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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [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: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Appelberg K, Sörensen L, Zetterström RH, Henriksson M, Wedell A, Levin LÅ. Cost-Effectiveness of Newborn Screening for Phenylketonuria and Congenital Hypothyroidism. J Pediatr 2023; 256:38-43.e3. [PMID: 36495999 DOI: 10.1016/j.jpeds.2022.10.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the long-term costs and health effects of the Swedish newborn screening program for classic phenylketonuria (PKU) alone and in combination with congenital hypothyroidism compared with no screening. STUDY DESIGN A decision-analytic model was developed to estimate and compare the long-term (80 years) costs and health effects of newborn screening for PKU and congenital hypothyroidism. Data were obtained from the literature and translated to Swedish conditions. A societal perspective was taken, including costs falling on health care providers, municipal care and services, as well as production loss due to morbidity. RESULTS Screening 100 000 newborns for PKU resulted in 73 gained quality-adjusted life-years (QALYs) compared with no screening. When adding congenital hypothyroidism, the number of gained QALYs was 232 compared with PKU alone, adding up to a total of 305 QALYs gained. Corresponding cost estimates were $80.8, $70.3, and $10.05 million USD for no screening, PKU screening, and PKU plus congenital hypothyroidism screening, respectively, indicating that screening for PKU plus congenital hypothyroidism was more effective and less costly compared with the other strategies. The majority of cost savings with PKU plus congenital hypothyroidism screening was due to reductions in productivity losses and municipal care and services costs. CONCLUSION The Swedish newborn screening program for PKU and congenital hypothyroidism saves substantial costs for society while generating additional QALYs, emphasizing the importance of public investments in early diagnosis and treatment.
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Affiliation(s)
- Kajsa Appelberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Lene Sörensen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rolf H Zetterström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Martin Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Wedell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Lars-Åke Levin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Sörensen L, von Döbeln U, Åhlman H, Ohlsson A, Engvall M, Naess K, Backman-Johansson C, Nordqvist Y, Wedell A, Zetterström RH. Expanded Screening of One Million Swedish Babies with R4S and CLIR for Post-Analytical Evaluation of Data. Int J Neonatal Screen 2020; 6:42. [PMID: 33073033 PMCID: PMC7423009 DOI: 10.3390/ijns6020042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022] Open
Abstract
Sweden has one neonatal screening laboratory, receiving 115 to 120 thousand samples per year. Among the one million babies screened by tandem mass spectrometry from November 2010 until July 2019, a total of 665 babies were recalled and 311 verified as having one of the diseases screened for with this methodology, giving a positive predictive value (PPV) of 47% and an incidence of 1:3200. The PPV was high (41%) already in the first year after start of screening, thanks to the availability of the collaborative project Region 4 Stork database. The PPV is presently 58%. This improvement was achieved by the implementation of second-tier analyses in the screening for methylmalonic aciduria, propionic aciduria, isovaleric aciduria, and homocystinuria, and the employment of various post analytical tools of the Region 4 Stork, and its successor the collaborative laboratory integrated reports.
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Affiliation(s)
- Lene Sörensen
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Ulrika von Döbeln
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Medical Biochemistry and Biophysics, Division of Molecular Metabolism, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Henrik Åhlman
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
| | - Annika Ohlsson
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Medical Biochemistry and Biophysics, Division of Molecular Metabolism, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Martin Engvall
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Karin Naess
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Medical Biochemistry and Biophysics, Division of Molecular Metabolism, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Carolina Backman-Johansson
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
| | - Yvonne Nordqvist
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Medical Biochemistry and Biophysics, Division of Molecular Metabolism, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Anna Wedell
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; (U.v.D.); (H.Å.); (A.O.); (M.E.); (K.N.); (C.B.-J.); (Y.N.); (A.W.); (R.H.Z.)
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
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Shoraka HR, Haghdoost AA, Baneshi MR, Bagherinezhad Z, Zolala F. Global prevalence of classic phenylketonuria based on Neonatal Screening Program Data: systematic review and meta-analysis. Clin Exp Pediatr 2020; 63:34-43. [PMID: 32024337 PMCID: PMC7029670 DOI: 10.3345/kjp.2019.00465] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023] Open
Abstract
Phenylketonuria is a disease caused by congenital defects in phenylalanine metabolism that leads to irreversible nerve cell damage. However, its detection in the early days of life can reduce its severity. Thus, many countries have started disease screening programs for neonates. The present study aimed to determine the worldwide prevalence of classic phenylketonuria using the data of neonatal screening studies. The PubMed, Web of Sciences, Sciences Direct, ProQuest, and Scopus databases were searched for related articles. Article quality was evaluated using the Joanna Briggs Institute Critical Appraisal Evaluation Checklist. A random effect was used to calculate the pooled prevalence, and a phenylketonuria prevalence per 100,000 neonates was reported. A total of 53 studies with 119,152,905 participants conducted in 1964-2017 were included in this systematic review. The highest prevalence (38.13) was reported in Turkey, while the lowest (0.3) in Thailand. A total of 46 studies were entered into the meta-analysis for pooled prevalence estimation. The overall worldwide prevalence of the disease is 6.002 per 100,000 neonates (95% confidence interval, 5.07-6.93). The metaregression test showed high heterogeneity in the worldwide disease prevalence (I2=99%). Heterogeneity in the worldwide prevalence of phenylketonuria is high, possibly due to differences in factors affecting the disease, such as consanguineous marriages and genetic reserves in different countries, study performance, diagnostic tests, cutoff points, and sample size.
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Affiliation(s)
- Hamid Reza Shoraka
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Modeling in health research center, Institute for futures studies in health, Kerman University of medical sciences, Kerman, Iran
| | - Zohre Bagherinezhad
- Department of Medical Library and Information Science, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzaneh Zolala
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Ohlsson A, Hunt M, Wedell A, von Döbeln U. Heterogeneity of disease-causing variants in the Swedish galactosemia population: Identification of 16 novel GALT variants. J Inherit Metab Dis 2019; 42:1008-1018. [PMID: 31194895 DOI: 10.1002/jimd.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Abstract
The aim was to determine disease-causing variants in the GALT gene which codes for the enzyme galactose-1-phosphate uridylyltransferase. Loss of activity of this enzyme causes classical galactosemia-a life threatening, treatable disorder, included in the Swedish newborn screening program since 1967. A total of 66 patients with the disease are known in Sweden and 56 index patients were investigated. An additional two patients with Duarte galactosemia were included. The disease-causing variants were identified in all patients. As reported from other countries only a few variants frequently recur in severe disease. The two variants p.(Gln188Arg) (c.563A>G) and p.(Met142Lys) (c.425T>A) are present in several index patients whereas the remaining are found in one to three patients each. The most common variant, p.(Gln188Arg), has an allele frequency of 51% in the cohort. A total of 16 novel variants were found among the 33 different variants in the cohort. Two of these are synonymous variants affecting splicing, demonstrating the importance of the evaluation of synonymous variants at the cDNA level. Concise sentence: Galactosemia is a rare disease in Sweden and the disease-causing variants are heterogenous including two synonymous variants.
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Affiliation(s)
- Annika Ohlsson
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Mary Hunt
- The School of Biological and Health Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Anna Wedell
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ulrika von Döbeln
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
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Xiang L, Tao J, Deng K, Li X, Li Q, Yuan X, Liang J, Yu E, Wang M, Wang H, Liu H, Zhu J. Phenylketonuria incidence in China between 2013 and 2017 based on data from the Chinese newborn screening information system: a descriptive study. BMJ Open 2019; 9:e031474. [PMID: 31444193 PMCID: PMC6707664 DOI: 10.1136/bmjopen-2019-031474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/02/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study examines the incidence and spatial clustering of phenylketonuria (PKU) in China between 2013 and 2017. METHODS Data from the Chinese Newborn Screening Information System were analysed to assess PKU incidence with 95% CIs by province, region and disease severity. Spatial clustering of PKU cases was analysed using global and local spatial autocorrelation analysis in the geographic information system. RESULTS The database contained 4925 neonates with confirmed PKU during the study period, corresponding to an incidence of 6.28 (95% CI: 6.11 to 6.46) per 100 000 neonates screened. Incidence was highest in the provinces of Gansu, Ningxia and Qinghai, where it ranged from 19.00 to 28.63 per 100 000 neonates screened. Overall incidence was higher in the northern part of the country, where classical disease predominated, than in the southern part, where mild disease predominated. PKU cases clustered spatially (global Moran's I=0.3603, Z=5.3097, p<0.001), and local spatial autocorrelation identified four northern provinces as high-high clusters (Gansu, Qinghai, Ningxia and Shanxi). CONCLUSIONS China shows an intermediate PKU incidence among countries, and incidence differs substantially among Chinese provinces and between northern and southern regions. Our results suggest the need to focus efforts on screening, diagnosing and treating PKU in high-incidence provinces.
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Affiliation(s)
- Liangcheng Xiang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Jing Tao
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Kui Deng
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Xuelian Yuan
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Erling Yu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Meixian Wang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
| | - Huiqing Wang
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
| | - Hanmin Liu
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
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Karlén J, Karlsson M, Eliasson H, Bonamy AKE, Halvorsen CP. Cardiac Troponin T in Healthy Full-Term Infants. Pediatr Cardiol 2019; 40:1645-1654. [PMID: 31489446 PMCID: PMC6848050 DOI: 10.1007/s00246-019-02199-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
Abstract
In this prospective cohort study of healthy full-term infants, we hypothesized that high-sensitivity cardiac troponin T (hs-cTnT) would be elevated in cord blood, compared with adult reference values, and that it would further increase over the first days of age. Cardiac troponin T has been shown to be significantly increased in healthy full-term newborns compared with adult reference values, but there is no established reference range. Most studies of cTnT in newborns have been performed before the introduction of high-sensitivity cTnT (hs-cTnT) assay. We conducted a study including 158 full-term newborns, at Stockholm South General Hospital. High-sensitivity cTnT was analyzed in umbilical cord blood and at 2-5 days of age. Median hs-cTnT (interquartile range) in cord blood was 34(26-44) ng/L; 99th percentile 88 ng/L. Median hs-cTnT at 2-5 days of age was 92(54-158) ng/L; 99th percentile 664 ng/L. We conclude that hs-cTnT is elevated in cord blood in healthy, full-term newborn infants compared with adult reference values, and that it increases significantly during the first days of life. Our findings further underline the need of caution when using hs-cTnT as a measurement of cardiac impact in newborns.
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Affiliation(s)
- Jonna Karlén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden.
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden.
| | - Mathias Karlsson
- Department of Medical Sciences, Biomedical Structure and Function, Uppsala University, 751 85, Uppsala, Sweden
| | - Håkan Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Pediatric Cardiology Department, Astrid Lindgrens Children's Hospital, Eugeniavägen 23, 171 64, Solna, Sweden
| | - Anna-Karin Edstedt Bonamy
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden
- Clinical Epidemiology Division, Karolinska Institutet, Karolinska vägen, 171 76, Stockholm, Sweden
| | - Cecilia Pegelow Halvorsen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden
- Neonatal Unit at Sachs' Children's and Youth Hospital, Hjalmar Cederströms gata 14, 118 61, Stockholm, Sweden
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Comparison of measurements of autoantibodies to glutamic acid decarboxylase and islet antigen-2 in whole blood eluates from dried blood spots using the RSR-enzyme linked immunosorbent assay kits and in-house radioimmunoassays. EXPERIMENTAL DIABETES RESEARCH 2010; 2010:173652. [PMID: 20613950 PMCID: PMC2896843 DOI: 10.1155/2010/173652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 09/07/2009] [Accepted: 03/24/2010] [Indexed: 11/18/2022]
Abstract
To evaluate the performance of dried blood spots (DBSs) with subsequent analyses of glutamic acid decarboxylase (GADA) and islet antigen-2 (IA-2A) with the RSR-ELISAs, we selected 80 children newly diagnosed with type 1 diabetes and 120 healthy women. DBSs from patients and controls were used for RSR-ELISAs while patients samples were analysed also with in-house RIAs.
The RSR-ELISA-GADA performed well with a specificity of 100%, albeit sensitivity (46%) was lower compared to in RIA (56%; P = .008). No prozone effect was observed after dilution of discrepant samples. RSR-ELISA-IA-2A achieved specificity of 69% and sensitivity was lower (59%) compared with RIA (66%; P < .001). Negative or low positive patients and control samples in the RSR-ELISA-IA-2A increased after dilution. Eluates from DBS can readily be used to analyse GADA with the RSR-ELISA, even if low levels of autoantibodies were not detected. Some factor could disturb RSR-ELISA-IA-2A analyses.
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Ghiasvand NM, Aledavood A, Ghiasvand R, Seyedin Borojeny F, Aledavood AR, Seyed S, Miner W, Saeb Taheri GR. Prevalence of classical phenylketonuria in mentally retarded individuals in Iran. J Inherit Metab Dis 2009; 32 Suppl 1:S283-7. [PMID: 19768570 DOI: 10.1007/s10545-009-1222-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 01/05/2023]
Abstract
Using Guthrie Biological Inhibition Assay, 4963 mentally retarded individuals housed in 31 cities and towns across the country were screened for PKU. The average prevalence of classical PKU in the study population was 2.1%, which is higher than that reported for most mentally retarded populations in other countries prior to the implementation of a nationwide newborn screening programme for PKU. The prevalence of PKU in 1814 mentally retarded inmates housed in shelters in Tehran was 2.81%, and the prevalence of the disease in 3149 inmates sheltered in other cities and towns was 1.68%. It appears that most of the difference between the prevalence of PKU in these two populations is due to a unique PKU referral pattern in Iran. The high prevalence of PKU in the mentally retarded population in Iran could be indicative of a high incidence of the disease among Iranian neonates. This in turn appears to be positively influenced by both a high frequency of the PKU allele and a high rate of consanguinity in the country. Our finding suggests that instead of limited local screening programmes in the country, a nationwide screening programme for PKU, especially if coupled with screening for congenital hypothyroidism, would be highly cost-effective and warranted.
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Affiliation(s)
- N M Ghiasvand
- Department of Biology, Grand Valley State University, Allendale, MI 49401, USA.
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Aim J, Holmgren G, Larsson A, Schimpfessel L. Histidinaemia in Sweden. Clin Genet 2008. [DOI: 10.1111/j.1399-0004.1981.tb01835.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yaqoob M, Bashir A, Zaman S, Ferngren H, Von Dobeln U, Gustavson KH. Mild intellectual disability in children in Lahore, Pakistan: aetiology and risk factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:663-671. [PMID: 15357686 DOI: 10.1111/j.1365-2788.2003.00573.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND One of the main objectives of studying intellectual disability (ID) in children is to explore its causes. A specific aetiological diagnosis is important in determining the prognosis, nature and extent of services needed to support affected children. METHODS Aetiology and risk factors in mild ID were studied in a cohort of longitudinally followed children (6-10 years of age, n = 40) in four population groups in and around Lahore, Pakistan. RESULTS The overall prevalence of mild ID was 6.2%. In 22% of the cases the onset of mild ID was prenatal with small for gestational age and multifactorial inheritance as the main underlying factors. During the postnatal period (28% of the cases), social deprivation and malnutrition were the major causes of ID. In a substantial proportion of the cases (50%), the cause of ID could not be traced. CONCLUSION The present study indicates a clear relationship of mild ID with prenatal and postnatal malnutrition and social deprivation. Two independent variables, maternal illiteracy and small head circumference at birth, showed a clear association with the development of mild mental disability among children in the study population.
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Affiliation(s)
- M Yaqoob
- Department of Paediatrics, Maternity and Children's Hospital, Al-Qassim, Saudi Arabia.
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12
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Hansen TW, Henrichsen B, Rasmussen RK, Carling A, Andressen AB, Skjeldal O. Neuropsychological and linguistic follow-up studies of children with galactosaemia from an unscreened population. Acta Paediatr 1996; 85:1197-201. [PMID: 8922083 DOI: 10.1111/j.1651-2227.1996.tb18228.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many galactosaemics appear to have neuropsychological and/or linguistic problems in spite of dietary treatment. Because the neonatal screening program in Norway does not include galactosaemia, we have re-examined Norwegian galactosaemics. Of 16 known patients, 8 patients participated in the study. They had been diagnosed between 2 and 11 weeks of age, and were between 9 months and 19 years old at the time of this study. All had very low or 0 activity of galactose-1-phosphate uridyl transferase. As part of the study all were examined neurologically, and had an age-appropriate developmental/IQ test, an ABR and an EEG, and a comprehensive psycholinguistic evaluation. The three youngest patients had normal developmental/IQ tests, while the five older patients had IQ scores in or below low range of normal. The majority had delayed language development and three patients were classified as having verbal dyspraxia. ABR and EEG showed mild pathology in the oldest patient only. Galactosaemia appears to be associated with significant risks of developmental and language delays in this unscreened population.
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Affiliation(s)
- T W Hansen
- Department of Pediatrics, Rikshospitalet, University of Oslo, Norway
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Yaqoob M, Bashir A, Tareen K, Gustavson KH, Nazir R, Jalil F, von Döbeln U, Ferngren H. Severe mental retardation in 2 to 24-month-old children in Lahore, Pakistan: a prospective cohort study. Acta Paediatr 1995; 84:267-72. [PMID: 7780247 DOI: 10.1111/j.1651-2227.1995.tb13627.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Severe mental retardation (developmental quotient (DQ) < 50) was investigated in 1303 children from 2 to 24 months of age, born during 1984-87 in four population groups representing different socio-economic levels in and around Lahore, Pakistan. The incidence per 1000 live births was 22 in the periurban slum, 9 in the urban slum, 7 in the village and 4 in the upper middle class group. The aetiology was prenatal in 79%, perinatal in 14% and untraceable in 7% of cases. Down's syndrome was the most common cause of severe mental retardation (36%). Impairments were studied at 2 years of age. Impairment of language was present in all, while locomotor dysfunction was seen in 89% of cases. Epilepsy and cerebral palsy were each present in 22% of cases. Mortality among these severely mentally retarded children was 36%.
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Affiliation(s)
- M Yaqoob
- Department of Social and Preventive Paediatrics, King Edward Medical College, Lahore, Pakistan
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14
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15
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von Döbeln U, Venizelos N, Hagenfeldt L. Retrospective diagnosis of 3-hydroxydicarboxylic aciduria by analysis of filter paper blood samples. J Inherit Metab Dis 1990; 13:165-8. [PMID: 2143242 DOI: 10.1007/bf01799680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Five patients with 3-hydroxydicarboxylic aciduria have been investigated. Two of them had elder siblings who had died unexpectedly in early infancy. Stored filter paper blood samples obtained from the patients and their siblings for neonatal screening were retrieved. Elevated levels of 3-hydroxy fatty acids were observed in the samples from three of the five patients with 3-hydroxydicarboxylic aciduria and in the samples from both siblings.
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Affiliation(s)
- U von Döbeln
- Department of Clinical Chemistry, Karolinska Hospital, Stockholm, Sweden
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16
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Mathias D, Bickel H. Follow-up study of 16 years neonatal screening for inborn errors of metabolism in West Germany. Eur J Pediatr 1986; 145:310-2. [PMID: 3770001 DOI: 10.1007/bf00439408] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Capillary blood samples from almost one million neonates from Baden-Württemberg were investigated for inborn errors of metabolism between 1969 and 1984 in our screening centre. Besides 7 patients with maple syrup urine disease (MSUD), 3 with homocystinuria and 18 with galactosaemia, a follow-up of the positive screening results confirmed 94 patients with phenylketonuria (PKU) and 76 with non-PKU hyperphenylalaninaemia (non-PKU HPA). The incidence of PKU is 1:10000, and that of HPA in the wider sense (PKU and non-PKU HPA) as obtained by newborn screening before further classification at 6 months 1:5532. For West Germany as a whole, the number of newly discovered cases with persistent hyperphenylalaninaemia was 1480 in the same period. The subdivision into PKU and non-PKU HPA is not yet possible from this figure. It is strongly suggested that the abnormal results of newborn screening for phenylalanine be designated as hyperphenylalaninaemia (in the wider sense) and that the terms "PKU" or "non-PKU HPA" be used only after further differentiation as carried out by us at the age of 6 months.
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Alm J, Bodegård G, Larsson A, Nyberg G, Zetterström R. Children with inborn errors of phenylalanine metabolism: prognosis and phenylalanine tolerance. ACTA PAEDIATRICA SCANDINAVICA 1986; 75:619-25. [PMID: 3751555 DOI: 10.1111/j.1651-2227.1986.tb10261.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-three children, who were detected by neonatal PKU screening, were followed for 8-18 years in one paediatric centre. Dietary treatment was started if the blood phenylalanine level exceeded 0.72 mmol/l. All 23 infants were initially given a low phenylalanine diet. The growth and development rates of the children did not differ significantly from those in a reference population, although one child had mild mental retardation and another had a short attention span. Fourteen children were still on a strict phenylalanine-restricted diet on their last follow-up (at 8-18 years of age). In nine children who were initially put on a low phenylalanine diet, it was possible to normalize the diet between 1/2 and 10 years of age, while maintaining the blood phenylalanine levels between 0.25 and 0.72 mmol/l. It seems likely that those of our patients who markedly increased their phenylalanine tolerance during childhood had a regulatory mutation of the phenylalanine hydroxylase system. A continuous reevaluation of each child treated with a low phenylalanine diet reduces the use of unnecessarily restricted diets.
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Mattingley JM. Paper chromatography of urinary amino acids. A 30 year survey of dietary influences on the normal pattern, and patients' results. Biomed Chromatogr 1986; 1:95-100. [PMID: 3506825 DOI: 10.1002/bmc.1130010302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the clinical laboratory, paper chromatography is still the most useful, simple, inexpensive procedure for initial identification of abnormalities of amino acid excretion. The results of its use for more than 8000 paediatric and adult renal patients is surveyed. Nonspecific generalized aminoaciduria was the most frequent abnormality found, comprising some 70% of abnormal results, with cystine-lysinuria the next most common. The identification of the abnormal excretory pattern of amino acids as distinct from the normal was complicated by the effects of the New Zealand diet. In particular, valine, citrulline, hydroxyproline and glutamic acid are found in considerable amounts as part of the normal pattern. Their dietary origin is discussed. Varying mixtures of monosaccharides and disaccharides occurred in association with a range of amino acid patterns.
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Affiliation(s)
- J M Mattingley
- Department of Laboratory Services, Wellington Hospital, New Zealand
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Hagberg B. Rett's syndrome: prevalence and impact on progressive severe mental retardation in girls. ACTA PAEDIATRICA SCANDINAVICA 1985; 74:405-8. [PMID: 4003065 DOI: 10.1111/j.1651-2227.1985.tb10993.x] [Citation(s) in RCA: 212] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The prevalence of Rett's syndrome was studied in a part of southwestern Sweden comprising five counties and the city of Gothenburg. In a population of 315469 children and adolescents, 6-17 years of age, 10 cases were detected, all girls. The corresponding prevalence was 0.65/10 000 girls, i.e. about twice that of phenylketonuria (PKU) in the same area. As progressive brain disorders/metabolic diseases together constitute 5-6% (1.5-2.0/10 000 children) of the aetiologies among severely mentally retarded persons of this age group in central Sweden, it can be concluded that within this group Rett's syndrome should be considered as an aetiological factor to think of in females. This syndrome might well be responsible for one-fourth to one-third of such cases among girls.
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Abstract
ecent epidemiological studies in Swedish school age children revealed a prevalence of severe mental retardation (SMR = IQ less than 50) of 0.3% and of mild mental retardation (MMR = IQ 50-70) around 0.4%. In SMR prenatal causes were found in 55%, perinatal in 15-20%, no traceable brain pathology in 18%. Corresponding figures for MMR were 23%, 18% and 55%, respectively. Down syndrome was the largest single cause of SMR and polygenic subcapacity considered to be that of MMR. Chromosomal errors were detected among 29% SMR and 4% MMR school children. Fragile X accounted for 4% SMR and 10% MMR in boys. Fetal alcohol syndromes constituted 8% of urban MMR. The contribution of inborn errors of metabolism was 4-5% and less than 1%, in SMR and MMR, respectively. Perinatal (28th prenatal week-28th postnatal day) brain damage was implicated in 15% of SMR and 18% of MMR. Pathogenetic data are considered for potential preventive measures.
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Alm J, Larsson A, Rosenqvist U. Health economic analysis of the Swedish neonatal metabolic screening programme. A method of optimizing routines. Med Decis Making 1982; 2:33-45. [PMID: 6820461 DOI: 10.1177/0272989x8200200107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A benefit-cost analysis was carried out to optimize the routines for neonatal metabolic screening. The basis of the study was provided by results of the Swedish neonatal screening programme from 1965 to 1979. During this period over one million infants were screened by the Guthrie test for phenylketonuria and galactosaemia, and for limited periods also for tyrosinaemia, homocystinuria and histidinaemia. The benefit-cost ratio was calculated for combinations of different screening tests, recall routines, and varying degrees of coverage. The largest benefit-cost ratio was obtained with combined screening for phenylketonuria and galactosaemia, using a borderline blood phenylalanine level of 0.50 mmol/L in the Guthrie test for phenylketonuria. However, the inaccuracy of this test necessitated the use of a lower blood phenylalanine level of 0.25 mmol/L and the acceptance of a lower benefit-cost ratio. An increase in the present 98% coverage of newborns by the screening programme was found to be an effective means of improving the benefit-cost ratio in the present programme.
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