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Pedersen E, de Jong Carmen CM, Jurca M, Berger DO, Sanz J, Sluka S, Poms M, Baumgartner MR, Regamey N, Kuehni CE, Barben J, Rueegg CS. Cystic fibrosis newborn screening in Switzerland - evaluation and scenarios for improvement after 11 years of follow-up. J Cyst Fibros 2024:S1569-1993(24)00053-5. [PMID: 38658252 DOI: 10.1016/j.jcf.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Newborn bloodspot screening (NBS) for cystic fibrosis (CF) is important for early diagnosis and treatment. However, screening can lead to false-positive results leading to unnecessary follow-up tests and distress. This study evaluated the 11-year performance of the Swiss CF-NBS programme, estimated optimal cut-offs for immunoreactive trypsinogen (IRT), and examined how simulated algorithms would change performance. METHODS The Swiss CF-NBS is based on an IRT-DNA algorithm with a second IRT (IRT-2) as safety net. We analysed data from 2011 to 2021, covering 959,006 IRT-1 analyses and 282 children with CF. We studied performance based on European Cystic Fibrosis Society (ECFS) standards including sensitivity, specificity, positive predictive value (PPV), false negative rate, and second heel-prick tests; identified optimal IRT cut-offs using receiver operating characteristics (ROC) curves; and calculated performance for simulated algorithms with different cut-offs for IRT-1, IRT-2, and safety net. RESULTS The Swiss CF-NBS showed excellent sensitivity (96 %, 10 false negative cases) but moderate PPV (25 %). Optimal IRT-1 and IRT-2 cut-offs were identified at 2.7 (>99th percentile) and 5.9 (>99.8th percentile) z-scores, respectively. Analysis of simulated algorithms showed that removing the safety net from the current algorithm could increase PPV to 30 % and eliminate >200 second heel-prick tests per year, while keeping sensitivity at 95 %. CONCLUSION The Swiss CF-NBS program performed well over 11 years but did not achieve the ECFS standards for PPV (≥30 %). Modifying or removing the safety net could improve PPV and reduce unnecessary follow-up tests while maintaining the ECFS standards for sensitivity.
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Affiliation(s)
- Esl Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - C M de Jong Carmen
- Division of Paediatric Respiratory Medicine and Allergy, Department of Paediatrics, University Children's Hospital Bern, Bern, Switzerland
| | - M Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; The University Children's Hospital Basel, Basel, Switzerland
| | - D O Berger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - J Sanz
- Department of Human Genetics, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Shm Sluka
- Newborn Screening Switzerland, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Poms
- Division of Metabolism and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M R Baumgartner
- Division of Metabolism and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - C E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Division of Paediatric Respiratory Medicine and Allergy, Department of Paediatrics, University Children's Hospital Bern, Bern, Switzerland
| | - J Barben
- Paediatric Pulmonology & CF Centre, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
| | - C S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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2
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Groden CM, Vetter CJ, Salih ZNI. Parental Experiences of Genetic Testing. Neoreviews 2024; 25:e151-e158. [PMID: 38425197 DOI: 10.1542/neo.25-3-e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Genetic testing is increasingly used in clinical practice in the neonatal period, including in NICUs. This testing may have psychological consequences for parents. To best support families, neonatal clinicians should be aware of the various ways in which parents view and respond to genetic testing. In this review, we summarize research on the parental experience of having a newborn infant undergo genetic testing.
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Affiliation(s)
| | - Cecelia J Vetter
- Ruth Lily Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Zeynep N I Salih
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
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3
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Odenwald B, Brockow I, Hanauer M, Lüders A, Nennstiel U. Is Our Newborn Screening Working Well? A Literature Review of Quality Requirements for Newborn Blood Spot Screening (NBS) Infrastructure and Procedures. Int J Neonatal Screen 2023; 9:35. [PMID: 37489488 PMCID: PMC10366861 DOI: 10.3390/ijns9030035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
Newborn screening using dried blood spots (NBS) is widely acknowledged as a highly successful procedure in secondary prevention. For a number of congenital disorders, severe disability or death are impressively prevented by early detection and early treatment through NBS. However, as with any other screening, NBS can also cause harm, and the principle that "the overall benefits of screening should outweigh the harms" must be considered when introducing and implementing NBS programmes. This publication compiles the results of a systematic literature research on requirements for NBS infrastructure and procedures which was conducted as part of a research project on the quality and shortcomings of the NBS pathway in Germany. The compilation contains the requirements and recommendations for realising the principle of "maximise benefits and minimise harms" in relevant NBS pathway components such as parental education and information, coverage, timeliness, laboratory quality assurance, follow-up of abnormal results, confirmatory diagnostics, documentation, and evaluation. The results reflect the complexity of NBS infrastructure, and thus, they illustrate the importance of considering and implementing NBS as a well-coordinated public health programme with continuous quality management. Special attention should be paid to the perspectives of parents and families. Some NBS issues can substantially benefit from digital instruments or international cooperation. The literature review presented here has contributed to a concept of proposals for the advancement of NBS in Germany, and despite different settings, it may as well be of interest for other countries to achieve the best possible course and outcome of NBS for each child.
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Affiliation(s)
- Birgit Odenwald
- Newborn Screening Centre/State Institute of Health, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany
| | | | | | | | - Uta Nennstiel
- Newborn Screening Centre/State Institute of Health, Bavarian Health and Food Safety Authority, 85764 Oberschleissheim, Germany
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4
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Hoang SC, Blumenschein P, Lilley M, Olshaski L, Bruce A, Wright NAM, Ridsdale R, Christian S. Secondary Reporting of G6PD Deficiency on Newborn Screening. Int J Neonatal Screen 2023; 9:ijns9020018. [PMID: 37092512 PMCID: PMC10123647 DOI: 10.3390/ijns9020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
In April 2019, the Alberta Newborn Screening Program expanded to include screening for classic galactosemia using a two-tier screening approach. This approach secondarily identifies infants with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The goals of this study were (i) to evaluate the performance of a two-tier galactosemia screening protocol, (ii) to explore the impact on and acceptability to families of reporting G6PD deficiency as a secondary finding, and (iii) assess the communication and follow-up process for positive G6PD deficiency screening results. The two-tiered galactosemia approach increased the positive predictive value (PPV) for galactosemia from 8% to 79%. An additional 119 positive newborn screen results were reported for G6PD deficiency with a PPV of 92%. The results show that there may be utility in reporting G6PD deficiency results. Most parents who participated in the study reported having some residual worry around the unexpected diagnosis; however, all thought it was helpful to know of their child's diagnosis of G6PD deficiency. Finally, the communication process for reporting G6PD deficiency newborn screen results was determined to result in appropriate follow up of infants.
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Affiliation(s)
- Stephanie C Hoang
- Genetics & Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2H7, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Pamela Blumenschein
- Genetics & Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2H7, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Margaret Lilley
- Genetics & Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2H7, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Larissa Olshaski
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Aisha Bruce
- Pediatric Hematology, Stollery Children's Hospital, Edmonton, AB T6G 2B7, Canada
| | - Nicola A M Wright
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Ross Ridsdale
- Genetics & Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2H7, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Susan Christian
- Genetics & Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2H7, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
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5
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Gapp S, Garbade SF, Feyh P, Brockow I, Nennstiel U, Hoffmann GF, Sommerburg O, Gramer G. German newborn screening for Cystic fibrosis: Parental perspectives and suggestions for improvements. Pediatr Pulmonol 2023; 58:844-852. [PMID: 36444714 DOI: 10.1002/ppul.26263] [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: 03/13/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Cystic fibrosis (CF) was added to the German newborn bloodspot screening (NBS) panel in 2016. This study assesses parental perceptions of CF-NBS and confirmatory testing. METHODS Prospective questionnaire-based survey administered to parents of children with positive CF-NBS over 40 months after initiation of CF-NBS in Southwest Germany. Parental perceptions were compared to results from Bavaria and Switzerland. RESULTS Questionnaires with 29 standardized questions were sent to 343 families with children born between October 2016 and January 2020. A total of 178 (51.9%) replied. Although required by law, only a minority were informed about CF-NBS by a physician. The information provided about NBS was sufficient for 78% of parents. Regarding the information about positive CF-NBS, 52.9% were satisfied but the majority expressed negative emotions (89.5%). While most of these were resolved after confirmatory diagnostics, 17% of parents of children with false-positive CF-NBS and 66.7% of children confirmed with CF remained anxious. Waiting time for sweat testing was >3 days in 56.1%, considerably longer than in more centralized screening systems. Parents who waited for a maximum of 3 days were significantly more satisfied. 70.7% of parents were satisfied with the information given during confirmatory diagnostics and 91.4% were satisfied with participating in CF-NBS. CONCLUSIONS CF-NBS stands in high regard with parents. Smooth organization, timely initiation of confirmatory testing, and professional communication are most important to limit parental anxiety. A more centralized system of confirmatory diagnostics appears advantageous in several regards as it reduces time from positive NBS to final diagnosis and increases parental satisfaction.
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Affiliation(s)
- Simon Gapp
- Center for Pediatric and Adolescent Medicine, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sven F Garbade
- Center for Pediatric and Adolescent Medicine, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrik Feyh
- Center for Pediatric and Adolescent Medicine, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Inken Brockow
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Uta Nennstiel
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Georg F Hoffmann
- Center for Pediatric and Adolescent Medicine, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center (TLRC), German Lung Research Center (DZL), University of Heidelberg, Heidelberg, Germany.,Center for Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Gwendolyn Gramer
- Center for Pediatric and Adolescent Medicine, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Medical Center Hamburg-Eppendorf, University Children's Hospital, Hamburg, Germany
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Tluczek A, Ersig AL, Lee S. Psychosocial Issues Related to Newborn Screening: A Systematic Review and Synthesis. Int J Neonatal Screen 2022; 8:ijns8040053. [PMID: 36278623 PMCID: PMC9589938 DOI: 10.3390/ijns8040053] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/20/2022] Open
Abstract
Genomic advances have contributed to a proliferation of newborn screening (NBS) programs. Psychosocial consequences of NBS have been identified as risks to these public health initiatives. Following PRISMA guidelines, this systematic review synthesizes findings from 92 evidence-based, peer-reviewed research reports published from 2000 through 2020 regarding psychosocial issues associated with NBS. Results describe parents' knowledge of and attitudes towards NBS, reactions to and understanding of positive NBS results, experiences of communication with health providers, decisions about carrier testing, and future pregnancies. Findings also explain the impact of positive NBS results on parent-child relationships, child development, informing children about carrier status, family burden, quality of life, and disparities. In conclusion, psychosocial consequences of receiving unexpected neonatal screening results and unsolicited genetic information remain significant risks to expansion of NBS. Findings suggest that risks may be mitigated by improved parent NBS education, effective communication, individualized genetic counseling, and anticipatory developmental guidance. Clinicians need to take extra measures to ensure equitable service delivery to marginalized subpopulations. Future investigations should be more inclusive of culturally and socioeconomically diverse families and conducted in low-resource countries. Providing these countries with adequate resources to develop NBS programs is an essential step towards achieving international health equity.
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Affiliation(s)
- Audrey Tluczek
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI 53705, USA
- Correspondence:
| | - Anne L. Ersig
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI 53705, USA
| | - Shinhyo Lee
- School of Nursing, Columbia University, 560 W 168th St, New York, NY 10032, USA
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7
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Haitjema S, Lubout CMA, Zijlstra JHM, Wolffenbuttel BHR, van Spronsen FJ. Communication of an Abnormal Metabolic New-Born Screening Result in The Netherlands: The Parental Perspective. Nutrients 2022; 14:nu14193961. [PMID: 36235614 PMCID: PMC9571573 DOI: 10.3390/nu14193961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022] Open
Abstract
In the Netherlands, abnormal New-Born Screening (NBS) results are communicated to parents by the general practitioner (GP). Good communication and consequential trust in professionals is of the utmost importance in the treatment of phenylketonuria (PKU). The aim of this study was to assess parental satisfaction regarding the communication of an abnormal NBS result for PKU in the Netherlands. An email containing the link to a web-based questionnaire was sent by the Dutch PKU Association to their members. Responses to open questions were categorized, data of both open and closed questions were analysed with descriptive statistics and the Chi-Square test using SPSS. Out of 113 parents of a child with PKU (born between 1979 and 2020), 68 stated they were overall unsatisfied with the first communication of the NBS result. Seventy-five parents indicated that wrong or no information about PKU was given. A significant decrease was found in the number of parents being contact by their own GP over the course of 40 years (p < 0.05). More than half of all parents were overall unsatisfied with the first communication of the abnormal NBS result for PKU. Further research on how to optimize communication of an abnormal NBS results is necessary.
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Affiliation(s)
- Sietske Haitjema
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Charlotte M. A. Lubout
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence:
| | - Justine H. M. Zijlstra
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Francjan J. van Spronsen
- Department of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Nielsen PB, Olesen HV, Jensen CS. Being affiliated to a cystic fibrosis centre is important for parents' everyday life. Acta Paediatr 2022; 111:2017-2024. [PMID: 35748537 PMCID: PMC9541786 DOI: 10.1111/apa.16466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
Aim Newborn screening represents a paradigm shift in the treatment of children with cystic fibrosis. This study aimed to explore parents' everyday life experiences from the time of diagnosis and in the following months. Methods Narrative interviews were conducted at Aarhus University Hospital, Denmark, with parents (mothers = 15 and fathers =14) of 15 term‐born children with a mean age of 2 weeks (range 1–3.5 weeks). Participant observation and field notes were used to complement interview data. The analysis was inspired by Kvale and Brinkmann. Results Three themes were identified. First, on diagnosis, a profound difference in parents' experience was observed depending on whether the diagnosis was communicated by a medical doctor from the cystic fibrosis team or by a paediatrician from another hospital. Second, during the initial meetings and subsequent relationships with the cystic fibrosis team, the knowledge and calmness exhibited by the doctors and nurses were very valuable. Third, regarding everyday life after the diagnosis, most parents described experiencing anxiety and concern for their child's future. Conclusion The parents' experiences highlighted essential elements that should be implemented to optimise the patient care pathway as they are fundamental to parents' ability to cope with the new living conditions.
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Affiliation(s)
- Pia Bonde Nielsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Hanne Vebert Olesen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark
| | - Claus Sixtus Jensen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark.,Research Centre for Emergency Medicine, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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Delivering Positive Newborn Screening Results: Cost Analysis of Existing Practice versus Innovative, Co-Designed Strategies from the ReSPoND Study. Int J Neonatal Screen 2022; 8:ijns8010019. [PMID: 35323198 PMCID: PMC8951105 DOI: 10.3390/ijns8010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Although the communication pathways of Newborn Bloodspot Screening (NBS) are a delicate task, these pathways vary across different conditions and are often not evidence-based. The ReSPoND interventions were co-designed by healthcare professionals alongside parents who had received a positive NBS result for their child. To calculate the cost of these co-designed strategies and the existing communication pathways, we interviewed 71 members of the clinical and laboratory staff of the 13 English NBS laboratories in the English National Health Service. Therefore, a scenario analysis was used to compare the cost of the existing communication pathways to the co-designed strategies delivered by (i) home-visits and (ii) telecommunications. On average, the existing communication pathway cost £447.08 per infant (range: £237.12 to £628.51) or £234,872.75 (£3635.99 to £1,932,986.23) nationally. Implementing the new interventions relying on home-visits exclusively would cost on average £521.62 (£312.84 to £646.39) per infant and £297,816.03 (£4506.37 to £2,550,284.64) nationally, or £447.19 (£235.79 to £552.03) and £231,342.40 (£3923.7 to £1,922,192.22) if implemented via teleconsultations, respectively. The new strategies delivered are not likely to require additional resources compared with current practice. Further research is needed to investigate whether this investment represents good value for money for the NHS budget.
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Chudleigh J, Barben J, Ren CL, Southern KW. International Approaches to Management of CFTR-Related Metabolic Syndrome/Cystic Fibrosis Screen Positive, Inconclusive Diagnosis. Int J Neonatal Screen 2022; 8:ijns8010005. [PMID: 35076474 PMCID: PMC8788507 DOI: 10.3390/ijns8010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
The main aim of the present study was to explore health professionals' reported experiences and approaches to managing children who receive a designation of cystic fibrosis transmembrane conductance regulator-related metabolic syndrome/cystic fibrosis screen positive inconclusive diagnosis following a positive NBS result for cystic fibrosis. An online questionnaire was distributed via Qualtrics Survey Software and circulated to a purposive, international sample of health professionals involved in managing children with this designation. In total, 101 clinicians completed the online survey: 39 from the US, six from Canada, and 56 from Europe (including the UK). Results indicated that while respondents reported minor deviations in practice, they were cognizant of recommendations in the updated guidance and for the most part, attempted to implement these into practice consistently internationally. Where variation was reported, the purpose of this appeared to be to enable clinicians to respond to either clinical assessments or parental anxiety in order to improve outcomes for the child and family. Further research is needed to determine if these findings are reflective of both a wider audience of clinicians and actual (rather than reported) practice.
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Affiliation(s)
- Jane Chudleigh
- School of Health Sciences, City, University of London, London EC1V 0HB, UK
- Correspondence: ; Tel.: +44-(0)-7977-933204
| | - Jürg Barben
- Children’s Hospital of Eastern Switzerland, 9000 St. Gallen, Switzerland;
| | - Clement L. Ren
- Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Kevin W. Southern
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool L69 3BX, UK;
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11
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Rosettenstein KR, Lain SJ, Wormleaton N, Jack MM. A systematic review of the outcomes of false-positive results on newborn screening for congenital hypothyroidism. Clin Endocrinol (Oxf) 2021; 95:766-781. [PMID: 34302303 DOI: 10.1111/cen.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/10/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The potential of harm to infants or their parents from a false positive (FP) newborn screening (NBS) result for congenital hypothyroidism (CH) is often cited as an argument against lowering of screening thresholds for CH. This systematic review (SR) examines the evidence of harm and factors that possibly contribute. STUDY DESIGN PRISMA guidelines were followed and the protocol was registered online (Prospero, ID CRD42019123950, 20 August 2019) before the search was conducted. Multiple electronic databases and grey literature were searched. Articles were included/excluded based on predetermined eligibility criteria. Included articles were appraised for quality, using the relevant Critical Appraisal Skills Program (CASP) tool. Data were extracted and results were tabulated and summarised as part of a narrative synthesis. RESULTS A total of six studies met the inclusion criteria. All were qualitative and three were based on the same cohort. Studies were published between 1983 and 1996. CASP appraisals scored 2/6 studies as moderate quality and 4/6 as low quality. Studies reported that FP results on CH screening may cause initial stress for parents and poorly defined behavioural disturbance in a small number of children, though these effects were generally not long-lasting. Poor screening processes and inadequate communication with parents, increased the risk of harm to parents and children, from FP results. CONCLUSION This SR found a small number of dated, qualitative studies of low to moderate quality, conducted soon after the initiation of NBS for CH. Conclusive evidence of the risks of harm from FP results and ways to mitigate harm, awaits further, well-designed studies.
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Affiliation(s)
- Kerri R Rosettenstein
- Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Kerri R. Rosettenstein, Department of Endocrinology, Sydney Children's Hospital Network, University of New South Wales, Sydney, New South Wales, Australia
| | - Samantha J Lain
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Nicola Wormleaton
- Douglas Piper Library, Northern Sydney Local Health District Libraries, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Michelle M Jack
- Department of Paediatric Endocrinology, Northern Clinical School, Royal North Shore Hospital, University of Sydney, Camperdown, New South Wales, Australia
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12
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Gokdemir Y, Eyuboglu TS, Emiralioglu N, Er B, Sen V, Pekcan S, Ergenekon AP, Hizal MG, Eryilmaz S, Kose M, Hangul M, Cakir E, Cokugras H, Kılınc AA, Sasıhuseyinoglu AS, Altintas DU, Gulen F, Eski A, Bingol A, Ozdemir A, Topal E, Gursoy TR, Girit S, Ay P, Yılmaz O. Geographical barriers to timely diagnosis of cystic fibrosis and anxiety level of parents during newborn screening in Turkey. Pediatr Pulmonol 2021; 56:3223-3231. [PMID: 34273142 DOI: 10.1002/ppul.25586] [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: 01/05/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the availability of cystic fibrosis (CF) screening countrywide, diagnostic delay is still a crucial issue. The objectives of this study were to explore the stages of the NBS process, determine the risk factors associated with diagnostic delay and evaluate parent anxiety and experience throughout the process. METHODS This is a multicenter cross-sectional study. A questionnaire was completed by parents of newborns diagnosed with CF via NBS in 17 centers. Socio-demographic characteristics, parent knowledge and experiences related to NBS, sweat test availability in the region of residence, and time to the definitive CF diagnosis were assessed through this questionnaire. Parents' anxiety levels were evaluated through the State-Trait Anxiety Inventory scales 1 and 2. Delayed diagnosis (DD) was defined as a definite CF diagnosis beyond the 8th week of life. Predictors of delayed CF diagnosis were evaluated by univariate and multivariate analysis. RESULTS A total of 220 CF patients diagnosed via NBS were enrolled; 82 (37.3%) babies had DD. Multivariable analysis indicated that residence in the Southeast Anatolia region of Turkey (OR = 10.79, 95% CI = 2.37-49.2) was associated with a higher incidence of DD compared with other regions in Turkey. Of the total, 216 (98.1%) of the caregivers regarded the NBS program as useful and 180 (82%) reported high anxiety levels. CONCLUSION The organization of newborn screening should take into account regional and socio-cultural characteristics to improve the early diagnosis of CF and also reduce the anxiety level of parents.
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Affiliation(s)
- Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Nagehan Emiralioglu
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Berrin Er
- Department of Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Sen
- Division of Pediatric Pulmonology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mina Gharibzadeh Hizal
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Kose
- Division of Pediatric Pulmonology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangul
- Division of Pediatric Pulmonology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, School of Medicine, Bezmi Alem Vakıf University, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzıt Kılınc
- Division of Pediatric Pulmonology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Derya Ufuk Altintas
- Division of Pediatric Allergy and Immunology, School of Medicine, Cukurova University, Adana, Turkey
| | - Figen Gulen
- Division of Pediatric Pulmonology, School of Medicine, Ege University, Istanbul, Turkey
| | - Aykut Eski
- Division of Pediatric Pulmonology, School of Medicine, Ege University, Istanbul, Turkey
| | - Aysen Bingol
- Division of Pediatric Pulmonology, School of Medicine, Akdeniz University, Istanbul, Turkey
| | | | - Erdem Topal
- Division of Pediatric Allergy and Immunology, School of Medicine, İnonu University, Malatya, Turkey
| | - Tugba Ramaslı Gursoy
- Division of Pediatric Pulmonology, School of Medicine, Gazi University, Ankara, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Pınar Ay
- Department of Public Health, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozge Yılmaz
- Division of Pediatric Pulmonology, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Chudleigh J, Shakespeare L, Holder P, Chinnery H, Hack G, Gill T, Gould R, Southern KW, Olander EK, Morris S, Bonham JR, Simpson A, Moody L. Co-designing improved communication to parents of newborn bloodspot screening results (Preprint). J Particip Med 2021; 14:e33485. [PMID: 35896023 PMCID: PMC9377474 DOI: 10.2196/33485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Each year in England, almost 10,000 parents are informed of their child’s positive newborn bloodspot screening (NBS) results. This occurs approximately 2 to 8 weeks after birth depending on the condition. Communication of positive NBS results is a subtle and skillful task, demanding thought, preparation, and evidence to minimize potentially harmful negative sequelae. Evidence of variability in the content and the way the result is currently communicated has the potential to lead to increased parental anxiety and distress. Objective This study focused on the development of co-designed interventions to improve the experiences of parents receiving positive NBS results for their children and enhance communication between health care professionals and parents. Methods An experience-based co-design approach was used to explore experiences and co-design solutions with 17 health professionals employed in 3 National Health Service Trusts in England and 21 parents (13/21, 62% mothers and 8/21, 38% fathers) of 14 children recruited from the same 3 National Health Service Trusts. Experiences with existing services were gathered via semistructured interviews with health professionals. Filmed narrative interviews with parents were developed into a composite film. The co-design process identified priorities for improving communication of positive NBS results through separate parent and health professional feedback events followed by joint feedback events. In total, 4 interventions were then co-designed between the participants through a web-based platform. Results Parents and health professionals provided positive feedback regarding the process of gathering experiences and identifying priorities. Themes identified from the parent interviews included impact of initial communication, parental reactions, attending the first clinic appointment, impact of health professionals’ communication strategies and skills, impact of diagnosis on family and friends, improvements to the communication of positive NBS results, and parents’ views on NBS. Themes identified from the health professional interviews included communication between health professionals, process of communicating with the family, parent- and family-centered care, and availability of resources and challenges to effective communication. In response to these themes, 4 interventions were co-designed: changes to the NBS card; standardized laboratory proformas; standardized communication checklists; and an email or letter for providing reliable, up-to-date, condition-specific information for parents following the communication of positive NBS results. Conclusions Parents and health professionals were able to successfully work together to identify priorities and develop co-designed interventions to improve communication of positive NBS results to parents. The resulting co-designed interventions address communication at different stages of the communication pathway to improve the experiences of parents receiving positive NBS results for their children. International Registered Report Identifier (IRRID) RR2-10.1186/s40814-019-0487-5
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Affiliation(s)
- Jane Chudleigh
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Lynette Shakespeare
- Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Pru Holder
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University, Twickenham, United Kingdom
| | - Gemma Hack
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tanya Gill
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rachel Gould
- Inherited Metabolic Diseases and Newborn Screening, Birmingham Women's and Children's NHS Trust, Birmingham, United Kingdom
| | - Kevin W Southern
- Department of Women's & Children's Health, University of Liverpool, Liverpool, United Kingdom
| | - Ellinor K Olander
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - James R Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | - Alan Simpson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, United Kingdom
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14
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Chudleigh J, Holder P, Moody L, Simpson A, Southern K, Morris S, Fusco F, Ulph F, Bryon M, Bonham JR, Olander E. Process evaluation of co-designed interventions to improve communication of positive newborn bloodspot screening results. BMJ Open 2021; 11:e050773. [PMID: 34452966 PMCID: PMC8404436 DOI: 10.1136/bmjopen-2021-050773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To implement and evaluate co-designed interventions to improve communication of positive newborn bloodspot screening results and make recommendations for future research and practice. DESIGN A process evaluation underpinned by Normalisation Process Theory. SETTING Three National Health Service provider organisations in England. PARTICIPANTS Twenty-four healthcare professionals (7 newborn screening laboratory staff and 24 clinicians) and 18 parents were interviewed. INTERVENTIONS Three co-designed interventions were implemented in practice: standardised laboratory proformas, communication checklists and an email/letter template. PRIMARY OUTCOME MEASURES Acceptability and feasibility of the co-designed interventions. RESULTS Auditing the implementation of these interventions revealed between 58%-76% of the items on the laboratory proforma and 43%-80% of items on the communication checklists were completed. Interviews with healthcare professionals who had used the interventions in practice provided positive feedback in relation to the purpose of the interventions and the ease of completion both of which were viewed as enhancing communication of positive newborn bloodspot screening results. Interviews with parents highlighted the perceived benefit of the co-designed interventions in terms of consistency, pacing and tailoring of information as well as providing reliable information to families following communication of the positive newborn bloodspot screening result. The process evaluation illuminated organisational and contextual barriers during implementation of the co-designed interventions in practice. CONCLUSION Variations in communication practices for positive newborn bloodspot screening results continue to exist. The co-designed interventions could help to standardise communication of positive newborn screening results from laboratories to clinicians and from clinicians to parents which in turn could improve parents' experience of receiving a positive newborn bloodspot screening result. Implementation highlighted some organisational and contextual barriers to effective adoption of the co-designed interventions in practice. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
- Jane Chudleigh
- School of Health Sciences, City University of London, London, UK
| | - Pru Holder
- School of Health Sciences, City University of London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, West Midlands, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK
| | - Kevin Southern
- Paediatrics, University of Liverpool, Liverpool, Merseyside, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Francesco Fusco
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - James R Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ellinor Olander
- School of Health Sciences, City University of London, London, UK
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15
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Communicating cystic fibrosis newborn screening results to parents. Eur J Pediatr 2021; 180:1313-1316. [PMID: 33067713 PMCID: PMC7567649 DOI: 10.1007/s00431-020-03829-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/08/2022]
Abstract
The way results of cystic fibrosis (CF) newborn screening are communicated to parents is critical yet is done differently across the globe. We surveyed parents of 101 children in our tertiary London paediatric centre with a 48% response rate. Parental responses were as follows: 40/42 (95%) said the information could not have been given over the phone and 39/43 (91%) said they wanted both partners present; 27/42 (64%) said it was helpful having the health visitor also present; and 37/40 (92%) felt it was acceptable to wait until the next day for the sweat test. We have reduced the time from first contact to arriving in the home to 2-3 h.Conclusion: We believe that this survey backs up our approach of a home visit by a CF nurse specialist with the family's health visitor to break the news. This is challenging in the current COVID-19 pandemic. What is Known: • Breaking bad news can have a lasting impact on parents when not done the right way. • Giving results of cystic fibrosis (CF) newborn screening is done differently within the UK and around the world. What is New: • Our parental survey revealed that the majority (92%) believed this should be done face to face and not over the telephone. • There was a mixed response to whether the parents should be told the genotype (assuming the CF centre knew), and thus the CF diagnosis before the confirmatory sweat test was carried out.
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16
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Chudleigh J, Chinnery H, Holder P, Carling RS, Southern K, Olander E, Moody L, Morris S, Ulph F, Bryon M, Simpson A. Processing of positive newborn screening results: a qualitative exploration of current practice in England. BMJ Open 2020; 10:e044755. [PMID: 33310815 PMCID: PMC7735110 DOI: 10.1136/bmjopen-2020-044755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research. DESIGN A qualitative exploratory design was employed using semi-structured interviews. SETTING Thirteen NBS laboratories in England. PARTICIPANTS Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed. RESULTS Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive. CONCLUSION The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent 'best practice' approach is required, not just in the UK but perhaps globally. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
- Jane Chudleigh
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University Twickenham, Twickenham, UK
| | - Pru Holder
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Rachel S Carling
- Biochemical Sciences, Viapath, Guys & St Thomas' NHS Foundation Trust, GKT School of Medical Education, King's College London, London, UK
| | - Kevin Southern
- Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ellinor Olander
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Stephen Morris
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital for Children NHS FoundationTrust, London, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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17
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Parents' Perspectives and Societal Acceptance of Implementation of Newborn Screening for SCID in the Netherlands. J Clin Immunol 2020; 41:99-108. [PMID: 33070266 PMCID: PMC7846522 DOI: 10.1007/s10875-020-00886-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022]
Abstract
Purpose While neonatal bloodspot screening (NBS) for severe combined immunodeficiency (SCID) has been introduced more than a decade ago, implementation in NBS programs remains challenging in many countries. Even if high-quality test methods and follow-up care are available, public uptake and parental acceptance are not guaranteed. The aim of this study was to describe the parental perspective on NBS for SCID in the context of an implementation pilot. Psychosocial aspects have never been studied before for NBS for SCID and are important for societal acceptance, a major criterion when introducing new disorders in NBS programs. Methods To evaluate the perspective of parents, interviews were conducted with parents of newborns with abnormal SCID screening results (N = 17). In addition, questionnaires about NBS for SCID were sent to 2000 parents of healthy newborns who either participated or declined participation in the SONNET-study that screened 140,593 newborns for SCID. Results Support for NBS for SCID was expressed by the majority of parents in questionnaires from both a public health perspective and a personal perspective. Parents emphasized the emotional impact of an abnormal screening result in interviews. (Long-term) stress and anxiety can be experienced during and after referral indicating the importance of uniform follow-up protocols and adequate information provision. Conclusion The perspective of parents has led to several recommendations for NBS programs that are considering screening for SCID or other disorders. A close partnership of NBS programs’ stakeholders, immunologists, geneticists, and pediatricians-immunologists in different countries is required for moving towards universal SCID screening for all infants. Electronic supplementary material The online version of this article (10.1007/s10875-020-00886-4) contains supplementary material, which is available to authorized users.
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Chudleigh J, Chinnery H, Bonham JR, Olander E, Moody L, Simpson A, Morris S, Ulph F, Bryon M, Southern K. Qualitative exploration of health professionals' experiences of communicating positive newborn bloodspot screening results for nine conditions in England. BMJ Open 2020; 10:e037081. [PMID: 33004391 PMCID: PMC7534703 DOI: 10.1136/bmjopen-2020-037081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore health professionals' experiences of communicating positive newborn bloodspot screening (NBS) results, highlight differences, share good practice and make recommendations for future research. DESIGN Qualitative exploratory design was employed using semi-structured interviews SETTING: Three National Health Service provider organisations in England PARTICIPANTS: Seventeen health professionals involved in communicating positive newborn bloodspot screening results to parents for all nine conditions currently included in the newborn bloodspot screening programme in England. RESULTS Findings indicated variation in approaches to communicating positive newborn bloodspot screening results to parents, largely influenced by resources available and the lack of clear guidance. Health professionals emphasised the importance of communicating results to families in a way that is sensitive to their needs. However, many challenges hindered communication including logistical considerations; difficulty contacting the family and other health professionals; language barriers; parental reactions; resource considerations; lack of training; and insufficient time. CONCLUSION Health professionals invest a lot of time and energy trying to ensure communication of positive newborn bloodspot screening results to families is done well. However, there continues to be great variation in the way these results are communicated to parents and this is largely influenced by resources available but also the lack of concrete guidance. How best to support health professionals undertaking this challenging and emotive task requires further exploration. We recommend evaluation of a more cohesive approach that meets the needs of parents and staff while being sensitive to the subtleties of each condition. TRIAL REGISTRATION NUMBER ISRCTN15330120.
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Affiliation(s)
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary's University Twickenham, Twickenham, London, UK
| | - Jim R Bonham
- Division of Pharmacy, Diagnostics and Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Ellinor Olander
- School of Health Sciences, City University London, London, UK
| | - Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, West Midlands, UK
| | - Alan Simpson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Fiona Ulph
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, University of Manchester, Manchester, UK
| | - Mandy Bryon
- Paediatric Psychology and Play Services, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Abstract
OBJECTIVE To evaluate the impact of state-mandated policies for pulse oximetry screening on healthcare utilisation, with a focus on use of echocardiograms. DATA SOURCES/STUDY SETTING Healthcare Cost and Utilisation Project, Statewide Inpatient Databases from 2008 to 2014 from six states. METHODS We defined pre- and post-mandate cohorts based on dates when pulse oximetry became mandated in each state. Linear segmented regression models for interrupted time series assessed associations between implementation of the screening and changes in rate of newborns with Critical CHD-negative echocardiogram results. We also evaluated the changes in rate of newborns who underwent echocardiogram but were not diagnosed with any health issues that could cause hypoxemia. RESULTS We identified 5967 critical CHD-negative echocardiograms (2847 and 3120 in the pre- and post-mandate periods, respectively). Our models detected a statistically significant increasing trend in rate of critical CHD-negative echocardiograms in the pre-mandate period (Incidence Rate Ratio: 1.08, p = 0.02), but did not detect any statistical differences in changes between pre- and post-mandate periods (Incidence Rate Ratio: 0.93, p = 0.14). Among non-Whites, an increasing trend of Critical CHD-negative echocardiogram during the pre-mandate period was detected (Incidence Rate Ratio 1.12, p < 0.01) and was attenuated during the post-mandate period (Incidence Rate Ratio 0.89, p = 0.02). Similar results were observed in the sensitivity analyses among both Whites and non-Whites. CONCLUSIONS Results suggest that mandatory state screening policies are associated with reductions in false-positive screening rates for hypoxemic conditions, with reductions primarily attributed to trends among non-Whites.
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20
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Chudleigh J, Chinnery H. Psychological Impact of NBS for CF. Int J Neonatal Screen 2020; 6:27. [PMID: 33073024 PMCID: PMC7422999 DOI: 10.3390/ijns6020027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
Newborn screening for cystic fibrosis has resulted in diagnosis often before symptoms are recognised, leading to benefits including reduced disease severity, decreased burden of care, and lower costs. The psychological impact of this often unsought diagnosis on the parents of seemingly well children is less well understood. The time during which the screening result is communicated to families but before the confirmatory test results are available is recognised as a period of uncertainty and it is this uncertainty that can impact most on parents. Evidence suggests this may be mitigated against by ensuring the time between communication and confirmatory testing is minimized and health professionals involved in communicating positive newborn screening results and diagnostic results for cystic fibrosis to families are knowledgeable and able to provide appropriate reassurance. This is particularly important in the case of false positive results or when the child is given a Cystic Fibrosis Screen Positive, Inconclusive Diagnosis designation. However, to date, there are no formal mechanisms in place to support health professionals undertaking this challenging role, which would enable them to meet the expectations set out in specific guidance.
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Affiliation(s)
- Jane Chudleigh
- School of Health Sciences, City, University of London, London EC1V 0HB, UK
| | - Holly Chinnery
- Faculty of Sports, Health and Applied Science, St Mary’s University, London TW1 4SX, UK;
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21
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Barben J, Chudleigh J. Processing Newborn Bloodspot Screening Results for CF. Int J Neonatal Screen 2020; 6:25. [PMID: 33073022 PMCID: PMC7422987 DOI: 10.3390/ijns6020025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
Every newborn bloodspot screening (NBS) result for cystic fibrosis (CF) consists of two parts: a screening part in the laboratory and a clinical part in a CF centre. When introducing an NBS programme, more attention is usually paid to the laboratory part, especially which algorithm is most suitable for the region or the country. However, the clinical part, how a positive screening result is processed, is often underestimated and can have great consequences for the affected child and their parents. A clear algorithm for the diagnostic part in CF centres is also important and influences the performance of a CF NBS programme. The processing of a positive screening result includes the initial information given to the parents, the invitation to the sweat test, what to do if a sweat test fails, information about the results of the sweat test, the inconclusive diagnosis and the carrier status, which is handled differently from country to country. The time until the definitive diagnosis and adequate information is given, is considered by the parents and the CF team as the most important factor. The communication of a positive NBS result is crucial. It is not a singular event but rather a process that includes ensuring the appropriate clinicians are aware of the result and that families are informed in the most efficient and effective manner to facilitate consistent and timely follow-up.
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Affiliation(s)
- Jürg Barben
- Division of Paediatric Pulmonology & CF Centre, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
| | - Jane Chudleigh
- School of Health Sciences, City, University of London, London EC1V 0HB, UK;
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Schwan K, Youngblom J, Weisiger K, Kianmahd J, Waggoner R, Fanos J. Family Perspectives on Newborn Screening for X-Linked Adrenoleukodystrophy in California. Int J Neonatal Screen 2019; 5:42. [PMID: 33073000 PMCID: PMC7510238 DOI: 10.3390/ijns5040042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 02/04/2023] Open
Abstract
X-linked adrenoleukodystrophy (ALD) is caused by gene variants in the ABCD1 gene, resulting in a varied clinical spectrum. Males with ALD present with symptoms ranging from isolated adrenal insufficiency and slowly progressive myelopathy to severe cerebral demyelination. Females who are heterozygous for ALD typically develop milder symptoms by late adulthood. Treatment for adrenal insufficiency associated with ALD exists in the form of cortisol, and cerebral ALD may be treated with stem cell transplantation. Currently, there is no treatment for myelopathy. Since 2013, at least 14 states have added ALD to their newborn screening (NBS) panel, including California in 2016. We examined the impact of a positive NBS result for ALD on families in California. Qualitative interviews were conducted with mothers of 10 children who were identified via NBS for ALD. Interviews were transcribed verbatim and analyzed using thematic analysis by two coders. Mothers felt strongly that ALD should be included on California's NBS panel; however, many expressed concerns over their experience. Themes included stress at initial phone call, difficulty living with uncertainty, concerns regarding mental health support, and desire for more information on disease progression, treatments and clinical trials. Mothers exhibited diverse coping strategies, including relying on faith, information seeking, and maintaining hope. Mothers' recommendations for healthcare providers included: educating providers making the initial phone call, providing patient-friendly resources, offering information about ongoing research, and streamlining care coordination. Advice for parents of children with ALD focused on staying hopeful and appreciating the time they have with their children. As more states add ALD to their NBS panel, it is important to improve the current model to promote family resiliency and autonomy.
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Affiliation(s)
- Katharina Schwan
- Department of Biological Sciences, California State University, Stanislaus, Turlock, CA 95382, USA;
| | - Janey Youngblom
- Department of Biological Sciences, California State University, Stanislaus, Turlock, CA 95382, USA;
| | - Kara Weisiger
- Department of Genetics, Kaiser Permanente Oakland Medical Center, Oakland, CA 94610, USA;
| | - Jessica Kianmahd
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA;
| | - Rebecca Waggoner
- Department of Psychology, University of California, Los Angeles, CA 90095, USA;
| | - Joanna Fanos
- Institute on Disability, University of New Hampshire, Durham, NH 03824, USA;
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Chudleigh J, Bonham J, Bryon M, Francis J, Moody L, Morris S, Simpson A, Ulph F, Southern K. Rethinking Strategies for Positive Newborn Screening Result (NBS+) Delivery (ReSPoND): a process evaluation of co-designing interventions to minimise impact on parental emotional well-being and stress. Pilot Feasibility Stud 2019; 5:108. [PMID: 31508239 PMCID: PMC6724281 DOI: 10.1186/s40814-019-0487-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/08/2019] [Indexed: 11/27/2022] Open
Abstract
Background Newborn blood spot (NBS) screening seeks to prevent ill health, disability and death through early diagnosis and effective intervention. Each year, around 10,000 parents of babies born in England are given a positive NBS result indicating their child may be affected or carriers of one of the nine conditions currently screened for. Despite guidance, these results are inconsistently delivered to parents across geographical regions. There is evidence that many parents are dissatisfied with how NBS results are communicated to them and that poor communication practices can lead to various negative sequelae. The purpose of this study is to co-design, implement and undertake a process evaluation of new, co-designed interventions to improve delivery of initial positive NBS results to parents. Methods This mixed-methods study will use four phases with defined outputs. Family Systems Theory will form the theoretical basis for the study. The principles and methods of experience-based co-design will underpin intervention development. Normalisation Process Theory will underpin the process evaluation of the interventions co-designed to improve the delivery of positive NBS results to parents. An economic analysis will determine resource use and costs of current practice and of implementing the new co-designed interventions. The nominal group technique will be used to inform the selection of suitable outcome measures for a future evaluation study. Discussion The main output of the proposed study will be co-designed interventions for initial communication of positive NBS results to parents ready to be evaluated in a definitive evaluation study. The interventions, co-designed with parents, will help to minimise potential negative sequelae associated with poor communication practices by considering parental and staff experiences as well as healthcare challenges such as finite resources. In addition, information about indicative costs associated with different communication strategies will be determined. It is anticipated it may also be possible to extrapolate principles of good communication practices from the present study for the delivery of bad news to parents for children newly diagnosed with other conditions including cancer and other chronic conditions such as diabetes or epilepsy. Trial registration ISRCTN 15330120 date of registration 17/01/2018
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Affiliation(s)
- Jane Chudleigh
- 1Centre for Maternal and Child Health Research, City, University of London, London, EC1V 0HB UK
| | - Jim Bonham
- 2Division of Pharmacy, Diagnostics and Genetics Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH UK
| | - Mandy Bryon
- 3Paediatric Psychology and Play Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH UK
| | - Jill Francis
- 4Division of Health Services Research and Management, City, University of London, London, EC1V 0HB UK
| | - Louise Moody
- 5School of Art and Design, Coventry University, Coventry, CV1 5FB UK
| | - Steve Morris
- 6Centre of Applied Health Research, University College London, London, WC1E 6BT UK
| | - Alan Simpson
- 7Centre for Mental Health Research, City, University of London, London, EC1V 0HB UK
| | - Fiona Ulph
- 8Division of Psychology and Mental Health, The University of Manchester, Manchester, M13 9PL UK
| | - Kevin Southern
- 9Women's and Children's Health, University of Liverpool, Liverpool, L69 3BX UK
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24
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International approaches for delivery of positive newborn bloodspot screening results for CF. J Cyst Fibros 2019; 18:614-621. [DOI: 10.1016/j.jcf.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/24/2022]
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25
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Brockow I, Nennstiel U. Parents' experience with positive newborn screening results for cystic fibrosis. Eur J Pediatr 2019; 178:803-809. [PMID: 30852643 DOI: 10.1007/s00431-019-03343-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
In Germany, screening for cystic fibrosis (CF) is part of the newborn screening since September 2016. The risk of psychological harm due to false-positive screening results is a longstanding concern. We investigated the parents' perception of the CF screening process in Bavaria and the communication after positive screening results with a questionnaire. Until August 2018, 192 children went through a final diagnostic testing after a positive CF screening result, and 105 (54.7%) families completed the questionnaire. Of these, only 30 parents obtained information about the newborn screening by a physician, despite this being mandatory in Germany. Parents being informed by a CF specialist (28.6%) about the positive screening result were more satisfied with the given information (80.0 versus 50% informed by the maternity ward), and the delay until the final diagnostic testing was shorter. More than 3 days between the information about the screening result and the diagnostic testing was too long for 77.7% of the families.Conclusion: Performing final diagnostic testing with only short delays and receiving satisfactory information is important. Therefore, parents should be informed directly by a CF center about positive screening results and only when sweat testing is possible within the next days. What is Known: • The risk of psychological harm due to false-positive screening results is a longstanding concern. • Satisfactory information about the positive CF screening result seem to reduce the parental stress. What is New: • Parents being informed directly by a CF specialist were more satisfied with the given information and the delay until the final diagnostic testing was shorter. • Our data support the concept that parents should better be informed directly by a CF specialist about positive screening results and only when sweat testing is possible within the next days to reduce parental stress.
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Affiliation(s)
- Inken Brockow
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Veterinaerstrasse 2, 85764, Oberschleissheim, Germany.
| | - Uta Nennstiel
- Screening Center, Bavarian Health and Food Safety Authority (LGL), Veterinaerstrasse 2, 85764, Oberschleissheim, Germany
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26
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Rueegg CS, Kuehni CE, Gallati S, Jurca M, Jung A, Casaulta C, Barben J. Comparison of two sweat test systems for the diagnosis of cystic fibrosis in newborns. Pediatr Pulmonol 2019; 54:264-272. [PMID: 30609259 DOI: 10.1002/ppul.24227] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In the national newborn screening programme for CF in Switzerland, we compared the performance of two sweat test methods, by investigating the feasibility and diagnostic performance of the Macroduct® collection method (with chloride mesurement) and Nanoduct® test (measuring conductivity) for diagnosing CF. STUDY-DESIGN We included all newborns with a positive screening result between 2011 and 2015 who were referred to a CF-centre for sweat testing. In the CF-centre, a Macroduct and Nanoduct sweat test were performed simultaneously. If sweat test results were positive or borderline, a DNA analysis was performed. Final diagnosis was based on genetic mutations. RESULTS Over 5 years, 445 children were screened positive and in 413 (114 with CF) at least one sweat test was performed (median age at first test, 22 days); both tests were performed in 371 children. A sweat test result was more often available with the Nanoduct compared to the Macroduct (79 vs 60%, P < 0.001). The Nanoduct was equally sensitive as the Macroduct in identifying newborns with CF (sensitivity 98 vs 99%) but less specific (specificity 79 vs 93%; P-value comparing ROC curves = 0.033). CONCLUSIONS This national multicentre study revealed high failure rates for Macroduct and Nanoduct in newborns in real life practice. While this needs to be addressed, our results suggested that performing the Nanoduct in addition to the Macroduct might speed up the diagnostic process because it more often yields valid results with comparable diagnostic performance. The addition of the Nanoduct sweat test can therefore help to reduce the stressful time of uncertainty for parents and to start appropriate treatment earlier.
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Affiliation(s)
- Corina S Rueegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Pediatrics, Respiratory Unit, University of Bern, Bern, Switzerland
| | - Sabina Gallati
- Division of Human Genetics, University Children's Hospital Bern, Bern, Switzerland
| | - Maja Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Carmen Casaulta
- Department of Pediatrics, Respiratory Unit, University of Bern, Bern, Switzerland
| | - Juerg Barben
- Division of Pediatric Pulmonology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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27
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Results of the Andalusian Cystic Fibrosis Neonatal Screening Program, 5 Years After Implementation. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.arbr.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Delgado Pecellín I, Pérez Ruiz E, Álvarez Ríos AI, Delgado Pecellín C, Yahyaoui Macías R, Carrasco Hernández L, Marcos Luque I, Caro Aguilera P, Moreno Valera MJ, Quintana Gallego ME. Results of the Andalusian Cystic Fibrosis Neonatal Screening Program, 5 Years After Implementation. Arch Bronconeumol 2018; 54:551-558. [PMID: 29983195 DOI: 10.1016/j.arbres.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Cystic fibrosis neonatal screening (CFNS), based on double determination of immunoreactive trypsinogen ([IRT] [IRT1/IRT2]), has been available in Andalusia since May 2011. If screening is positive, a sweat test is performed, and if that is positive or inconclusive, genetic testing is requested. OBJECTIVE To analyze CFNS, based on results from the first 4.5 years of the program. MATERIALS AND METHODS Prospective descriptive study of neonates undergoing CFNS. IRT levels, sweat chloride, and mutations were recorded. Statistical analysis was performed using SPSS 12.0. RESULTS Between May 2011 and December 2016, 474,953 neonates underwent CFNS. Of these, 1,087 (0.23%) had elevated IRT2. Since CFNS was introduced, 73 cases of cystic fibrosis were diagnosed; 60 were diagnosed by positive CFNS, and 13 were diagnosed by other means. In one case, the patient developed a typical clinical picture of cystic fibrosis, but had not undergone CFNS at the decision of the parents; the remaining 12 had a negative CFNS (false negatives). Of these, one patient was diagnosed before symptoms developed, as his twin brother had a positive CFNS result; another had chloride at the upper limit of normal, and was subsequently diagnosed with genetic testing before symptoms appeared; and 10 patients developed clinical signs and symptoms. Excluding patients with meconium ileus, sensitivity and specificity of the CFNS program were 85.71% and 99.78%, respectively. The incidence of the disease in Andalusia is 1/6,506 live births. CONCLUSION These results are a basis for reflection on possible areas for improvement of the CFNS algorithm, and thought may be given to the introduction of genetic studies to increase sensitivity and reduce false positives.
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Affiliation(s)
- Isabel Delgado Pecellín
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Estela Pérez Ruiz
- Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, IBIMA, España
| | - Ana Isabel Álvarez Ríos
- Servicio de Bioquímica Clínica, Sección de Metabolopatías, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Carmen Delgado Pecellín
- Servicio de Bioquímica Clínica, Sección de Metabolopatías, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Raquel Yahyaoui Macías
- UGC Laboratorio, Sección de Metabolopatías, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), España
| | - Laura Carrasco Hernández
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Irene Marcos Luque
- Departamento de Medicina Materno-Fetal, Genética y Reproducción, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Sevilla, España
| | - Pilar Caro Aguilera
- Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, IBIMA, España
| | - María José Moreno Valera
- Unidad de Neumología y Alergia Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España; Unidad de Gestión Clínica de Neonatal, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - María Esther Quintana Gallego
- Unidad de Fibrosis Quística, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
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Psychosocial impact on mothers receiving expanded newborn screening results. Eur J Hum Genet 2018; 26:477-484. [PMID: 29379194 DOI: 10.1038/s41431-017-0069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/20/2017] [Accepted: 11/18/2017] [Indexed: 01/01/2023] Open
Abstract
Expanded newborn screening (NBS) for genetic disorders has improved diagnosis of numerous treatable diseases, positively impacting children's health outcomes. However, research about the psychological impact of expanded NBS on families, especially mothers, has been mixed. Our study examined associations between maternal experiences of expanded NBS and subsequent psychosocial functioning and parenting stress in mothers whose infants received either true negative (TN), true positive (TP) or false positive (FP) results after a 4- to 6-month period. The Parenting Stress Index and the Depression, Anxiety and Stress Scale were used to assess symptoms of anxiety, stress and depression in 3 sets of mothers, whose infants received TN (n = 31), TP (n = 8) or FP (n = 18) results. Multivariate analyses of variance (MANOVA) results revealed no significant differences among these three groups of mothers regarding overall anxiety, stress and depression. However, FP mothers experienced lower levels of stress related to their own health compared to TN group. Two potential trends were also identified; results suggested TN mothers might experience higher levels of isolation than mothers in the TP group and that FP mothers might report higher stress levels in relation to spousal relationships compared to the TN group. FP mothers seemed to report similar or better levels of psychosocial functioning than TN mothers. Our findings are encouraging with respect to impacts of NBS on maternal well-being. We also identify key areas for improvement (parental education) and research (isolation and spousal relationships).
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Jessup M, Smyth W, Abernethy G, Shields L, Douglas T. Family-centred care for families living with cystic fibrosis in a rural setting: A qualitative study. J Clin Nurs 2017; 27:e590-e599. [PMID: 29048768 DOI: 10.1111/jocn.14105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore experiences of family-centred care among parents of children with cystic fibrosis living far from tertiary treatment centres and to understand what such distances mean to their care. BACKGROUND Australia is a large continent. However, many families with a child with cystic fibrosis live in regional areas, often thousands of kilometres away from the primary treatment centres located in Australia's coastal capital cities. DESIGN A qualitative, phenomenological design using a Van Manen () approach. METHODS Individual, semi-structured interviews were conducted with parents (n = 7) of a child with cystic fibrosis who lived in regional Australia. Thematic content data analysis was used. RESULTS The essence of the participants' experience was their seeking certainty and continuity in the changeable realm of cystic fibrosis while negotiating a collaborative approach to their child's care. Five core themes and two subthemes were identified: "Daily care: a family affair," including the subtheme "Accessing expert care"; "Family-centred care: seeking inclusion"; "Control versus collaboration: seeking mutual trust," with the subtheme "The team who grows with you"; "Future projections"; and "The CF circle." CONCLUSION Some concerns are not unlike those of their city counterparts, but can be intensified by their sense of distance and isolation. RELEVANCE TO CLINICAL PRACTICE Insight into this unique milieu from the parents' perspective is requisite so that care is appropriate to such a challenging environment and incorporates the whole family.
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Affiliation(s)
- Melanie Jessup
- Australian Catholic University/Metro North Hospital and Health Service, Brisbane, QLD, Australia.,Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Wendy Smyth
- Townsville Hospital and Health Service, Townsville, QLD, Australia.,College of Healthcare Sciences, Townsville, QLD, Australia.,James Cook University, Townsville, QLD, Australia
| | - Gail Abernethy
- College of Medicine and Dentistry, Atherton, QLD, Australia.,James Cook University, Atherton, QLD, Australia
| | - Linda Shields
- Charles Sturt University, Bathurst, NSW, USA.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Tonia Douglas
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, QLD, USA.,Faculty of Medicine, Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
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Feasibility and normal values of an integrated conductivity (Nanoduct™) sweat test system in healthy newborns. J Cyst Fibros 2017; 16:465-470. [DOI: 10.1016/j.jcf.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/12/2017] [Accepted: 04/03/2017] [Indexed: 12/30/2022]
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Barben J, Castellani C, Dankert-Roelse J, Gartner S, Kashirskaya N, Linnane B, Mayell S, Munck A, Sands D, Sommerburg O, Pybus S, Winters V, Southern KW. The expansion and performance of national newborn screening programmes for cystic fibrosis in Europe. J Cyst Fibros 2016; 16:207-213. [PMID: 28043799 DOI: 10.1016/j.jcf.2016.12.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Newborn screening (NBS) for cystic fibrosis (CF) is a well-established public health strategy with international standards. The aim of this study was to provide an update on NBS for CF in Europe and assess performance against the standards. METHODS Questionnaires were sent to key workers in each European country. RESULTS In 2016, there were 17 national programmes, 4 countries with regional programmes and 25 countries not screening in Europe. All national programmes employed different protocols, with IRT-DNA the most common strategy. Five countries were not using DNA analysis. In addition, the processing and structure of programmes varied considerably. Most programmes were achieving the ECFS standards with respect to timeliness, but were less successful with respect to sensitivity and specificity. CONCLUSIONS There has been a steady increase in national CF NBS programmes across Europe with variable strategies and outcomes that reflect the different approaches.
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Affiliation(s)
- Jürg Barben
- Cystic Fibrosis Centre, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
| | - Carlo Castellani
- Cystic Fibrosis Centre, Azienda Ospedaliera Verona, Verona, Italy
| | | | - Silvia Gartner
- Cystic Fibrosis Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nataliya Kashirskaya
- Department of Cystic Fibrosis, Research Centre for Medical Genetics, Moscow, Russia
| | - Barry Linnane
- Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland
| | - Sarah Mayell
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anne Munck
- AFDPHE & Hôpital Robert Debré, Paris, France
| | - Dorota Sands
- Cystic Fibrosis Centre, Institute of Mother and Child, Warsaw, Poland
| | - Olaf Sommerburg
- Division of Pediatric Pulmonology & Allergy, Department of Pediatrics III, University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Simon Pybus
- Institute in the Park, Alder Hey Children's Hospital, University of Liverpool, UK
| | - Victoria Winters
- Institute in the Park, Alder Hey Children's Hospital, University of Liverpool, UK
| | - Kevin W Southern
- Institute in the Park, Alder Hey Children's Hospital, University of Liverpool, UK
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33
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Barben J, Southern KW. Cystic fibrosis screen positive, inconclusive diagnosis. Curr Opin Pulm Med 2016; 22:617-22. [DOI: 10.1097/mcp.0000000000000314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Massie J. Newborn screening and population carrier screening for cystic fibrosis: Two ends of the same rope. J Cyst Fibros 2016; 15:407-8. [PMID: 27261366 DOI: 10.1016/j.jcf.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Australia; Department of Paediatrics, University of Melbourne, Australia; Infection, Immunity, Environment Theme, Murdoch Children's Research Institute, Australia; Children's Bioethics Centre, Royal Children's Hospital, Australia.
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