents were favorable toward screening. Clinical benefits were the most important outcome; reproductive risk information and early diagnosis were also valued, although 8% disvalued early diagnosis, and reproductive risk information was least important. All respondents preferred to avoid FP results and overdiagnosis but were willing to accept these to achieve moderate clinical benefit, accepting higher rates of harms to achieve significant benefit. Several 2-way interactions between attributes were statistically significant: respondents were willing to accept a higher FP rate for significant clinical benefit but preferred a lower rate for moderate benefit; similarly, respondents valued early diagnosis more when associated with significant rather than moderate clinical benefit. CONCLUSIONS Members of the public prioritized clinical benefits for affected infants and preferred to minimize harms. These findings suggest support for newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms.
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Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada;
| | - Robin Z Hayeems
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Céline Cressman
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Julian Little
- Departments of Epidemiology and Community Medicine and
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Pranesh Chakraborty
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Yves Giguère
- Department of Medical Biology, Centre Hospitalier Universitaire de Quebec, University of Laval, Quebec City, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; and Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, Canada
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Vallejo-Torres L, Castilla I, Couce ML, Pérez-Cerdá C, Martín-Hernández E, Pineda M, Campistol J, Arrospide A, Morris S, Serrano-Aguilar P. Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency. Pediatrics 2015; 136:e424-32. [PMID: 26169436 DOI: 10.1542/peds.2014-3399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are conflicting views as to whether testing for biotinidase deficiency (BD) ought to be incorporated into universal newborn screening (NBS) programs. The aim of this study was to evaluate the cost-effectiveness of adding BD to the panel of conditions currently screened under the national NBS program in Spain. METHODS We used information from the regional NBS program for BD that has been in place in the Spanish region of Galicia since 1987. These data, along with other sources, were used to develop a cost-effectiveness decision model that compared lifetime costs and health outcomes of a national birth cohort of newborns with and without an early detection program. The analysis took the perspective of the Spanish National Health Service. Effectiveness was measured in terms of quality-adjusted life years (QALYs). We undertook extensive sensitivity analyses around the main model assumptions, including a probabilistic sensitivity analysis. RESULTS In the base case analysis, NBS for BD led to higher QALYs and higher health care costs, with an estimated incremental cost per QALY gained of $24,677. Lower costs per QALY gained were found when conservative assumptions were relaxed, yielding cost savings in some scenarios. The probability that BD screening was cost-effective was estimated to be >70% in the base case at a standard threshold value. CONCLUSIONS This study indicates that NBS for BD is likely to be a cost-effective use of resources.
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Affiliation(s)
- Laura Vallejo-Torres
- Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, La Laguna, Spain; Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Islas Canarias, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Department of Applied Health Research, University College London, London, England;
| | - Iván Castilla
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Islas Canarias, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Departamento de Ingeniería Informática y de Sistemas. Universidad de La Laguna. La Laguna, Spain
| | - María L Couce
- Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Instituto para el Desarrollo e Integración de la Sanidad (IDIS), Madrid, Spain
| | - Celia Pérez-Cerdá
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Centro de Diagnóstico de Enfermedades Moleculares, Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Martín-Hernández
- Unidad Pediátrica de Enfermedades Raras. E. Mitocondriales-E. Metabólicas Hereditarias, Departamento de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mercé Pineda
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Fundación del Hospital Universitario Sant Joan de Déu, Barcelona, Spain
| | - Jaume Campistol
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Servicio Neurología, Hospital Universitario Sant Joan de Déu, Barcelona, Spain
| | - Arantzazu Arrospide
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Unidad de Investigación Sanitaria de AP-OSIs Gipuzkoa, Organización Sanitaria Integrada Alto Deba, Arrasate, Guipúzcoa, Spain; and
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, England
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; Servicio de Evaluación del Servicio Canario de la Salud (SESCS), El Rosario, Spain
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Viggiano E, Marabotti A, Burlina AP, Cazzorla C, D'Apice MR, Giordano L, Fasan I, Novelli G, Facchiano A, Burlina AB. Clinical and molecular spectra in galactosemic patients from neonatal screening in northeastern Italy: structural and functional characterization of new variations in the galactose-1-phosphate uridyltransferase (GALT) gene. Gene 2015; 559:112-8. [PMID: 25592817 DOI: 10.1016/j.gene.2015.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
Classical galactosemia is an autosomal recessive inborn error of metabolism due to mutations of the GALT gene leading to toxic accumulation of galactose and derived metabolites. With the benefit of early diagnosis by neonatal screening and early therapy, the acute presentation of classical galactosemia can be prevented. However, despite early diagnosis and treatment, the long term outcome for these patients is still unpredictable because they may go on to develop cognitive disability, speech problems, neurological and/or movement disorders and, in females, ovarian dysfunction. The objectives of the current study were to report our experience with a group of galactosemic patients identified through the neonatal screening programs in northeastern Italy during the last 30years. No neonatal deaths due to galactosemia complications occurred after the introduction of the neonatal screening program. However, despite the early diagnosis and dietary treatment, the patients with classical galactosemia showed one or more long-term complications. A total of 18 different variations in the GALT gene were found in the patient cohort: 12 missense, 2 frameshift, 1 nonsense, 1 deletion, 1 silent variation, and 1 intronic. Six (p.R33P, p.G83V, p.P244S, p.L267R, p.L267V, p.E271D) were new variations. The most common variation was p.Q188R (12 alleles, 31.5%), followed by p.K285N (6 alleles, 15.7%) and p.N314D (6 alleles, 15.7%). The other variations comprised 1 or 2 alleles. In the patients carrying a new mutation, the biochemical analysis of GALT activity in erythrocytes showed an activity of <1%. In silico analysis (SIFT, PolyPhen-2 and the computational analysis on the static protein structure) showed potentially damaging effects of the six new variations on the GALT protein, thus expanding the genetic spectrum of GALT variations in Italy. The study emphasizes the difficulty in establishing a genotype-phenotype correlation in classical galactosemia and underlines the importance of molecular diagnostic testing prior to making any treatment.
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Affiliation(s)
- E Viggiano
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - A Marabotti
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084 Fisciano, SA, Italy
| | - A P Burlina
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Consultant in Neurometabolic Hereditary Diseases at the University Hospital of Padova, Italy
| | - C Cazzorla
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - M R D'Apice
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata" and Fondazione PTV "Policlinico Tor Vergata", Rome, Italy
| | - L Giordano
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - I Fasan
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - G Novelli
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata" and Fondazione PTV "Policlinico Tor Vergata", Rome, Italy
| | - A Facchiano
- National Research Council, Institute of Food Science, via Roma 64, 83100 Avellino, Italy
| | - A B Burlina
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy.
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Zillmer LR, Russo R, Manzano BM, Ivanaga I, Nascimento OA, Souza AALD, Santos G, Rodriguez F, Miravitlles M, Jardim JR. Validation and development of an immunonephelometric assay for the determination of alpha-1 antitrypsin levels in dried blood spots from patients with COPD. J Bras Pneumol 2014; 39:547-54. [PMID: 24310627 PMCID: PMC4075886 DOI: 10.1590/s1806-37132013000500004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/19/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To validate and develop an immunonephelometric assay for the determination of
alpha-1 antitrypsin (AAT) levels in dried blood spots from COPD patients in
Brazil. METHODS: We determined AAT levels in serum samples and dried blood spots from 192 COPD
patients. For the preparation of dried blood spots, a disk (diameter, 6 mm) was
placed into a tube, eluted with 200 µL of PBS, and stored overnight at 4ºC. All of
the samples were analyzed by immunonephelometry in duplicate. We used the
bootstrap resampling method in order to determine a cut-off point for AAT levels
in dried blood spots. RESULTS: The correlation coefficient between the AAT levels in serum samples and those in
dried blood spots was r = 0.45. For dried blood spots, the cut-off value was 2.02
mg/dL (97% CI: 1.45-2.64 mg/dL), with a sensitivity, specificity, positive
predictive value, and negative predictive value of 100%, 95.7%, 27.2%, and 100%,
respectively. CONCLUSIONS: This method for the determination of AAT levels in dried blood spots appears to
be a reliable screening tool for patients with AAT deficiency.
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Affiliation(s)
- Laura Russo Zillmer
- Universidade Federal de São Paulo, Department of Pulmonology, Pulmonary Rehabilitation Center, São Paulo, Brazil
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Indicators of newborn screening for congenital hypothyroidism in Sri Lanka: program challenges and way forward. BMC Health Serv Res 2014; 14:385. [PMID: 25212576 PMCID: PMC4167276 DOI: 10.1186/1472-6963-14-385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 09/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Many of the countries in the Asia Pacific Region are just initiating newborn screening programs for selected metabolic and other congenital disorders. The present study is aimed at evaluating the congenital hypothyroidism screening program in the Southern region of Sri Lanka in terms of coverage, effectiveness of detecting and managing the cases. Methods The Newborn Screening System Database of Sri Lanka was reviewed from January 2011 to December 2012. The data of 47 babies who tested positive for hypothyroidism were analyzed. Results Total of 78,167 babies (99.0% of live births) were screened. Of them, 5.8% (n = 4,472) were discharged within 12 hrs of delivery where as 58.1% (n = 44969) were discharged afterwards but within next 12 hrs (i.e., day 1). The positive predictive value for congenital hypothyroidism (CH) was 9.0%. The incidences of primary CH among screened infants were 1:1682. False positive rate among screened infants was maintained below 0.70%. Mean age of serum confirmation was 23.8 (±8) days. Conclusions In the light of the present findings, we would suggest direct communication systems, linking newborn screening program to the family unit. This would enhance timely follow-up for screen-positive infants and facilitate information sharing. Establishing a program with, public-private sector partnership should be considered. Costs could be contained if the specimen collection, its transportation and communication are carried out by this partnership and the laboratory tests are conducted by a non-profit organization such as a University in order to achieve the goal of universal coverage. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-385) contains supplementary material, which is available to authorized users.
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Cifuentes Cifuentes MY, Estrada Vizcaíno A, Romero C. R. Galactosemia como causa de ictericia neonatal. REVISTA DE LA FACULTAD DE MEDICINA 2014. [DOI: 10.15446/revfacmed.v62n2.45420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Medici C, Varacchi C, Gonzalez G, Lemes A, Cerisola A, Pedemonte V, Blau N. Unusual Case of Phenylketonuria With Atypical Brain Magnetic Resonance Imaging Findings. J Child Neurol 2013; 28:1496-1499. [PMID: 22965559 DOI: 10.1177/0883073812457591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phenylketonuria is a treatable inborn error of amino acid metabolism caused by deficiency of the enzyme phenylalanine hydroxylase, responsible for converting phenylalanine to tyrosine. We report a 10-month-old boy with psychomotor regression and infantile spasms. He was diagnosed with classic phenylketonuria and West syndrome. Treatment was initiated with phenylalanine-restricted diet and vigabatrin. After 5 months of treatment, he persists with developmental delay, severe hypotonia, swallowing disorder, and drug-resistant epilepsy. Brain magnetic resonance imaging showed the typical abnormalities in supratentorial white matter and exceptional infratentorial and basal ganglia compromise. Severity of white matter abnormalities and neurologic symptoms correlates with blood levels of phenylalanine. Infratentorial changes occur in severe cases. Other mechanisms could take part in cases like this with atypical neuroimaging abnormalities of the basal ganglia.
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Affiliation(s)
- Conrado Medici
- 1Pediatric Neurology Department, School of Medicine, Pereira Rossell Children's Hospital, Montevideo, Uruguay
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Maciel LMZ, Kimura ET, Nogueira CR, Mazeto GMFS, Magalhães PKR, Nascimento ML, Nesi-França S, Vieira SE. Hipotireoidismo congênito: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia. ACTA ACUST UNITED AC 2013; 57:184-92. [DOI: 10.1590/s0004-27302013000300004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 02/13/2023]
Abstract
O hipotireoidismo congênito (HC) é o distúrbio endócrino congênito mais frequente, com incidência variando de 1:2.000 a 1:4.000 crianças nascidas vivas e uma das principais causas de retardo mental que pode ser prevenida. Os Programas de Triagem Neonatal para a doença permitem a identificação precoce dos afetados e seu tratamento de modo a evitar as complicações da falta do hormônio. A maioria dos casos de hipotireoidismo congênito é decorrente de disgenesias tireoidianas (85%), entre elas a ectopia, hipoplasia ou agenesia tireoidianas, e os demais resultam de defeitos de síntese hormonal. As crianças afetadas (> 95%) geralmente não apresentam sintomas sugestivos da doença ao nascimento. Os sintomas e sinais mais comuns são: icterícia neonatal prolongada, choro rouco, letargia, movimentos lentos, constipação, macroglossia, hérnia umbilical, fontanelas amplas, hipotonia e pele seca. Várias estratégias são utilizadas para a triagem do HC. No Brasil, esta é obrigatória por lei e geralmente é feita com a dosagem de TSH em sangue seco coletado do calcanhar. A idade recomendada para sua realização é após as 48 horas de vida até o quarto dia. A confirmação diagnóstica é obrigatória com as dosagens de TSH e T4 livre ou T4 total.
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Mahmood U, Imran M, Naik SI, Cheema HA, Saeed A, Arshad M, Mahmood S. Detection of common mutations in the GALT gene through ARMS. Gene 2012; 509:291-4. [DOI: 10.1016/j.gene.2012.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 11/24/2022]
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Mak C, Lam C, Law C, Siu W, Kwong L, Chan K, Chan W, Chow K, Lee K, Chan W, Chan A. Parental attitudes on expanded newborn screening in Hong Kong. Public Health 2012; 126:954-9. [DOI: 10.1016/j.puhe.2012.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 04/07/2012] [Accepted: 08/02/2012] [Indexed: 12/20/2022]
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Feuchtbaum L, Cunningham G, Sciortino S. Questioning the Need for Informed Consent: A Case Study of California's Experience with a Pilot Newborn Screening Research Project. J Empir Res Hum Res Ethics 2012; 2:3-14. [PMID: 19385846 DOI: 10.1525/jer.2007.2.3.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CALIFORNIA PROVIDES MANDATORY newborn screening for disorders that cause irreversible, severe disabilities if not identified and treated early in life. Parental consent is not required. In 2001, the Genetic Disease Branch was mandated to pilot test a new technology that could identify many additional disorders using the same blood specimen already collected. Study participation required informed consent, which was obtained for 47% of births during the study timeframe. The inability of hospitals to carry out the consent procedure for all newborns resulted in denial of testing and missed cases. If informed consent were waived, all newborns could have been tested. Several empirical questions are posed and each is examined from the perspective of society, the parents and the newborn. It is concluded that the legitimate needs of society and the interests of newborns should not be sacrificed to respond to the autonomy interests of the few parents who did not wish their infant to participate in the study, and that in the future, parental consent should be waived for projects evaluating new screening technologies.
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Affiliation(s)
- Lisa Feuchtbaum
- California Department of Health Services, Genetic Disease Branch, Richmond, CA (USA)
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48
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Ryckman KK, Berberich SL, Shchelochkov OA, Cook DE, Murray JC. Clinical and environmental influences on metabolic biomarkers collected for newborn screening. Clin Biochem 2012; 46:133-8. [PMID: 23010448 DOI: 10.1016/j.clinbiochem.2012.09.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Identifying common clinical and environmental factors that influence newborn metabolic biomarkers will improve the utilization of metabolite panels for clinical diagnostic medicine. DESIGN AND METHODS Environmental effects including gender, season of birth, gestational age, birth weight, feeding method and age at time of collection were evaluated for over 50 metabolites collected by the Iowa Neonatal Metabolic Screening Program on 221,788 newborns over a six year period. RESULTS We replicated well known observations that low birth weight and preterm infants have higher essential amino acids and lower medium and long chain acylcarnitine levels than their term counterparts. Smaller, but still significant, differences were observed for gender and timing of sample collection, specifically the season in which the infant was born. Most intriguing were our findings of higher thyroid stimulating hormone in the winter months (P<1×10(-40)) which correlated with an increased false positive rate of congenital hypothyroidism in the winter (0.9%) compared to summer (0.6%). Previous studies, conducted globally, have identified an increased prevalence of suspected and confirmed cases of congenital hypothyroidism in the winter months. We found that the percentage of unresolved suspected cases were slightly higher in the winter (0.3% vs. 0.2%). CONCLUSIONS We identified differences in metabolites by gestational age, birth weight, gender and season. Some are widely reported such as gestational age and birth weight, while others such as the effect of seasonality are not as well studied.
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Affiliation(s)
- Kelli K Ryckman
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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49
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Kochar IPS, Jindal R. Diagnosis and management of congenital adrenal hyperplasia in the child and adolescent. APOLLO MEDICINE 2011. [DOI: 10.1016/s0976-0016(11)60002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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50
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DeLuca JM, Kearney MH, Norton SA, Arnold GL. Parents' experiences of expanded newborn screening evaluations. Pediatrics 2011; 128:53-61. [PMID: 21708804 DOI: 10.1542/peds.2010-3413] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Abnormal results of newborn screening for common metabolic diseases are known to create substantial distress for parents. We explored parents' perceptions during diagnostic evaluations for newer disorders that are less well understood. METHODS Thirty families completed 48 open-ended interviews before and/or after parents received confirmatory test results for their infants. Qualitative content analysis was used to analyze the data. RESULTS Parents were shocked by the notification of the abnormal test result. Their urgent and often frustrating searches for information dominated the early phase of the screening process. Treatment center personnel were mainly informative and reassuring, but waiting for results exacerbated parents' distress. Equivocal results from diagnostic testing created uncertainties for parents regarding their infants' long-term health. After counseling, some parents reported inaccurate ideas about the disorders despite exposure to large amounts of information. Regardless of the challenges and anxieties of the evaluation, nearly every parent thought newborn screening was an important program for infant health. CONCLUSIONS The evaluation of a newborn for an abnormal screening result was highly stressful for parents. To help reduce parents' distress, improvements in communications and clinical services are needed. Recommendations of useful Internet sites and discussions of this information may benefit parents. Tailoring counseling to meet the needs of culturally and educationally diverse families is needed. Families and infants with equivocal results are a new group of patients who merit comprehensive clinical follow-up.
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Affiliation(s)
- Jane M DeLuca
- University of Rochester, School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642, USA.
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