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Escudero-Ávila R, Delgado-Pecellín C, Moreno-Valera MJ, Carrasco-Hernández L, Quintana-Gallego ME, Delgado-Pecellín I. False negatives in the newborn screening for cystic fibrosis in Western Andalusia: Results from a 10-year experience. Pediatr Pulmonol 2023; 58:2464-2468. [PMID: 36196044 DOI: 10.1002/ppul.26183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/18/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in the Caucasian population, with an incidence of 1:5000 live births. In 2011, the screening of CF was implemented in the Andalusian Public Health newborn screening program by using immunoreactive trypsinogen and chloride sweat test (IRT/IRT/sweat test) determinations. Since then, 79 children have been diagnosed with CF in our health area (Western Andalusia). The aim of this study was to evaluate the efficiency of this screening method and to examinate the characteristics of those CF infants who had a negative screening but who were later diagnosed. In the 2011-2021 period 462,049 newborns were screened for CF using a two-step IRT determination and chloride sweat test. Sixty-three infants were diagnosed with CF in our health area thanks to the screening, and 15 CF children had a negative screening result and were finally diagnosed by molecular sequencing of the CFTR gene. The most frequent symptoms that led to the diagnosis of those false negative (FN) patients were hyponatremic dehydration (mean age 9.75 ± 1.5 months) and recurrent wheezing (mean age 24 ± 14.5 months). The molecular analysis of the CFTR gene on those FN showed a diversity of genotypes, identifying more than 10 different mutations. CONCLUSION: The rate of FN patients obtained in this study is inadmissibly high, and the protocol used in this region has not been updated despite the advances in genetic testing in the past 10 years. An improvement on CF newborn screening should be implemented, adding molecular analysis of the CFTR gene.
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Affiliation(s)
- Rocío Escudero-Ávila
- Unidad de Neumología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, España
| | | | - M José Moreno-Valera
- Unidad de Neumología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, España
| | - Laura Carrasco-Hernández
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España, Sevilla, España
| | - M Esther Quintana-Gallego
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España, Sevilla, España
| | - Isabel Delgado-Pecellín
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España, Sevilla, España
- Dpto. de Pediatría, Universidad de Sevilla, Sevilla, España
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2
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Fingerhut R, Rueegg CS, Imahorn O, Pedersen ESL, Kuehni CE, Gallati S, Regamey N, Barben J. Immunoreactive trypsinogen in healthy newborns and infants with cystic fibrosis. Arch Dis Child Fetal Neonatal Ed 2023; 108:176-181. [PMID: 36351789 DOI: 10.1136/archdischild-2021-323549] [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: 11/18/2021] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Newborn screening (NBS) for cystic fibrosis (CF) was introduced in Switzerland in 2011 based on an immunoreactive trypsinogen (IRT)-DNA-IRT protocol. CF diagnosis was confirmed by sweat test and/or genetics but remained inconclusive for some newborns (cystic fibrosis transmembrane conductance regulator related metabolic syndrome (CRMS)/CF screen positive, inconclusive diagnosis (CFSPID)). We aimed to (1) Describe IRT levels in healthy newborns in the first year of life and by gestational age (GA), and (2) Compare IRT at two time points between healthy newborns and newborns with CF and CRMS/CFSPID. DESIGN Retrospective study. SETTING National NBS database. PATIENTS All children with an IRT measurement by heel prick test from 2011 to 2019. INTERVENTIONS None. MAIN OUTCOME MEASURES IRT values were extracted from the National NBS Laboratory, and clinical characteristics of positively screened children from the CF-NBS database. Second IRT assessment in positively screened children was usually performed after 18-24 days. We calculated internal IRT Z-Scores and multiples of the median to compare our results across different laboratory tools. RESULTS Among 815 899 children; 232 were diagnosed with CF, of whom 36 had meconium ileus (MI); 27 had CRMS/CFSPID. Among all samples analysed, mean IRT Z-Scores were higher for newborns with GA <33 weeks and ≥43 weeks (all Z-Scores >0.11) compared with term babies (all Z-Scores ≤0.06). Repeated IRT Z-Scores after a median (IQR) of 19 (17-22) days remained high for infants with CF with or without MI but decreased for infants with CRMS/CFSPID. CONCLUSIONS Measurement of a second IRT value can help distinguish between children with CRMS/CFSPID and CF, early in life.
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Affiliation(s)
- Ralph Fingerhut
- Swiss Newborn Screening Laboratory, University Children's Hospital Zürich, Zurich, Zürich, Switzerland
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Orell Imahorn
- Division of Pediatric Pulmonology, Ostschweizer Kinderspital, St Gallen, St Gallen, Switzerland
| | | | - Claudia Elisabeth Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Bern, Switzerland.,Children's Hospital, Division of Pediatric Pulmonology, University of Bern, Bern, Bern, Switzerland
| | - Sabina Gallati
- Children's Hospital, Division of Human Genetics, Inselspital University Hospital Bern, Bern, Bern, Switzerland
| | - Nicolas Regamey
- Children's Hospital, Division of Paediatric Pulmonology, Luzerner Kantonsspital, Luzern, Luzern, Switzerland
| | - Jürg Barben
- Division of Pediatric Pulmonology, Ostschweizer Kinderspital, St Gallen, St Gallen, Switzerland
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3
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McColley SA, Martiniano SL, Ren CL, Sontag MK, Rychlik K, Balmert L, Elbert A, Wu R, Farrell PM. Disparities in first evaluation of infants with cystic fibrosis since implementation of newborn screening. J Cyst Fibros 2023; 22:89-97. [PMID: 35871976 DOI: 10.1016/j.jcf.2022.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We evaluated whether implementation of cystic fibrosis (CF) newborn screening (NBS) leads to equitable timeliness of initial evaluation. We compared age at first event (AFE, age at sweat test, encounter and/or care episode) between infants categorized as Black/African American, American Indian/ Native Alaskan, Asian, and/or Hispanic and/or other (Group 1) to White and not Hispanic infants (Group 2). METHODS This retrospective cohort study from the Cystic Fibrosis Foundation Patient Registry (CFFPR) included infants born 2010-2018. Race and ethnicity categories followed US Census definitions. The primary outcome was AFE; the secondary outcome was weight for age (WFA) z-score averaged 12 to < 24 months. We compared distributions by Wilcoxon rank-sum test and proportions by Chi-square or Fisher's exact tests. A nested cohort study used a linear mixed effects model of variables that affect WFA, chosen a priori, to evaluate associations with 1-year WFA z-score. RESULTS Among 6354 infants, 21% were in Group 1. Group 1 median AFE was 31 days (IQR 19, 49) and Group 2 was 22 days (IQR 14,36) (p< .001). Median WFA z-score at 1-2 years was lower in Group 1. In 3017 infants with complete data on variables of interest, AFE, Black race, CFTR variant class I-III, prematurity and public insurance were associated with lower 1-year WFA z-score. CONCLUSIONS Differences in AFE for infants with CF from historically marginalized groups may exacerbate long standing health disparities. We speculate that inequitable identification of CFTR gene variants and/or bias may influence timeliness of evaluation after an out-of-range NBS.
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Affiliation(s)
- Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States.
| | - Stacey L Martiniano
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Children's Hospital Colorado, Aurora, CO, United States
| | - Clement L Ren
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Marci K Sontag
- Center for Public Health Innovation, CI International, Littleton, CO, United States
| | - Karen Rychlik
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States
| | - Lauren Balmert
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Runyu Wu
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Philip M Farrell
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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4
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Hendrix C, McCrary M, Hou R, Abate G. Diagnosis and Management of Pulmonary NTM with a Focus on Mycobacterium avium Complex and Mycobacterium abscessus: Challenges and Prospects. Microorganisms 2022; 11:microorganisms11010047. [PMID: 36677340 PMCID: PMC9861392 DOI: 10.3390/microorganisms11010047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are ubiquitous. NTM can affect different organs and may cause disseminated diseases, but the pulmonary form is the most common form. Pulmonary NTM is commonly seen in patients with underlying diseases. Pulmonary Mycobacterium avium complex (MAC) is the most common NTM disease and M. abscessus (MAB) is the most challenging to treat. This review is prepared with the following objectives: (a) to evaluate new methods available for the diagnosis of pulmonary MAC or MAB, (b) to assess advances in developing new therapeutics and their impact on treatment of pulmonary MAC or MAB, and (c) to evaluate the prospects of preventive strategies including vaccines against pulmonary MAC or MAB. METHODS A literature search was conducted using PubMed/MEDLINE and multiple search terms. The search was restricted to the English language and human studies. The database query resulted in a total of 197 publications. After the title and abstract review, 64 articles were included in this analysis. RESULTS The guidelines by the American Thoracic Society (ATS), European Respiratory Society (ERS), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and Infectious Diseases Society of America (IDSA) are widely applicable. The guidelines are based on expert opinion and there may be a need to broaden criteria to include those with underlying lung diseases who may not fulfill some of the criteria as 'probable cases' for better follow up and management. Some cases with only one culture-positive sputum sample or suggestive histology without a positive culture may benefit from new methods of confirming NTM infection. Amikacin liposomal inhalation suspension (ALIS), gallium containing compounds and immunotherapies will have potential in the management of pulmonary MAC and MAB. CONCLUSIONS the prevalence of pulmonary NTM is increasing. The efforts to optimize diagnosis and treatment of pulmonary NTM are encouraging. There is still a need to develop new diagnostics and therapeutics.
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Kharrazi M, Sacramento C, Comeau AM, Hale JE, Caggana M, Kay DM, Lee R, Reilly B, Thompson JD, Nasr SZ, Kleyn M, Hoffman G, Baker MW, Clarke C, Harris CL, Dorley MC, Fryman H, Sutaria A, Hietala A, Winslow H, Richards H, Therrell BL. Missed Cystic Fibrosis Newborn Screening Cases due to Immunoreactive Trypsinogen Levels below Program Cutoffs: A National Survey of Risk Factors. Int J Neonatal Screen 2022; 8:ijns8040058. [PMID: 36412584 PMCID: PMC9680406 DOI: 10.3390/ijns8040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022] Open
Abstract
Testing immunoreactive trypsinogen (IRT) is the first step in cystic fibrosis (CF) newborn screening. While high IRT is associated with CF, some cases are missed. This survey aimed to find factors associated with missed CF cases due to IRT levels below program cutoffs. Twenty-nine states responded to a U.S-wide survey and 13 supplied program-related data for low IRT false screen negative cases (CFFN) and CF true screen positive cases (CFTP) for analysis. Rates of missed CF cases and odds ratios were derived for each factor in CFFNs, and two CFFN subgroups, IRT above ("high") and below ("low") the CFFN median (39 ng/mL) compared to CFTPs for this entire sample set. Factors associated with "high" CFFN subgroup were Black race, higher IRT cutoff, fixed IRT cutoff, genotypes without two known CF-causing variants, and meconium ileus. Factors associated with "low" CFFN subgroup were older age at specimen collection, Saturday birth, hotter season of newborn dried blood spot collection, maximum ≥ 3 days laboratories could be closed, preterm birth, and formula feeding newborns. Lowering IRT cutoffs may reduce "high" IRT CFFNs. Addressing hospital and laboratory factors (like training staff in collection of blood spots, using insulated containers during transport and reducing consecutive days screening laboratories are closed) may reduce "low" IRT CFFNs.
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Affiliation(s)
- Martin Kharrazi
- California Department of Public Health, Richmond, CA 94804, USA
- Sequoia Foundation, La Jolla, CA 92037, USA
- Correspondence:
| | | | - Anne Marie Comeau
- New England Newborn Screening Program, UMass Chan Medical School, Worcester, MA 01605, USA
| | - Jaime E. Hale
- New England Newborn Screening Program, UMass Chan Medical School, Worcester, MA 01605, USA
| | - Michele Caggana
- New York State Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA
| | - Denise M. Kay
- New York State Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA
| | - Rachel Lee
- Texas Department of State Health Services, Austin, TX 78756, USA
| | - Brendan Reilly
- Texas Department of State Health Services, Austin, TX 78756, USA
| | - John D. Thompson
- Washington State Department of Health, Public Health Laboratories, Newborn Screening Program, Shoreline, WA 98155, USA
| | - Samya Z. Nasr
- Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mary Kleyn
- Michigan Department of Health and Human Services, Lansing, MI 48913, USA
| | - Gary Hoffman
- Wisconsin Newborn Screening Laboratory at Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA
| | - Mei W. Baker
- Wisconsin Newborn Screening Laboratory at Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA
| | - Colleen Clarke
- Louisiana Office of Public Health, Baton Rouge, LA 70802, USA
| | | | - M. Christine Dorley
- Tennessee Department of Health, Newborn Screening Laboratory and Follow-Up Program, Nashville, TN 37216, USA
| | - Hilary Fryman
- Tennessee Department of Health, Newborn Screening Laboratory and Follow-Up Program, Nashville, TN 37216, USA
| | - Ankit Sutaria
- Georgia Department of Public Health, Atlanta, GA 30303, USA
| | - Amy Hietala
- Minnesota Department of Health, Public Health Laboratory, Newborn Screening, St. Paul, MN 55164, USA
| | - Holly Winslow
- Minnesota Department of Health, Public Health Laboratory, Newborn Screening, St. Paul, MN 55164, USA
| | | | - Bradford L. Therrell
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
- Department of Pediatrics, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78249, USA
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6
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Qussous K, Abdulhamid I, Kleyn M, Schuen J, Nasr SZ. Five cases of missed cystic fibrosis heterozygous mutations identified after a positive newborn screen on a sibling. Respir Med Case Rep 2022; 36:101572. [PMID: 35059286 PMCID: PMC8760430 DOI: 10.1016/j.rmcr.2021.101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 12/04/2022] Open
Abstract
In Michigan (MI), NBS for CF was started in October 2007 using the IRT/DNA protocol. In 2016, a component of the Hologic molecular test kit used by the MI NBS lab was recalled (40 CF mutation 2nd tier test). This recall had a major impact on states using the Hologic test kits in their NBS programs. Michigan specimens were sent to another state's NBS Lab for 2nd tier testing using the Luminex 60 mutation test kit until the Luminex kit could be procured and validated in MI. In this report, we present five cases born during this time period. These cases were initially reported out as having normal NBS results for CF but had heterozygous F508 del (c.1521_1523delCTT) mutations later identified. Of the five cases, one was diagnosed with CF (Case1), one with CF related metabolic syndrome (CRMS), and the other three were carriers.
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Affiliation(s)
- Khaleel Qussous
- University of Michigan Division of Pediatric Pulmonary Ann Arbor, Michigan, USA
| | - Ibrahim Abdulhamid
- Children's Hospital of Michigan Division of Pediatric Pulmonary and Sleep Medicine Detroit, Michigan, USA
| | - Mary Kleyn
- Michigan Department of Health and Human Services Lansing, Michigan, USA
| | - John Schuen
- Helen DeVos Children's Hospital, Spectrum Health Medical Group Section of Pediatric Pulmonary Medicine and Sleep Medicine Grand Rapids, Michigan, USA
| | - Samya Z. Nasr
- University of Michigan Division of Pediatric Pulmonary Ann Arbor, Michigan, USA
- Corresponding author. University of Michigan Department of Pediatrics, Division of Pediatric Pulmonary Medicine, 1500 E. Medical Center Dr. Ann Arbor, MI, 48109-5212, USA.
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Martiniano SL, Elbert AA, Farrell PM, Ren CL, Sontag MK, Wu R, McColley SA. Outcomes of infants born during the first 9 years of CF newborn screening in the United States: A retrospective Cystic Fibrosis Foundation Patient Registry cohort study. Pediatr Pulmonol 2021; 56:3758-3767. [PMID: 34469079 DOI: 10.1002/ppul.25658] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Newborn screening (NBS) for cystic fibrosis (CF) was implemented in all US states and DC by 2010. This hypothesis-generating study was designed to form the basis of additional analyses and to plan quality improvement initiatives. The aims were to describe the outcomes of infants with CF born during the first 9 years of universal NBS. METHODS We included participants in the CF Foundation Patient Registry born 2010-2018 with age of recorded CF diagnosis 0-365 days old. We compared the age of center-reported diagnosis, age at first CF event (defined as earliest sweat test, clinic visit, or hospitalization), demographics, and outcomes between three cohorts born between 2010-2012, 2013-2015, and 2016-2018. RESULTS In 6354 infants, the median age at first CF event decreased from the first to the third cohort. Weight-for-age (WFA) was < 10th percentile in about 40% of infants at the first CF Center visit. Median WFA z-score at 1-2 years was more than 0 but height-for-age (HFA) z-score was less than 0 through age 5-6 years. The second cohort had a higher HFA z-score than the first cohort at age 5-6 years. Pseudomonas aeruginosa infection was less common in later cohorts. About 1/3 of infants were hospitalized in the first year of life with no changes over time. CONCLUSION Over 9 years of CF NBS, median age at first CF event decreased. CF NBS had positive health impacts, but early life nutritional deficits and a high rate of infant hospitalizations persist.
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Affiliation(s)
- Stacey L Martiniano
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Clement L Ren
- Division of Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Marci K Sontag
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.,Center for Public Health Innovation at CI International, USA
| | | | - Susanna A McColley
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Pulmonary and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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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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Kahwash BM, Yonkof JR, Abraham RS, Mustillo PJ, Abu-Arja R, Rangarajan HG, Scherzer R. Delayed-Onset ADA1 (ADA) Deficiency Not Detected by TREC Screen. Pediatrics 2021; 147:peds.2020-005579. [PMID: 33975924 DOI: 10.1542/peds.2020-005579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
A 9-month-old boy presented to a community pediatrician with a recent history of failure to thrive. Workup revealed neutropenia and lymphopenia. Subsequent admission for fever and pneumonia revealed an absolute neutrophil count of 860 and absolute lymphocyte count of 214. Lymphopenia affected all lymphocyte subsets and his naïve and memory CD4+ T-cell ratio was inverted for age. Immunoglobulin levels were normal for age, and tetanus and diphtheria antibody titers were protective. The profound lymphopenia raised suspicion for severe combined immunodeficiency (SCID), despite a normal newborn screening by T-cell receptor excision circle analysis. He did not have a previous history of recurrent fevers or infections, had attended day care, and had received all age-appropriate vaccines. He subsequently was diagnosed with Pneumocystis jirovecii pneumonia, adenovirus upper respiratory infection, and rotaviral diarrhea. An enzyme assay revealed absent adenosine deaminase (ADA) activity and elevated erythrocyte deoxyadenosine nucleotides. With genetic sequencing, 2 pathogenic variants in the ADA gene were confirmed. Acute management of ADA-SCID is aimed at restoration of enzyme activity, followed by curative therapy. The patient is currently on immunoglobulin therapy and recombinant ADA (Revcovi), with an excellent immune response, while awaiting sibling hematopoietic cell transplant from a matched sibling. Hypomorphic ADA variants can present with delayed-onset SCID, and some of these patients are missed by SCID newborn screening. A careful review of a complete blood cell count might offer clues and promote confirmatory diagnostic investigation.
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Affiliation(s)
- Basil M Kahwash
- Division of Allergy and Immunology, Department of Otolaryngology, College of Medicine, The Ohio State University, Columbus, Ohio; and .,Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer R Yonkof
- Division of Allergy and Immunology, Department of Otolaryngology, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Nationwide Children's Hospital, Columbus, Ohio
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10
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Teper A, Smithuis F, Rodríguez V, Salvaggio O, Maccallini G, Aranda C, Lubovich S, Zaragoza S, García-Bournissen F. Comparison between two newborn screening strategies for cystic fibrosis in Argentina: IRT/IRT versus IRT/PAP. Pediatr Pulmonol 2021; 56:113-119. [PMID: 33095477 DOI: 10.1002/ppul.25130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The benefits of early cystic fibrosis (CF) detection using newborn screening (NBS) has led to widespread use in NBS programs. Since 2002, a two-stage immunoreactive trypsinogen (IRT/IRT) screening strategy has been used as a CFNBS method in all public maternity units in the City of Buenos Aires, Argentina. However, novel screening strategies may be more efficient. The aim of this study is to prospectively compare two CFNBS strategies: IRT/IRT and IRT/PAP (pancreatitis-associated protein). METHODS A two-year prospective study was performed. IRT was measured in dried blood samples collected 48-72 h after birth. When an IRT value was abnormal, PAP was determined, and a second visit was scheduled to obtain another sample for IRT before 25 days of life. Newborns with a positive CFNBS were referred for a confirmatory sweat test. RESULTS There were 69,827 births in the City of Buenos Aires during the period studied; 918 (1.31%) had an abnormal IRT. A total of 207 children (22.5%) failed to return for the second IRT, but only two PAP (0.2%) were not performed. IRT/IRT was more likely to lead to a referral for sweat testing than IRT/PAP (odds ratio 2.3 [95% confidence interval 1.8-2.9], p < .001). Sensitivity and specificity were: 80% and 100% and 86.5% and 82.6% for IRT/IRT and IRT/PAP strategies, respectively. CONCLUSION The IRT/PAP strategy is more sensitive than IRT/IRT and has similar specificity; it avoids a second visit and unnecessary sweat testing, and it reduces loss to follow-up in our population.
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Affiliation(s)
- Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Fernando Smithuis
- Newborn Screening Laboratory, Hospital General de Agudos Dr. Carlos Durand, City of Buenos Aires, Argentina
| | - Viviana Rodríguez
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Orlando Salvaggio
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Gustavo Maccallini
- Newborn Screening Laboratory, Hospital General de Agudos Dr. Carlos Durand, City of Buenos Aires, Argentina
| | - Claudio Aranda
- Newborn Screening Laboratory, Hospital General de Agudos Dr. Carlos Durand, City of Buenos Aires, Argentina
| | - Silvina Lubovich
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Silvina Zaragoza
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Facundo García-Bournissen
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Maciel LMZ, Magalhães PKR, Ciampo IRLD, Sousa MLBD, Fernandes MIM, Sawamura R, Bittar RR, Molfetta GAD, Silva Júnior WAD. The first five-year evaluation of cystic fibrosis neonatal screening program in São Paulo State, Brazil. CAD SAUDE PUBLICA 2020; 36:e00049719. [PMID: 33111836 DOI: 10.1590/0102-311x00049719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/20/2020] [Indexed: 11/21/2022] Open
Abstract
The Hospital of the Ribeirão Preto Medical School, University of São Paulo is one of the three screening centers in São Paulo State, Brazil, and has included a test for cystic fibrosis (CF) since February 6, 2010, by a court order. We evaluated the first five years of this CF-newborn screening program. The original immunoreactive trypsinogen (IRT)/IRT screening protocol was adopted in Brazil. A total of 173,571 newborns were screened, 1,922 (1.1%) of whom showed IRT1 ≥ 70ng/mL. Of these, 1,795 (93.4%) collected IRT2, with elevated results (IRT2 ≥ 70ng/mL) in 102 of them (5.2%). We identified a total of 26 CF cases during this period, including three CF cases that were not detected by the CF-newborn screening. The incidence of the disease among the screened babies was 1:6,675 newborns screened. Median age at the initial evaluation was 42 days, comparable to that of neonates screened with the IRT/DNA protocol. Almost all infants with CF already exhibited some manifestations of the disease during the neonatal period. The mutation most frequently detected in the CF cases was F508del. These findings suggest the early age at the beginning of treatment at our center was due to the effort of the persons involved in the program regarding an effective active search. Considering the false negative results of CF-newborn screening and the early onset of clinical manifestations of the disease in this study, pediatricians should be aware of the diagnosis of CF even in children with negative test.
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Affiliation(s)
| | | | | | | | | | - Regina Sawamura
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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An Enzyme Immunoassay for Determining Immunoreactive Trypsinogen (IRT) in Dried Blood Spots on Filter Paper Using an Ultra-Microanalytical System. Appl Biochem Biotechnol 2018; 186:1034-1046. [DOI: 10.1007/s12010-018-2785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 12/30/2022]
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Abstract
PURPOSE OF REVIEW The aim of this study was to provide an overview of the current understanding of the pathophysiology, diagnosis and management of cystic fibrosis-liver disease (CFLD). RECENT FINDINGS CFLD has a variety of manifestations. Previously, it was thought that patients progressed from mild cholestatic disease to cirrhosis to decompensated cirrhosis with portal hypertension. Newer evidence suggests that some patients may develop cirrhosis while others develop noncirrhotic portal hypertension. Advances in our understanding of the pathophysiology of disease necessitate modifications to the current diagnostic criteria. Both fibroscan and noninvasive biomarkers can be used to identify patients with cirrhosis and portal hypertension. Ursodeoxycholic acid remains the mainstay of therapy despite a paucity of rigorous studies supporting its use. Novel therapeutic agents such as CF transmembrane conductance regulator (CFTR) modulators and potentiators are encouraging but need to be evaluated specifically in CFLD. SUMMARY A better understanding of the pathophysiology of disease is critical to developing more disease-specific diagnostics and therapeutics.
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The Cystic Fibrosis Foundation Patient Registry. Design and Methods of a National Observational Disease Registry. Ann Am Thorac Soc 2018; 13:1173-9. [PMID: 27078236 DOI: 10.1513/annalsats.201511-781oc] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The Cystic Fibrosis Foundation Patient Registry (CFFPR) is an ongoing patient registry study that collects longitudinal demographic, clinical, and treatment information about persons with cystic fibrosis (CF) in the United States. CF is a life-shortening genetic disorder that occurs in approximately 1 in 3,500 births in the United States. High-quality observational data is important for clinical research, quality improvement, and clinical management. OBJECTIVES To describe the data collection, patient population, and key limitations of the CFFPR. METHODS Inclusion criteria for the CFFPR include diagnosis with CF or a CFTR-associated disorder, care at an accredited care center program, and provision of informed consent. Data from clinic visits and hospitalizations are collected through a secure website. Loss to follow-up and generalizability were examined using several methods. The accuracy of CFFPR data was evaluated with an audit of 2012 CFFPR data compared to the medical record. MEASUREMENTS AND MAIN RESULTS Since 1986, the CFFPR contains the records of 48,463 individuals with CF. Participation among individuals seen at accredited care centers is high, and loss to follow-up is low. An audit of 2012 CFFPR data suggests that the CFFPR contains 95% of clinic visits and 90% of hospitalizations found in the medical record for these patients, and nearly all of the audited fields were highly accurate. CONCLUSIONS Registries such as the CFFPR are important tools for research, clinical care, and tracking incidence, mortality and population trends.
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Coffey MJ, Whitaker V, Gentin N, Junek R, Shalhoub C, Nightingale S, Hilton J, Wiley V, Wilcken B, Gaskin KJ, Ooi CY. Differences in Outcomes between Early and Late Diagnosis of Cystic Fibrosis in the Newborn Screening Era. J Pediatr 2017; 181:137-145.e1. [PMID: 27837951 DOI: 10.1016/j.jpeds.2016.10.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/07/2016] [Accepted: 10/12/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate children with cystic fibrosis (CF) who had a late diagnosis of CF (LD-CF) despite newborn screening (NBS) and compare their clinical outcomes with children diagnosed after a positive NBS (NBS-CF). STUDY DESIGN A retrospective review of patients with LD-CF in New South Wales, Australia, from 1988 to 2010 was performed. LD-CF was defined as NBS-negative (negative immunoreactive trypsinogen or no F508del) or NBS-positive but discharged following sweat chloride < 60 mmol/L. Cases of LD-CF were each matched 1:2 with patients with NBS-CF for age, sex, hospital, and exocrine pancreatic status. RESULTS A total of 45 LD-CF cases were identified (39 NBS-negative and 6 NBS-positive) with 90 NBS-CF matched controls. Median age (IQR) of diagnosis for LD-CF and NBS-CF was 1.35 (0.4-2.8) and 0.12 (0.03-0.2) years, respectively (P <.0001). Estimated incidence of LD-CF was 1 in 45 000 live births. Compared with NBS-CF, LD-CF had more respiratory manifestations at time of diagnosis (66% vs 4%; P <.0001), a higher rate of hospital admission per year for respiratory illness (0.49 vs 0.2; P = .0004), worse lung function (forced expiratory volume in 1 second percentage of predicted, 0.88 vs 0.97; P = .007), and higher rates of chronic colonization with Pseudomonas aeruginosa (47% vs 24%; P = .01). The LD-CF cohort also appeared to be shorter than NBS-CF controls (mean height z-score -0.65 vs -0.03; P = .02). CONCLUSIONS LD-CF, despite NBS, seems to be associated with worse health before diagnosis and worse later growth and respiratory outcomes, thus providing further support for NBS programs for CF.
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Affiliation(s)
- Michael J Coffey
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Viola Whitaker
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Natalie Gentin
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of General Pediatrics, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Rosie Junek
- The Children's Hospital at Westmead, Sydney, Australia
| | - Carolyn Shalhoub
- Department of Medical Genetics, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Scott Nightingale
- GrowUpWell Priority Research Centre, University of Newcastle, Newcastle, Australia; Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, Australia
| | - Jodi Hilton
- University of Newcastle, Newcastle, Australia; Department of Respiratory Medicine, John Hunter Children's Hospital, Newcastle, Australia
| | - Veronica Wiley
- The Children's Hospital at Westmead, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Bridget Wilcken
- The Children's Hospital at Westmead, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Kevin J Gaskin
- The Children's Hospital at Westmead, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Chee Y Ooi
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia.
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Woodruff SA, Sontag MK, Accurso FJ, Sokol RJ, Narkewicz MR. Prevalence of elevated liver enzymes in children with cystic fibrosis diagnosed by newborn screen. J Cyst Fibros 2017; 16:139-145. [DOI: 10.1016/j.jcf.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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Skolnik K, Kirkpatrick G, Quon BS. Nontuberculous Mycobacteria in Cystic Fibrosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:259-274. [PMID: 28035194 PMCID: PMC5155018 DOI: 10.1007/s40506-016-0092-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacteria (NTM) are found in approximately 10 % of cystic fibrosis (CF) patients, but only a portion will develop NTM disease. The management of CF lung disease should be optimized, including antibiotic therapy targeted to the individual's usual airway bacteria, prior to considering treatment for NTM lung disease. Those who meet criteria for NTM lung disease may not necessarily require treatment and could be monitored expectantly if symptoms and radiographic findings are minimal. However, the presence of Mycobacterium abscessus complex (MABSC), severe lung disease, and/or anticipated lung transplant should prompt NTM therapy initiation. For CF patients with Mycobacterium avium complex (MAC), recommended treatment includes triple antibiotic therapy with a macrolide, rifampin, and ethambutol. Azithromycin is generally our preferred macrolide in CF as it is better tolerated and has fewer drug-drug interactions. MABSC treatment is more complex and requires an induction phase (oral macrolide and two IV agents including amikacin) as well as a maintenance phase (nebulized amikacin and two to three oral antibiotics including a macrolide). The induction phase may range from one to three months (depending on infection severity, treatment response, and medication tolerability). For both MAC and MABSC, treatment duration is extended 1-year post-culture conversion. However, in patients who do not achieve culture negative status but tolerate therapy, we consider ongoing treatment for mycobacterial suppression and prevention of disease progression.
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Affiliation(s)
- Kate Skolnik
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta Canada
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
- Rockyview General Hospital Respirology Offices, 7007 14th Street SW, Calgary, AB T2V 1P9 Canada
| | - Gordon Kirkpatrick
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
| | - Bradley S. Quon
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC Canada
- St. Paul’s Hospital, 8B Providence Wing, 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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18
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Sontag MK, Lee R, Wright D, Freedenberg D, Sagel SD. Improving the Sensitivity and Positive Predictive Value in a Cystic Fibrosis Newborn Screening Program Using a Repeat Immunoreactive Trypsinogen and Genetic Analysis. J Pediatr 2016; 175:150-158.e1. [PMID: 27131402 DOI: 10.1016/j.jpeds.2016.03.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/16/2016] [Accepted: 03/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the performance of a new cystic fibrosis (CF) newborn screening algorithm, comprised of immunoreactive trypsinogen (IRT) in first (24-48 hours of life) and second (7-14 days of life) dried blood spot plus DNA on second dried blood spot, over existing algorithms. STUDY DESIGN A retrospective review of the IRT/IRT/DNA algorithm implemented in Colorado, Wyoming, and Texas. RESULTS A total of 1 520 079 newborns were screened, 32 557 (2.1%) had abnormal first IRT; 8794 (0.54%) on second. Furthermore, 14 653 mutation analyses were performed; 1391 newborns were referred for diagnostic testing; 274 newborns were diagnosed; and 201/274 (73%) of newborns had 2 mutations on the newborn screening CFTR panel. Sensitivity was 96.2%, compared with sensitivity of 76.1% observed with IRT/IRT (105 ng/mL cut-offs, P < .0001). The ratio of newborns with CF to heterozygote carriers was 1:2.5, and newborns with CF to newborns with CFTR-related metabolic syndrome was 10.8:1. The overall positive predictive value was 20%. The median age of diagnosis was 28, 30, and 39.5 days in the 3 states. CONCLUSIONS IRT/IRT/DNA is more sensitive than IRT/IRT because of lower cut-offs (∼97 percentile or 60 ng/mL); higher cut-offs in IRT/IRT programs (>99 percentile, 105 ng/mL) would not achieve sufficient sensitivity. Carrier identification and identification of newborns with CFTR-related metabolic syndrome is less common in IRT/IRT/DNA compared with IRT/DNA. The time to diagnosis is nominally longer, but diagnosis can be achieved in the neonatal period and opportunities to further improve timeliness have been enacted. IRT/IRT/DNA algorithm should be considered by programs with 2 routine screens.
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Affiliation(s)
- Marci K Sontag
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Rachel Lee
- Laboratory Services Section, Texas Department of State Health Services, Austin, TX; Laboratory Services Division, Colorado Department of Public Health and Environment, Denver, CO
| | - Daniel Wright
- Laboratory Services Division, Colorado Department of Public Health and Environment, Denver, CO
| | - Debra Freedenberg
- Laboratory Services Section, Texas Department of State Health Services, Austin, TX
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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Kay DM, Maloney B, Hamel R, Pearce M, DeMartino L, McMahon R, McGrath E, Krein L, Vogel B, Saavedra-Matiz CA, Caggana M, Tavakoli NP. Screening for cystic fibrosis in New York State: considerations for algorithm improvements. Eur J Pediatr 2016; 175:181-93. [PMID: 26293390 DOI: 10.1007/s00431-015-2616-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/04/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022]
Abstract
UNLABELLED Newborn screening for cystic fibrosis (CF), a chronic progressive disease affecting mucus viscosity, has been beneficial in both improving life expectancy and the quality of life for individuals with CF. In New York State from 2007 to 2012 screening for CF involved measuring immunoreactive trypsinogen (IRT) levels in dried blood spots from newborns using the IMMUCHEM(™) Blood Spot Trypsin-MW ELISA kit. Any specimen in the top 5% IRT level underwent DNA analysis using the InPlex(®) CF Molecular Test. Of the 1.48 million newborns screened during the 6-year time period, 7631 babies were referred for follow-up. CF was confirmed in 251 cases, and 94 cases were diagnosed with CF transmembrane conductance regulated-related metabolic syndrome or possible CF. Nine reports of false negatives were made to the program. Variation in daily average IRT was observed depending on the season (4-6 ng/ml) and kit lot (<3 ng/ml), supporting the use of a floating cutoff. The screening method had a sensitivity of 96.5%, specificity of 99.6%, positive predictive value of 4.5%, and negative predictive value of 99.5%. CONCLUSION Considerations for CF screening algorithms should include IRT variations resulting from age at specimen collection, sex, race/ethnicity, season, and manufacturer kit lots. WHAT IS KNOWN Measuring IRT level in dried blood spots is the first-tier screen for CF. Current algorithms for CF screening lead to substantial false-positive referral rates. WHAT IS NEW IRT values were affected by age of infant when specimen is collected, race/ethnicity and sex of infant, and changes in seasons and manufacturer kit lots The prevalence of CF in NYS is 1 in 4200 with the highest prevalence in White infants (1 in 2600) and the lowest in Black infants (1 in 15,400).
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Affiliation(s)
- Denise M Kay
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Breanne Maloney
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Rhonda Hamel
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Melissa Pearce
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Lenore DeMartino
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Rebecca McMahon
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Emily McGrath
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Lea Krein
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Beth Vogel
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Carlos A Saavedra-Matiz
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Michele Caggana
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA.
| | - Norma P Tavakoli
- Division of Genetics, Wadsworth Center, New York State Department of Health, David Axelrod Institute, 120, New Scotland Ave., Albany, NY, 12208, USA. .,Department of Biomedical Sciences, School of Public Health, State University of New York, Albany, NY, USA.
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20
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21
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Miller MR, Soave D, Li W, Gong J, Pace RG, Boëlle PY, Cutting GR, Drumm ML, Knowles MR, Sun L, Rommens JM, Accurso F, Durie PR, Corvol H, Levy H, Sontag MK, Strug LJ. Variants in Solute Carrier SLC26A9 Modify Prenatal Exocrine Pancreatic Damage in Cystic Fibrosis. J Pediatr 2015; 166:1152-1157.e6. [PMID: 25771386 PMCID: PMC4530786 DOI: 10.1016/j.jpeds.2015.01.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 12/12/2014] [Accepted: 01/23/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test the hypothesis that multiple constituents of the apical plasma membrane residing alongside the causal cystic fibrosis (CF) transmembrane conductance regulator protein, including known CF modifiers SLC26A9, SLC6A14, and SLC9A3, would be associated with prenatal exocrine pancreatic damage as measured by newborn screened (NBS) immunoreactive trypsinogen (IRT) levels. STUDY DESIGN NBS IRT measures and genome-wide genotype data were available on 111 subjects from Colorado, 37 subjects from Wisconsin, and 80 subjects from France. Multiple linear regression was used to determine whether any of 8 single nucleotide polymorphisms (SNPs) in SLC26A9, SLC6A14, and SLC9A3 were associated with IRT and whether other constituents of the apical plasma membrane contributed to IRT. RESULTS In the Colorado sample, 3 SLC26A9 SNPs were associated with NBS IRT (min P=1.16×10(-3); rs7512462), but no SLC6A14 or SLC9A3 SNPs were associated (P>.05). The rs7512462 association replicated in the Wisconsin sample (P=.03) but not in the French sample (P=.76). Furthermore, rs7512462 was the top-ranked apical membrane constituent in the combined Colorado and Wisconsin sample. CONCLUSIONS NBS IRT is a biomarker of prenatal exocrine pancreatic disease in patients with CF, and a SNP in SLC26A9 accounts for significant IRT variability. This work suggests SLC26A9 as a potential therapeutic target to ameliorate exocrine pancreatic disease.
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Affiliation(s)
- Melissa R. Miller
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Soave
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Weili Li
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jiafen Gong
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rhonda G. Pace
- Cystic Fibrosis-Pulmonary Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Pierre-Yves Boëlle
- Pierre et Marie Curie University-Paris 6, Paris, France,Biostatistics Department, St Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut National de la Santé et la Researche Médicale (INSERM), UMR-S 1136, Paris, France
| | - Garry R. Cutting
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mitchell L. Drumm
- Departments of Pediatrics and Genetics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael R. Knowles
- Cystic Fibrosis-Pulmonary Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lei Sun
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Johanna M. Rommens
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Frank Accurso
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA,Department of Pediatrics, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Peter R. Durie
- Program in Physiology and Experimental Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Harriet Corvol
- Pierre et Marie Curie University-Paris 6, Paris, France,Pediatric Pulmonology Department, Trousseau Hospital, AP-HP, Inserm U938, Paris, France
| | - Hara Levy
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA,Children’s Research Institute, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marci K. Sontag
- Department of Pediatrics, Children’s Hospital of Colorado, Aurora, Colorado, USA,Department of Epidemiology, Colorado School of Public Health University of Colorado Denver, Aurora, Colorado, USA
| | - Lisa J. Strug
- Program in Genetics and Genome Biology, the Hospital for Sick Children, Toronto, Ontario, Canada,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Abdulhamid I, Kleyn M, Langbo C, Gregoire-Bottex M, Schuen J, Shanmugasundaram K, Nasr SZ. Improving the Rate of Sufficient Sweat Collected in Infants Referred for Sweat Testing in Michigan. Glob Pediatr Health 2014; 1:2333794X14553625. [PMID: 27335913 PMCID: PMC4804676 DOI: 10.1177/2333794x14553625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective. Sweat collected for testing should have quantity not sufficient (QNS) rate of ≤10% in babies ≤3 months of age. Michigan (MI) cystic fibrosis (CF) centers' QNS rates were 12% to 25% in 2009. This project was initiated to reduce sweat QNS rates in MI. Methods/Steps. (a) Each center's sweat testing procedures were reviewed by a consultant. (b) Each center received a report with recommendations to improve QNS rates. (c) Technicians visited other participating centers to observe their procedures. Results. A total of 778 infants were identified as positive via CF newborn screening over a 2-year period. The mean age at time of sweat test was 23.2 days (SD ± 13.0 days). The overall QNS percent decreased from 14.4% to 9.5% (P = .04) during the study. Conclusion. This project and teamwork approach led to a decrease of sweat test QNS rates, opportunities to solve a common problem, and improved quality of care.
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Affiliation(s)
- Ibrahim Abdulhamid
- Children's Hospital of Michigan Cystic Fibrosis Center, Detroit, MI, USA
| | - Mary Kleyn
- Michigan Department of Community Health, Lansing, MI, USA
| | - Carrie Langbo
- Michigan Department of Community Health, Lansing, MI, USA
| | | | - John Schuen
- Helen DeVos Children's Hospital Cystic Fibrosis Center, Grand Rapids, MI, USA
| | | | - Samya Z Nasr
- University of Michigan Cystic Fibrosis Center, Ann Arbor, MI, USA
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Ferril GR, Nick JA, Getz AE, Barham HP, Saavedra MT, Taylor-Cousar JL, Nichols DP, Curran-Everett D, Kingdom TT, Ramakrishnan VR. Comparison of radiographic and clinical characteristics of low-risk and high-risk cystic fibrosis genotypes. Int Forum Allergy Rhinol 2014; 4:915-20. [PMID: 25224556 DOI: 10.1002/alr.21412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/13/2014] [Accepted: 08/05/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.
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Affiliation(s)
- Geoffrey R Ferril
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO
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Nshimyumukiza L, Bois A, Daigneault P, Lands L, Laberge AM, Fournier D, Duplantie J, Giguère Y, Gekas J, Gagné C, Rousseau F, Reinharz D. Cost effectiveness of newborn screening for cystic fibrosis: A simulation study. J Cyst Fibros 2014; 13:267-74. [DOI: 10.1016/j.jcf.2013.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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Commentary. Curr Probl Pediatr Adolesc Health Care 2013; 43:157-8. [PMID: 23790608 DOI: 10.1016/j.cppeds.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Botkin JR, Goldenberg AJ, Rothwell E, Anderson RA, Lewis MH. Retention and research use of residual newborn screening bloodspots. Pediatrics 2013; 131:120-7. [PMID: 23209103 PMCID: PMC3529945 DOI: 10.1542/peds.2012-0852] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The storage and use of residual newborn screening dried blood specimens has generated significant controversy in the past 5 years, primarily because of public concerns over the lack of parental knowledge and consent for these activities. State policies addressing the management of these specimens vary widely, and there is currently little guidance to aid new state policy development to address the concerns of program professionals, investigators, and the general public. This article offers guidance for state policy based on multiple sources of data, including public attitudes, professional statements, state experience, and an analysis of the ethical, social, legal, and biomedical issues from a multidisciplinary group of scholars. This guidance will be useful for state programs that seek to develop policies that are informed by a contemporary analysis of the key ethical, legal, and social aspects of this practice. This article represents the work of the authors and does not represent American Academy of Pediatrics policy.
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Wells J, Rosenberg M, Hoffman G, Anstead M, Farrell PM. A decision-tree approach to cost comparison of newborn screening strategies for cystic fibrosis. Pediatrics 2012; 129:e339-47. [PMID: 22291119 PMCID: PMC3269109 DOI: 10.1542/peds.2011-0096] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Because cystic fibrosis can be difficult to diagnose and treat early, newborn screening programs have rapidly developed nationwide but methods vary widely. We therefore investigated the costs and consequences or specific outcomes of the 2 most commonly used methods. METHODS With available data on screening and follow-up, we used a simulation approach with decision trees to compare immunoreactive trypsinogen (IRT) screening followed by a second IRT test against an IRT/DNA analysis. By using a Monte Carlo simulation program, variation in the model parameters for counts at various nodes of the decision trees, as well as for costs, are included and applied to fictional cohorts of 100 000 newborns. The outcome measures included the numbers of newborns given a diagnosis of cystic fibrosis and costs of screening strategy at each branch and cost per newborn. RESULTS Simulations revealed a substantial number of potential missed diagnoses for the IRT/IRT system versus IRT/DNA. Although the IRT/IRT strategy with commonly used cutoff values offers an average overall cost savings of $2.30 per newborn, a breakdown of costs by societal segments demonstrated higher out-of-pocket costs for families. Two potential system failures causing delayed diagnoses were identified relating to the screening protocols and the follow-up system. CONCLUSIONS The IRT/IRT screening algorithm reduces the costs to laboratories and insurance companies but has more system failures. IRT/DNA offers other advantages, including fewer delayed diagnoses and lower out-of-pocket costs to families.
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Affiliation(s)
| | - Marjorie Rosenberg
- Biostatistics and Medical Informatics, and
- Wisconsin School of Business, University of Wisconsin, Madison, Wisconsin
| | - Gary Hoffman
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin; and
| | - Michael Anstead
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Philip M. Farrell
- Departments of Population Health Sciences
- Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Rock MJ, Levy H, Zaleski C, Farrell PM. Factors accounting for a missed diagnosis of cystic fibrosis after newborn screening. Pediatr Pulmonol 2011; 46:1166-74. [PMID: 22081556 PMCID: PMC4469987 DOI: 10.1002/ppul.21509] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 06/12/2011] [Indexed: 11/07/2022]
Abstract
Newborn screening is a public health policy program involving the centralized testing laboratory, infant and their family, primary care provider, and subspecialist for confirmatory testing and follow-up of abnormal results. Cystic fibrosis (CF) newborn screening has now been enacted in all 50 states and the District of Columbia and throughout many countries in the world. Although CF neonatal screening will identify the vast majority of infants with CF, there are many factors in the newborn screening system that can lead to a missed diagnosis of CF. To inform clinicians, this article summarizes the CF newborn screening system and highlights 14 factors that can account for a missed diagnosis of CF. Care providers should maintain a high suspicion for CF if there are compatible symptoms, regardless of the results of the newborn screening test. These factors in newborn screening programs leading to a missed diagnosis of CF present opportunities for quality improvement in specimen collection, laboratory analysis of immunoreactive tryspinogen (IRT) and CF mutation testing, communication, and sweat testing.
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Affiliation(s)
- Michael J Rock
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin 53792, USA.
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Young RL, Malcolm KC, Kret JE, Caceres SM, Poch KR, Nichols DP, Taylor-Cousar JL, Saavedra MT, Randell SH, Vasil ML, Burns JL, Moskowitz SM, Nick JA. Neutrophil extracellular trap (NET)-mediated killing of Pseudomonas aeruginosa: evidence of acquired resistance within the CF airway, independent of CFTR. PLoS One 2011; 6:e23637. [PMID: 21909403 PMCID: PMC3164657 DOI: 10.1371/journal.pone.0023637] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/21/2011] [Indexed: 01/11/2023] Open
Abstract
The inability of neutrophils to eradicate Pseudomonas aeruginosa within the cystic fibrosis (CF) airway eventually results in chronic infection by the bacteria in nearly 80 percent of patients. Phagocytic killing of P. aeruginosa by CF neutrophils is impaired due to decreased cystic fibrosis transmembrane conductance regulator (CFTR) function and virulence factors acquired by the bacteria. Recently, neutrophil extracellular traps (NETs), extracellular structures composed of neutrophil chromatin complexed with granule contents, were identified as an alternative mechanism of pathogen killing. The hypothesis that NET-mediated killing of P. aeruginosa is impaired in the context of the CF airway was tested. P. aeruginosa induced NET formation by neutrophils from healthy donors in a bacterial density dependent fashion. When maintained in suspension through continuous rotation, P. aeruginosa became physically associated with NETs. Under these conditions, NETs were the predominant mechanism of killing, across a wide range of bacterial densities. Peripheral blood neutrophils isolated from CF patients demonstrated no impairment in NET formation or function against P. aeruginosa. However, isogenic clinical isolates of P. aeruginosa obtained from CF patients early and later in the course of infection demonstrated an acquired capacity to withstand NET-mediated killing in 8 of 9 isolates tested. This resistance correlated with development of the mucoid phenotype, but was not a direct result of the excess alginate production that is characteristic of mucoidy. Together, these results demonstrate that neutrophils can kill P. aeruginosa via NETs, and in vitro this response is most effective under non-stationary conditions with a low ratio of bacteria to neutrophils. NET-mediated killing is independent of CFTR function or bacterial opsonization. Failure of this response in the context of the CF airway may occur, in part, due to an acquired resistance against NET-mediated killing by CF strains of P. aeruginosa.
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Affiliation(s)
- Robert L Young
- Department of Medicine, National Jewish Health, Denver, Colorado, United States of America.
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MacLean JE, Solomon M, Corey M, Selvadurai H. Cystic fibrosis newborn screening does not delay the identification of cystic fibrosis in children with negative results. J Cyst Fibros 2011; 10:333-7. [DOI: 10.1016/j.jcf.2011.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/26/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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Dunn CT, Skrypek MM, Powers ALR, Laguna TA. The need for vigilance: the case of a false-negative newborn screen for cystic fibrosis. Pediatrics 2011; 128:e446-9. [PMID: 21727111 PMCID: PMC8202520 DOI: 10.1542/peds.2010-0286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cystic fibrosis (CF) is the most common life-limiting recessive genetic disorder in the white population. CF is caused by abnormalities in the gene that codes for the cystic fibrosis transmembrane conductance regulator protein (CFTR) and may result in severe chronic lung disease, poor growth, and malnutrition. Physicians often do not consider CF in the differential diagnosis of an infant with failure to thrive in the presence of a negative newborn screening (NBS) result. In Minnesota, newborn infants are screened for CF by immunoreactive trypsinogen (IRT) testing followed by DNA analysis if the IRT screen result is abnormal. All positive NBS results are followed by confirmatory sweat-testing by pilocarpine iontophoresis. We present here the case of a 1-month-old white boy with failure to thrive, chronic diarrhea, and severe malnutrition. Minnesota state CF NBS results were negative at birth (IRT: 43 ng/mL [96% cutoff value: 52 ng/mL]). Clinical symptoms resulted in sweat-testing by Gibson-Cooke pilocarpine iontophoresis at 1 month of age, and the result was positive (102 mmol Cl(-)/L [normal: ≤30 mmol Cl(-)/L]). CFTR mutation analysis confirmed a homozygous f508del genotype, and stool pancreatic elastase testing revealed severe exocrine pancreatic insufficiency. This case represents the first known false-negative result in Minnesota since the initiation of NBS for CF in 2006, which illustrates the importance of considering CF in the evaluation of an infant with failure to thrive and symptoms of malabsorption, regardless of NBS results.
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Affiliation(s)
- Christina T. Dunn
- Department of Pediatrics, University of Minnesota and University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota; and
| | - Mary M. Skrypek
- Department of Pediatrics, University of Minnesota and University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota; and
| | - Amy L. R. Powers
- University of Minnesota Medical Center, Fairview and University of Minnesota Cystic Fibrosis Center, Minneapolis, Minnesota
| | - Theresa A. Laguna
- Department of Pediatrics, University of Minnesota and University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota; and
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Earley MC, Laxova A, Farrell PM, Driscoll-Dunn R, Cordovado S, Mogayzel PJ, Konstan MW, Hannon WH. Implementation of the first worldwide quality assurance program for cystic fibrosis multiple mutation detection in population-based screening. Clin Chim Acta 2011; 412:1376-81. [PMID: 21514289 PMCID: PMC4086748 DOI: 10.1016/j.cca.2011.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 04/08/2011] [Accepted: 04/08/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND CDC's Newborn Screening Quality Assurance Program collaborated with several U.S. Cystic Fibrosis Care Centers to collect specimens for development of a molecular CFTR proficiency testing program using dried-blood spots for newborn screening laboratories. METHODS Adult and adolescent patients or carriers donated whole blood that was aliquoted onto filter paper cards. Five blind-coded specimens were sent to participating newborn screening laboratories quarterly. Proficiency testing results were evaluated based on presumptive clinical assessment. Individual evaluations and summary reports were sent to each participating laboratory and technical consultations were offered if incorrect assessments were reported. RESULTS The current CDC repository contains specimens with 39 different CFTR mutations. Up to 45 laboratories have participated in the program. Three years of data showed that correct assessments were reported 97.7% of the time overall when both mutations could be determined. Incorrect assessments that could have lead to a missed case occurred 0.9% of the time, and no information was reported 1.1% of the time due to sample failure. CONCLUSIONS Results show that laboratories using molecular assays to detect CFTR mutations are performing satisfactorily. The programmatic results presented demonstrate the importance and complexity of providing proficiency testing for DNA-based assays.
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Affiliation(s)
- Marie C Earley
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Óscar Fielbaum C. Avances en fibrosis quística. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70407-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rock MJ, Sharp JK. Cystic fibrosis and CRMS screening: what the primary care pediatrician should know. Pediatr Ann 2010; 39:759-68. [PMID: 21162484 DOI: 10.3928/00485713-20101117-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Berry JG, Bloom S, Foley S, Palfrey JS. Health inequity in children and youth with chronic health conditions. Pediatrics 2010; 126 Suppl 3:S111-9. [PMID: 21123473 DOI: 10.1542/peds.2010-1466d] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Over the last decades, there have been great advances in health care delivered to children with chronic conditions, but not all children have benefitted equally from them. OBJECTIVES To describe health inequities experienced by children with chronic health conditions. METHODS We performed a literature review of English-language studies identified from the Medline, Centers for Disease Control and Prevention, National Cancer Institute, and Cystic Fibrosis Foundation Web sites that were published between January 1985 and May 2009, included children aged 0 to 18 years, and contained the key words "incidence," "prevalence," "survival," "mortality," or "disparity" in the title or abstract for the following health conditions: acute leukemia, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, cystic fibrosis, diabetes mellitus, Down syndrome, HIV/AIDS, major congenital heart defects, major depressive disorder, sickle cell anemia, spina bifida, and traumatic brain injury. RESULTS Black children had higher rates of cerebral palsy and HIV/AIDS, were less likely to be diagnosed with ADHD, had more emergency department visits, hospitalizations, and had higher mortality rates associated with asthma; and survived less often with Down syndrome, type 1 diabetes, and traumatic brain injury when compared with white children. Hispanic children had higher rates of spina bifida from Mexico-born mothers, had higher rates of HIV/AIDS and depression, were less likely to be diagnosed with ADHD, had poorer glycemic control with type 1 diabetes, and survived less often with acute leukemia compared with white children. CONCLUSIONS Serious racial and ethnic health and health care inequities persist for children with chronic health conditions.
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Affiliation(s)
- Jay G Berry
- Complex Care Service, Program for Patient Safety and Quality, Children's Hospital Boston, Fegan 10, 300 Longwood Ave, Boston, MA 02115, USA.
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Frequency of Usher syndrome in two pediatric populations: Implications for genetic screening of deaf and hard of hearing children. Genet Med 2010; 12:512-6. [PMID: 20613545 DOI: 10.1097/gim.0b013e3181e5afb8] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Usher syndrome is a major cause of genetic deafness and blindness. The hearing loss is usually congenital and the retinitis pigmentosa is progressive and first noticed in early childhood to the middle teenage years. Its frequency may be underestimated. Newly developed molecular technologies can detect the underlying gene mutation of this disorder early in life providing estimation of its prevalence in at risk pediatric populations and laying a foundation for its incorporation as an adjunct to newborn hearing screening programs. METHODS A total of 133 children from two deaf and hard of hearing pediatric populations were genotyped first for GJB2/6 and, if negative, then for Usher syndrome. Children were scored as positive if the test revealed > or =1 pathogenic mutations in any Usher gene. RESULTS Fifteen children carried pathogenic mutations in one of the Usher genes; the number of deaf and hard of hearing children carrying Usher syndrome mutations was 15/133 (11.3%). The population prevalence was estimated to be 1/6000. CONCLUSION Usher syndrome is more prevalent than has been reported before the genome project era. Early diagnosis of Usher syndrome has important positive implications for childhood safety, educational planning, genetic counseling, and treatment. The results demonstrate that DNA testing for Usher syndrome is feasible and may be a useful addition to newborn hearing screening programs.
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Sommerburg O, Lindner M, Muckenthaler M, Kohlmueller D, Leible S, Feneberg R, Kulozik AE, Mall MA, Hoffmann GF. Initial evaluation of a biochemical cystic fibrosis newborn screening by sequential analysis of immunoreactive trypsinogen and pancreatitis-associated protein (IRT/PAP) as a strategy that does not involve DNA testing in a Northern European population. J Inherit Metab Dis 2010; 33:S263-71. [PMID: 20714932 DOI: 10.1007/s10545-010-9174-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/07/2010] [Accepted: 07/08/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ethical concerns and disadvantages of newborn screening (NBS) for cystic fibrosis (CF) related to genetic testing have raised controversies and impeded implementation of CF NBS in some countries. In the present study, we used a prospective and sequential immunoreactive trypsinogene (IRT)/pancreatitis-associated protein (PAP) strategy, with IRT as first and PAP as second tier, and validated this biochemical approach against the widely used IRT/DNA protocol in a population-based NBS study in southwest Germany. METHODS Prospective quantitation of PAP and genetic analysis for the presence of four mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene most prevalent in southwest Germany (F508del, R553X, G551D, G542X) were performed in all newborns with IRT > 99.0th percentile. NBS was rated positive when either PAP was ≥1.0 ng/mL and/or at least one CFTR mutation was detected. In addition, IRT > 99.9th percentile was also considered a positive rating. Positive rating led to referral to a CF centre for testing of sweat Cl(-) concentration. FINDINGS Out of 73,759 newborns tested, 98 (0.13%) were positive with IRT/PAP and 56 (0.08%) with IRT/DNA. After sweat testing of 135 CF NBS-positive infants, 13 were diagnosed with CF. Detection rates were similar for both IRT/PAP and IRT/DNA. One of the 13 diagnosed CF newborns had a PAP concentration <1.0 ng/mL. CONCLUSIONS Sequential measurement of IRT/PAP provides good sensitivity and specificity and allows reliable and cost-effective CF NBS which circumvents the necessity of genetic testing with its inherent ethical problems.
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Affiliation(s)
- Olaf Sommerburg
- Division of Paediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Paediatrics III, University of Heidelberg, Im Neuenheimer Feld 430, Heidelberg, Germany.
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Sermet-Gaudelus I, Munck A, Rota M, Roussey M, Feldmann D. Recommandations françaises pour la réalisation et l’interprétation du test de la sueur dans le cadre du dépistage néonatal de la mucoviscidose. Arch Pediatr 2010; 17:1349-58. [DOI: 10.1016/j.arcped.2010.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 06/24/2010] [Indexed: 11/26/2022]
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Nick JA, Chacon CS, Brayshaw SJ, Jones MC, Barboa CM, St Clair CG, Young RL, Nichols DP, Janssen JS, Huitt GA, Iseman MD, Daley CL, Taylor-Cousar JL, Accurso FJ, Saavedra MT, Sontag MK. Effects of gender and age at diagnosis on disease progression in long-term survivors of cystic fibrosis. Am J Respir Crit Care Med 2010; 182:614-26. [PMID: 20448091 PMCID: PMC2937235 DOI: 10.1164/rccm.201001-0092oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 05/06/2010] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Long-term survivors of cystic fibrosis (CF) (age > 40 yr) are a growing population comprising both patients diagnosed with classic manifestations in childhood, and nonclassic phenotypes typically diagnosed as adults. Little is known concerning disease progression and outcomes in these cohorts. OBJECTIVES Examine effects of age at diagnosis and gender on disease progression, setting of care, response to treatment, and mortality in long-term survivors of CF. METHODS Retrospective analysis of the Colorado CF Database (1992-2008), CF Foundation Registry (1992-2007), and Multiple Cause of Death Index (1992-2005). MEASUREMENTS AND MAIN RESULTS Patients with CF diagnosed in childhood and who survive to age 40 years have more severe CFTR genotypes and phenotypes compared with adult-diagnosed patients. However, past the age of 40 years the rate of FEV(1) decline and death from respiratory complications were not different between these cohorts. Compared with males, childhood-diagnosed females were less likely to reach age 40 years, experienced faster FEV(1) declines, and no survival advantage. Females comprised the majority of adult-diagnosed patients, and demonstrated equal FEV(1) decline and longer survival than males, despite a later age at diagnosis. Most adult-diagnosed patients were not followed at CF centers, and with increasing age a smaller percentage of CF deaths appeared in the Cystic Fibrosis Foundation Registry. However, newly diagnosed adults demonstrated sustained FEV(1) improvement in response to CF center care. CONCLUSIONS For patients with CF older than 40 years, the adult diagnosis correlates with delayed but equally severe pulmonary disease. A gender-associated disadvantage remains for females diagnosed in childhood, but is not present for adult-diagnosed females.
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Affiliation(s)
- Jerry A Nick
- Adult Cystic Fibrosis Program, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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Collaco JM, Panny SR, Hamosh A, Mogayzel PJ. False negative cystic fibrosis newborn screen. Clin Pediatr (Phila) 2010; 49:214-6. [PMID: 20164071 DOI: 10.1177/0009922809342893] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, 200 N. Wolfe Street, Baltimore, MD 21287, USA.
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A new cystic fibrosis newborn screening algorithm: IRT/IRT1 upward arrow/DNA. J Pediatr 2009; 155:618-22. [PMID: 19540513 DOI: 10.1016/j.jpeds.2009.03.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/30/2009] [Accepted: 03/26/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate an immunoreactive trypsinogen (IRT) IRT/IRT1 upward arrow/DNA algorithm, aimed at improving sensitivity while decreasing cystic fibrosis (CF) carrier identification. STUDY DESIGN New technologies allow the measurement of the second IRT level solely in infants with an elevated first IRT level. Specimens with an elevated second IRT level undergo mutation analysis. We tested the projected efficacy with retrospective data from Colorado. RESULTS All known infants with CF would have been identified with our proposed IRT cutoff points, and 3 would have been missed with our mutation panel. Two of 3 missed cases would have been identified by using a failsafe method (IRT >99.9th percentile), yielding a sensitivity rate of 99.7% (95% CI, 98.4-99.9). Estimated reduction in carrier detection was 80% compared with IRT/DNA. CONCLUSION IRT/IRT1 upward arrow/DNA appears to improve cystic fibrosis newborn screen sensitivity while decreasing carrier identification, providing an alternative to IRT/IRT in states that obtain 2 blood spots.
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Abstract
Newborn screening (NBS) for cystic fibrosis (CF) has evolved considerably from its beginnings. We review the early history of NBS in the USA and the evolution of CF NBS from its conception in observational studies, to the development of mass-screening methodology in the 1970s, and to its early applications in the USA and other countries. We review the development of current CF NBS algorithms, particularly the development of those used in the Wisconsin randomized controlled trial, and discuss the comparative utility of different algorithms. We also discuss the identified nutritional and respiratory benefits of CF NBS, discuss treatment strategies for newborns identified with CF, and also discuss opportunities for slowing the progression of this disease.
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Affiliation(s)
- Jack K Sharp
- Pediatric Pulmonology, Department of Pediatrics, The Women and Children's Hospital of Buffalo, The State University of New York at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
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Kloosterboer M, Hoffman G, Rock M, Gershan W, Laxova A, Li Z, Farrell PM. Clarification of laboratory and clinical variables that influence cystic fibrosis newborn screening with initial analysis of immunoreactive trypsinogen. Pediatrics 2009; 123:e338-46. [PMID: 19171585 DOI: 10.1542/peds.2008-1681] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To ensure that each newborn receives an equitable test of the highest possible sensitivity, we recognized the necessity to reassess immunoreactive trypsinogen and DNA issues in cystic fibrosis newborn screening algorithms. Our objectives included clarification of various factors that influence immunoreactive trypsinogen concentrations and resolution of long-standing questions about variations in immunoreactive trypsinogen levels among newborns. METHODS Immunoreactive trypsinogen data on 660443 newborns who were born between July 1, 1994, and June 30, 2004, were abstracted from the Wisconsin State Laboratory of Hygiene databases and deidentified for analysis. Using a compiled data set, we analyzed various demographic characteristics to determine their role, if any, in immunoreactive trypsinogen variation. Specifically, season of birth, reagent lot, and birth weight were examined. Sensitivities of the most common cystic fibrosis newborn screening protocols, namely immunoreactive trypsinogen/immunoreactive trypsinogen and immunoreactive trypsinogen/DNA, were also investigated. RESULTS Mean and 95th percentile immunoreactive trypsinogen levels were shown to vary by both season and reagent lot number and affect sensitivity of the assay. Low birth weight infants had significantly higher immunoreactive trypsinogen values than normal birth weight infants. Sensitivities were also found to vary on the basis of the algorithm used, with the highest sensitivity of 96.2% calculated for an immunoreactive trypsinogen/DNA protocol with 23 cystic fibrosis transmembrane conductance regulator mutation analyses compared with 80.2% with the immunoreactive trypsinogen/immunoreactive trypsinogen method used in 9 states. CONCLUSIONS Floating, rather than fixed, cutoff values for the initial immunoreactive trypsinogen portion of any cystic fibrosis newborn screening protocol are generally necessary on the basis of the seasonal and reagent lot variations observed. Because of its lower sensitivity, immunoreactive trypsinogen/immunoreactive trypsinogen does not optimize detection of patients with cystic fibrosis.
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Affiliation(s)
- Molly Kloosterboer
- Departments of Population Health Sciences, University of Wisconsin, Madison, WI 53726-2397, USA
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Abstract
Cystic fibrosis transmembrane conductance regulator-related disorders encompass a disease spectrum from focal male reproductive tract involvement in congenital absence of the vas deferens to multiorgan involvement in classic cystic fibrosis. The reproductive, gastrointestinal, and exocrine manifestations of cystic fibrosis transmembrane conductance regulator deficiency are correlated with CFTR genotype, whereas the respiratory manifestations that are the main cause of morbidity and mortality in cystic fibrosis are less predictable. Molecular genetic testing of CFTR has led to new diagnostic strategies and will enable targeting of molecular therapies now in development. Older diagnostic methods that measure sweat chloride and nasal potential difference nonetheless remain important because of their sensitivity and specificity. In addition, the measurement of immunoreactive trypsinogen and the genotyping of CFTR alleles are key to newborn screening programs because of low cost. The multiorgan nature of cystic fibrosis leads to a heavy burden of care, thus therapeutic regimens are tailored to the specific manifestations present in each patient. The variability of cystic fibrosis lung disease and the variable expressivity of mild CFTR alleles complicate genetic counseling for this autosomal recessive disorder. Widespread implementation of newborn screening programs among populations with significant cystic fibrosis mutation carrier frequencies is expected to result in increasing demands on genetic counseling resources.
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Ross LF. Newborn screening for cystic fibrosis: a lesson in public health disparities. J Pediatr 2008; 153:308-13. [PMID: 18718257 PMCID: PMC2569148 DOI: 10.1016/j.jpeds.2008.04.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 03/31/2008] [Accepted: 04/24/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Lainie Friedman Ross
- Department of Pediatrics and the MacLean Center for Clinical Medical Ethics at the University of Chicago, Chicago, IL, USA
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47
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Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. J Pediatr 2008; 153:S4-S14. [PMID: 18639722 PMCID: PMC2810958 DOI: 10.1016/j.jpeds.2008.05.005] [Citation(s) in RCA: 671] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Newborn screening (NBS) for cystic fibrosis (CF) is increasingly being implemented and is soon likely to be in use throughout the United States, because early detection permits access to specialized medical care and improves outcomes. The diagnosis of CF is not always straightforward, however. The sweat chloride test remains the gold standard for CF diagnosis but does not always give a clear answer. Genotype analysis also does not always provide clarity; more than 1500 mutations have been identified in the CF transmembrane conductance regulator (CFTR) gene, not all of which result in CF. Harmful mutations in the gene can present as a spectrum of pathology ranging from sinusitis in adulthood to severe lung, pancreatic, or liver disease in infancy. Thus, CF identified postnatally must remain a clinical diagnosis. To provide guidance for the diagnosis of both infants with positive NBS results and older patients presenting with an indistinct clinical picture, the Cystic Fibrosis Foundation convened a meeting of experts in the field of CF diagnosis. Their recommendations, presented herein, involve a combination of clinical presentation, laboratory testing, and genetics to confirm a diagnosis of CF.
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Affiliation(s)
- Philip M. Farrell
- Department of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Frank J. Accurso
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO
| | | | - Garry R. Cutting
- Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD
| | - Peter R. Durie
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vicky A. Legrys
- Department of Allied Health Sciences, University of North Carolina, Chapel Hill, NC
| | - John Massie
- Department of Respiratory Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Richard B. Parad
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Michael J. Rock
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
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48
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Chien YH, Chiang SC, Zhang XK, Keutzer J, Lee NC, Huang AC, Chen CA, Wu MH, Huang PH, Tsai FJ, Chen YT, Hwu WL. Early detection of Pompe disease by newborn screening is feasible: results from the Taiwan screening program. Pediatrics 2008; 122:e39-45. [PMID: 18519449 DOI: 10.1542/peds.2007-2222] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pompe disease is an autosomal recessive lysosomal storage disorder that is caused by deficient acid alpha-glucosidase activity and results in progressive, debilitating, and often life-threatening symptoms involving the musculoskeletal, respiratory, and cardiac systems. Recently, enzyme replacement therapy with alglucosidase alpha has become possible, but the best outcomes in motor function have been achieved when treatment was initiated early. The aim of this study was to test the feasibility of screening newborns in Taiwan for Pompe disease by using a fluorometric enzymatic assay to determine acid alpha-glucosidase activity in dried blood spots. METHODS We conducted a large-scale newborn screening pilot program between October 2005 and March 2007. The screening involved measuring acid alpha-glucosidase activity in dried blood spots of approximately 45% of newborns in Taiwan. The unscreened population was monitored as a control. RESULTS Of the 132 538 newborns screened, 1093 (0.82%) repeat dried blood-spot samples were requested and retested, and 121 (0.091%) newborns were recalled for additional evaluation. Pompe disease was confirmed in 4 newborns. This number was similar to the number of infants who received a diagnosis of Pompe disease in the control group (n = 3); however, newborn screening resulted in an earlier diagnosis of Pompe disease: patients were <1 month old compared with 3 to 6 months old in the control group. CONCLUSIONS To our knowledge, this is the first large-scale study to show that newborn screening for Pompe disease is feasible. Newborn screening allows for earlier diagnosis of Pompe disease and, thus, for assessment of the value of an earlier start of treatment.
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Affiliation(s)
- Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University School of Medicine, Taipei, Taiwan
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49
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Laguna TA, Sagel SD, Sontag MK, Accurso FJ. The clinical course of a Mexican female with cystic fibrosis and the novel genotype S531P/S531P. J Cyst Fibros 2008; 7:454-6. [PMID: 18463004 DOI: 10.1016/j.jcf.2008.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 01/08/2008] [Accepted: 03/14/2008] [Indexed: 10/22/2022]
Abstract
The case of a 16 year-old Mexican female with cystic fibrosis and the novel genotype S531P/S531P is presented. Her clinical course has consisted of recurrent pancreatitis and rapidly progressive lung disease complicated by Mycobacterium kansasii and Penicillium infection. This report illustrates the need for better characterization of CFTR mutations in a Hispanic population to aid in clinical care.
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Affiliation(s)
- Theresa A Laguna
- Department of Pediatrics, University of Colorado School of Medicine and The Children's Hospital, 13123 E. 16th Ave, B-395, Aurora, CO 80045, USA.
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50
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Lebo RV, Omlor GJ. Targeted extended cystic fibrosis mutation testing on known and at-risk patients and relatives. ACTA ACUST UNITED AC 2008; 11:427-44. [PMID: 18294061 DOI: 10.1089/gte.2007.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper reports mathematically derived residual risks of being a carrier or being affected with cystic fibrosis following various screening scenarios to assist in interpreting test results and advising patients. While parental screening with 23 American College of Medical Genetics (ACMG) cystic fibrosis mutations defines the 64% of affected U.S. Caucasian fetuses with two detectable mutations, newborn screening for elevated immunoreactive trypsinogen (IRT) and sweat chloride identifies an additional 36% of affected newborns with zero or one detected mutation. The relatives of these affected newborns with less than two detectable mutations have higher posterior (after) 23 mutation-negative test risks of carrying undetected mutations. These calculations emphasize how knowledge of the mutations in the related affected patient substantially improves upon the quality of after-test advice to patients. Furthermore, negative tests of the partner without a family history and/or more extensive cystic fibrosis transmembrane conductance regulator (CFTR) gene testing also increases the likelihood that a negative report is truly negative. When a newborn patient with zero or one detected CFTR mutation has an inconclusive sweat test result, the sweat test should be repeated before ordering additional often unnecessary CFTR gene sequencing. Given the same composite mutation panel test accuracy, a higher proportion of reported test results would be correct during parental screening than when testing at-risk fetuses or symptomatic newborns. Prenatal and newborn screening would be enhanced substantially by medical professionals offering copies of all positive parental and newborn test reports to the parents to share with their relatives. These principles are likely to be applicable to other genetic diseases as the most common mutation frequencies are reported.
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Affiliation(s)
- Roger V Lebo
- Department of Pathology, Akron Children's Hospital, Akron, OH 44308-1062, USA.
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