1
|
Rosenfeld M, Ostrenga J, Cromwell EA, Magaret A, Szczesniak R, Fink A, Schechter MS, Faro A, Ren CL, Morgan W, Sanders DB. Real-world Associations of US Cystic Fibrosis Newborn Screening Programs With Nutritional and Pulmonary Outcomes. JAMA Pediatr 2022; 176:990-999. [PMID: 35913705 PMCID: PMC9344390 DOI: 10.1001/jamapediatrics.2022.2674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
IMPORTANCE Newborn screening (NBS) for cystic fibrosis (CF) has been universal in the US since 2010, but its association with clinical outcomes is unclear. OBJECTIVE To describe the real-world effectiveness of NBS programs for CF in the US on outcomes up to age 10 years. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study using CF Foundation Patient Registry data from January 1, 2000, to December 31, 2018. The staggered implementation of NBS programs by state was used to compare longitudinal outcomes among children in the same birth cohort born before vs after the implementation of NBS for CF in their state of birth. Participants included children with an established diagnosis of CF born between January 1, 2000, to December 31, 2018, in any of the 44 states that implemented NBS for CF between 2003 and 2010. Data were analyzed from October 5, 2020, to April 22, 2022. EXPOSURES Birth before vs after the implementation of NBS for CF in the state of birth. MAIN OUTCOMES AND MEASURES Longitudinal trajectory of height and weight percentiles from diagnosis, lung function (forced expiratory volume in 1 second, [FEV1] percent predicted) from age 6 years, and age at initial and chronic infection with Pseudomonas aeruginosa using linear mixed-effects and time-to-event models adjusting for birth cohort and potential confounders. RESULTS A total of 9571 participants (4713 female participants [49.2%]) were eligible for inclusion, with 4510 (47.1%) in the pre-NBS cohort. NBS was associated with higher weight and height percentiles in the first year of life (weight, 6.0; 95% CI, 3.1-8.4; height, 6.6; 95% CI, 3.8-9.3), but these differences decreased with age. There was no association between NBS and FEV1 at age 6 years, but the percent-predicted FEV1 did increase more rapidly with age in the post-NBS cohort. NBS was associated with older age at chronic P aeruginosa infection (hazard ratio, 0.69; 95% CI, 0.54-0.89) but not initial P aeruginosa infection (hazard ratio, 0.88; 95% CI, 0.77-1.01). CONCLUSIONS AND RELEVANCE NBS for CF in the US was associated with improved nutritional status up to age 10 years, a more rapid increase in lung function, and delayed chronic P aeruginosa infection. In the future, as highly effective modulator therapies become available for infants with CF, NBS will allow for presymptomatic initiation of these disease-modifying therapies before irreversible organ damage.
Collapse
Affiliation(s)
- Margaret Rosenfeld
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | | | | | - Amalia Magaret
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Rhonda Szczesniak
- Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Aliza Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland,National Organization for Rare Disorders, Washington, District of Columbia
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Clement L. Ren
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson
| | - Don B. Sanders
- Department of Pediatrics, Indiana University, Indianapolis
| |
Collapse
|
2
|
Barreda CB, Farrell PM, Laxova A, Eickhoff JC, Braun AT, Coller RJ, Rock MJ. Newborn screening alone insufficient to improve pulmonary outcomes for cystic fibrosis. J Cyst Fibros 2021; 20:492-498. [PMID: 32546430 PMCID: PMC7736297 DOI: 10.1016/j.jcf.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Wisconsin Cystic Fibrosis Neonatal Screening Project was a randomized clinical trial (RCT) revealing that children receiving an early diagnosis of CF via newborn screening (NBS) had improved nutritional outcomes but similar lung disease severity compared to those who presented clinically. Because the evaluations of these subjects by protocol ended in 2012, our objective was to assess long-term pulmonary and mortality outcomes. METHODS Retrospective analysis of the RCT cohort utilized longitudinal outcome measures obtained from the Cystic Fibrosis Foundation Patient Registry (CFFPR). Data included screening assignment, clinical characteristics, percent predicted forced expiratory volume in 1 s (ppFEV1) and mortality. A random intercept model was used to compare the ppFEV1 decline of subjects between the two groups up to age 26 years. Mortality was analyzed using the Kaplan-Meier method. RESULTS Of the 145 subjects who consented to the original study, 104 subjects met inclusion criteria and had adequate data in the CFFPR. Of 57 subjects in the screened group and 47 in the control group, the rates of ppFEV1 decline were 1.76%/year (95% CI 1.62 to 1.91%) and 1.43%/year (95% CI 1.26 to 1.60%), respectively (p<0.0002). Pseudomonas aeruginosa acquired before 2 years was partially responsible. There was no difference in mortality between the two groups. CONCLUSIONS NBS alone does not improve pulmonary outcomes in CF, particularly when other risk factors supervene. In an era prior to strict infection control and current therapies, NBS for CF may be associated with worse pulmonary outcomes.
Collapse
Affiliation(s)
- Christina B Barreda
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Philip M Farrell
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Anita Laxova
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Andrew T Braun
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| | - Michael J Rock
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
| |
Collapse
|
3
|
Rueegg CS, Barben J, Hafen GM, Moeller A, Jurca M, Fingerhut R, Kuehni CE. Newborn screening for cystic fibrosis - The parent perspective. J Cyst Fibros 2015; 15:443-51. [PMID: 26751132 DOI: 10.1016/j.jcf.2015.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Newborn screening for CF started 01/2011 in Switzerland. We investigated the parents' opinions about the information received, their feelings, and overall approval of the screening. METHODS This is a prospective questionnaire survey of all parents of positively screened children. Parents were phoned by CF-centres and invited for diagnostic investigations. They completed a questionnaire after the visit to the CF-centre. RESULTS From 2011-2013, 246 families received the questionnaire and 138 (56%) replied. Of these 77 (60%) found the information received at birth satisfactory; 124 (91%) found the information provided in the CF-centre satisfactory. Most parents (n=98, 78%) felt troubled or anxious when the CF-centre called, 51 (38%) remained anxious after the visit. Most parents (n=122; 88%) were satisfied with the screening, 4 (3%) were not, and 12 (9%) were unsure. CONCLUSIONS The smooth organisation of the screening process, with personal information by a CF specialist and short delays between this information and the final diagnostic testing, might have contributed to reduce anxiety among parents. Most families were grateful that their child had been screened, and are happy with the process.
Collapse
Affiliation(s)
- Corina S Rueegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Jürg Barben
- Division of Pediatric Pulmonology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Gaudenz M Hafen
- Department of Pediatrics, Respiratory Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Maja Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | | |
Collapse
|
4
|
Grosse SD. Showing Value in Newborn Screening: Challenges in Quantifying the Effectiveness and Cost-Effectiveness of Early Detection of Phenylketonuria and Cystic Fibrosis. Healthcare (Basel) 2015; 3:1133-57. [PMID: 26702401 PMCID: PMC4686149 DOI: 10.3390/healthcare3041133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/05/2015] [Indexed: 01/24/2023] Open
Abstract
Decision makers sometimes request information on the cost savings, cost-effectiveness, or cost-benefit of public health programs. In practice, quantifying the health and economic benefits of population-level screening programs such as newborn screening (NBS) is challenging. It requires that one specify the frequencies of health outcomes and events, such as hospitalizations, for a cohort of children with a given condition under two different scenarios-with or without NBS. Such analyses also assume that everything else, including treatments, is the same between groups. Lack of comparable data for representative screened and unscreened cohorts that are exposed to the same treatments following diagnosis can result in either under- or over-statement of differences. Accordingly, the benefits of early detection may be understated or overstated. This paper illustrates these common problems through a review of past economic evaluations of screening for two historically significant conditions, phenylketonuria and cystic fibrosis. In both examples qualitative judgments about the value of prompt identification and early treatment to an affected child were more influential than specific numerical estimates of lives or costs saved.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; ; Tel.: +1-404-498-3074
| |
Collapse
|
5
|
Cortés E, Roldán AM, Palazón-Bru A, Rizo-Baeza MM, Manero H, Gil-Guillén VF. Differences in immunoreactive trypsin values between type of feeding and ethnicity in neonatal cystic fibrosis screening: a cross-sectional study. Orphanet J Rare Dis 2014; 9:166. [PMID: 25377995 PMCID: PMC4228057 DOI: 10.1186/s13023-014-0166-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied the differences in immunoreactive trypsin (IRT) in neonatal screening for cystic fibrosis (CF) associated individually with the age of the newborn, ethnicity and environmental temperature. In this study, we determine the overall influence of environmental temperature at birth, gender, feeding, gestational age, maternal age and ethnic origin on an abnormal IRT result. METHODS Cross-sectional observational study. A sample was selected of newborns from Alicante (Spain) who underwent neonatal CF screening in 2012-2013. Primary variable: abnormal IRT levels (≥65 ng/ml). Secondary variables: gender, maternal origin, maternal age (years) (<20, 20-40, >40), gestational age (weeks) (<32, 32-37, >37), type of feeding (natural, formula, mixed and special nutrition), >20 days from birth to blood collection, and average temperature during the month of birth (in°C). Using a multivariate logistic regression model the adjusted odds ratios (ORs) were estimated to analyze the association between atypical IRT levels and the study variables. The α error was 5% and confidence intervals (CI) were calculated for the most relevant parameters. RESULTS Of a total of 13,310 samples, 199 were abnormal (1.34%). Significant associated factors: feeding method (natural → OR = 1; mixed → OR = 0.53, 95% CI: 0.31-0.89; formula → OR = 0.72, 95% CI: 0.48-1.07; special → OR = 21.88, 95% CI: 6.92-69.14; p < 0.001). CONCLUSIONS Newborns receiving special nutrition have a 20-fold higher risk for abnormal IRT levels, and screening is advisable once normalized feeding is initiated. It is advisable to consider ethnic variability. Seasonality was not important.
Collapse
Affiliation(s)
- Ernesto Cortés
- Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University, San Juan de Alicante, Spain.
| | - Ana María Roldán
- Clinical Analysis Department, Alicante General University Hospital, Alicante, Spain.
| | - Antonio Palazón-Bru
- Clinical Medicine Department, Miguel Hernández University, Carretera de Valencia-Alicante S/N, 03550, San Juan de Alicante, Spain.
| | | | - Herminia Manero
- Clinical Analysis Department, Alicante General University Hospital, Alicante, Spain.
| | - Vicente Francisco Gil-Guillén
- Clinical Medicine Department, Miguel Hernández University, Carretera de Valencia-Alicante S/N, 03550, San Juan de Alicante, Spain.
| |
Collapse
|
6
|
Cohen-Cymberknoh M, Shoseyov D, Kerem E. Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. Am J Respir Crit Care Med 2011; 183:1463-71. [PMID: 21330455 DOI: 10.1164/rccm.201009-1478ci] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The survival of patients with cystic fibrosis (CF) continues to improve. The discovery and cloning of the CFTR gene more than 21 years ago led to the identification of the structure and function of the CFTR chloride channel. New therapies based on the understanding of the function of CFTR are currently under development. The better clinical status and improved survival of patients with CF is not only a result of understanding of the molecular mechanisms of CF but also a result of the development of therapeutic strategies that are based on insights into the natural course of the disease. Current CF treatments that target respiratory infections, inflammation, mucociliary clearance, and nutritional status are associated with improved pulmonary function and reduced exacerbations. Patients benefit from treatment at a specialized CF center by a multidisciplinary dedicated team with emphasis being placed on frequent visits, periodic testing, and monitoring adherence to therapy. The purpose of this review is to survey recent developments in CF care that are responsible for the improved survival and quality of life of patients with CF.
Collapse
Affiliation(s)
- Malena Cohen-Cymberknoh
- Department of Pediatrics and CF Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | |
Collapse
|
7
|
Abstract
Nutritional status is strongly associated with pulmonary function and survival in cystic fibrosis patients. Attainment of a normal growth pattern in childhood and maintenance of adequate nutritional status in adulthood represent major goals of multidisciplinary cystic fibrosis centers. International guidelines on energy intake requirements, pancreatic enzyme-replacement therapy and fat-soluble vitamin supplementation are of utmost importance in daily practice. The present review summarizes the most up-to-date information on early nutritional management in newly diagnosed patients and evaluates the benefits of aggressive nutritional support, assessment of nutritional status, recommendations for nutrition-related management in pancreatic-insufficient patients and the possible therapeutic impact of fat intake modulation upon inflammatory status.
Collapse
Affiliation(s)
- Anne Munck
- CF Center, University Hospital Robert Debré, AP-HP 48, bd Serurier 75019 Paris, France.
| |
Collapse
|
8
|
Rodrigues R, Magalhaes P, Fernandes M, Gabetta C, Ribeiro A, Pedro K, Valdetaro F, Santos J, Souza RD, Pazin Filho A, Maciel L. Neonatal screening for cystic fibrosis in São Paulo State, Brazil: a pilot study. Braz J Med Biol Res 2009; 42:973-8. [DOI: 10.1590/s0100-879x2009005000017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 07/16/2009] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - K.P. Pedro
- Associação de Pais e Amigos dos Excepcionais, Brasil
| | | | | | | | | | | |
Collapse
|
9
|
Castellani C, Southern KW, Brownlee K, Dankert Roelse J, Duff A, Farrell M, Mehta A, Munck A, Pollitt R, Sermet-Gaudelus I, Wilcken B, Ballmann M, Corbetta C, de Monestrol I, Farrell P, Feilcke M, Férec C, Gartner S, Gaskin K, Hammermann J, Kashirskaya N, Loeber G, Macek M, Mehta G, Reiman A, Rizzotti P, Sammon A, Sands D, Smyth A, Sommerburg O, Torresani T, Travert G, Vernooij A, Elborn S. European best practice guidelines for cystic fibrosis neonatal screening. J Cyst Fibros 2009; 8:153-73. [PMID: 19246252 DOI: 10.1016/j.jcf.2009.01.004] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 01/15/2009] [Indexed: 11/27/2022]
|
10
|
McKay K, Wilcken B. Newborn screening for cystic fibrosis offers an advantage over symptomatic diagnosis for the long term benefit of patients: the motion for. Paediatr Respir Rev 2008; 9:290-4. [PMID: 19026370 DOI: 10.1016/j.prrv.2008.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Comprehensive newborn screening for cystic fibrosis has occurred for more than 25 years in some regions and the results of randomised controlled trials reporting the outcomes have been published. Testing protocols for CF have recently been reviewed and the sensitivity and specificity of these protocols are high. In spite of this, many remain sceptical in respect of the advantages conferred by newborn screening for CF. Every study of newborn screening has shown that diagnosis occurs at a significantly younger age. While this alone is sufficient to justify newborn screening, the clinical course of those diagnosed via newborn screening indicates that many additional advantages accrue. These include a decreased morbidity and mortality in early life, facilitation of better growth and prevention of vitamin deficiency in early infancy, as well as some indication of an advantage in terms of pulmonary status later in life. This review summarises the arguments in favour of newborn screening for CF.
Collapse
Affiliation(s)
- Karen McKay
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, The University of Sydney, Westmead 2145, NSW, Australia.
| | | |
Collapse
|
11
|
Rodrigues R, Gabetta CS, Pedro KP, Valdetaro F, Fernandes MIM, Magalhães PKR, Januário JN, Maciel LMZ. Cystic fibrosis and neonatal screening. CAD SAUDE PUBLICA 2008; 24 Suppl 4:s475-84. [DOI: 10.1590/s0102-311x2008001600002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 02/21/2008] [Indexed: 11/22/2022] Open
Abstract
The clinical and diagnostic aspects of cystic fibrosis have been extensively reviewed, with an emphasis on neonatal screening. This systematic literature review involved a search for relevant contributions in the PubMed and SciELO databases. The first references to cystic fibrosis date to the Middle Ages. Cystic fibrosis is the most frequent autosomal recessive hereditary disease among Caucasians (1:2,000 to 3,500). More than 1,000 mutations lead to the disease, the most common being "F508, with 70% prevalence among Canadian, Northern European, and American Caucasians and 23 to 55% prevalence among Brazilians. The basic defect is in chloride ion secretion. Cystic fibrosis screening has long been controversial, and after almost three decades, there are few nationwide programs (most are regional or local). However, the U.S. Centers for Disease Control and Prevention (CDC) has concluded that screening for cystic fibrosis is justified. The lack of a specific screening test and the ethnic heterogeneity of the Brazilian population pose challenges for neonatal screening.
Collapse
|
12
|
Grosse SD, Rosenfeld M, Devine OJ, Lai HJ, Farrell PM. Potential impact of newborn screening for cystic fibrosis on child survival: a systematic review and analysis. J Pediatr 2006; 149:362-6. [PMID: 16939748 DOI: 10.1016/j.jpeds.2006.04.059] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/10/2006] [Accepted: 04/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate the population impact of child mortality as a result of cystic fibrosis (CF) potentially preventable by newborn screening. STUDY DESIGN A systematic literature review of mortality in children with classic CF without meconium ileus (MI) in screened and unscreened cohorts was extended by contacting investigators for unpublished data. In addition, survival in US states with and without newborn screening (NBS) programs for CF was compared using data from the Cystic Fibrosis Foundation Patient Registry (CFFPR). RESULTS Among non-US studies, CF-related mortality risk to approximately 10 years of age was lower by 5 to 10 per 100 in screened cohorts. Unpublished US data from a trial of NBS for CF indicate no CF-related deaths to 10 years of age in either cohort. CFFPR data suggest improved survival among children with CF born in US states with NBS, with a CF-related mortality difference to 10 years of age between the screened and unscreened groups between 1.5 and 2 per 100 children with CF without MI. CONCLUSION In addition to improving nutritional outcomes, newborn screening for CF may result in improved child survival. The absolute differential in mortality risk, although modest in size, appears comparable to NBS for certain other genetic disorders.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | | | | | | | | |
Collapse
|
13
|
Almeida ADM, Godinho TM, Teles MS, Rehem APP, Jalil HM, Fukuda TG, Araújo ÊP, Matos EC, Muritiba Júnior DC, Dias CPF, Pimentel HM, Fontes MIMM, Acosta AX. Avaliação do Programa de Triagem Neonatal na Bahia no ano de 2003. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2006. [DOI: 10.1590/s1519-38292006000100010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: descrever e avaliar o perfil do Programa de Triagem Neonatal baiano em 2003. MÉTODOS: estudo descritivo baseado no banco de dados do Serviço de Referência de Triagem Neonatal baiano com todos os recém-nascidos que realizaram a triagem na rede de coleta do Estado em 2003. RESULTADOS: observou-se implantação do programa em 94,5% dos municípios. A média mensal de testados foi de 13.991 (72,51% dos recém-nascidos registrados). Na coleta, 63,9% das crianças estavam com idade entre oito dias e um mês, 14,5% com até sete dias e 21,6% com mais de um mês. A incidência observada foi de 1:22.000 para fenilcetonúria, 1:4.000 para o hipotireoidismo congênito e 1:650 para as hemoglobinopatias. CONCLUSÕES: o Programa de Triagem Neonatal baiano mostrou, em 2003, dificuldades quanto a cobertura preconizada em 100%; a faixa etária ideal para realização da coleta; ao tempo entre a coleta e a chegada das amostras ao Serviço de Referência em Triagem Neonatal; ao tempo de entrega dos resultados à família; e ao tempo de reconvocação dos casos positivos. Assim, são necessárias algumas melhorias para agilizar esses processos.
Collapse
|
14
|
|
15
|
|
16
|
Sims EJ, McCormick J, Mehta G, Mehta A. Newborn screening for cystic fibrosis is associated with reduced treatment intensity. J Pediatr 2005; 147:306-11. [PMID: 16182666 DOI: 10.1016/j.jpeds.2005.05.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 04/22/2005] [Accepted: 05/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine whether the improved clinical status after newborn screening (NBS) for cystic fibrosis (CF) segregates with increased therapeutic intervention compared with presentation by clinical diagnosis (CD). STUDY DESIGN In 2002, two populations (1 to 9 years of age) who presented (excluding meconium ileus) by NBS < or = 3 months of age or by CD were compared in an observational, cross-sectional design. NBS and CD populations (184 and 950 patients, respectively) were divided into 3-year age groups (1 to 3, 4 to 6, and 7 to 9 years). Therapies of duration >3 months were compared together with Pseudomonas aeruginosa infection status. RESULTS NBS patients < or = 6 years of age received significantly fewer and less demanding therapies not explained by age, genotype, geography, or social deprivation. In 7- to 9-year-olds, significantly fewer NBS patients received intravenous antibiotics. NBS patients without P aeruginosa infection received significantly fewer therapies, but no differences were found between intermittently or chronically infected NBS and CD populations. Comparable results were found in deltaF508/deltaF508 subpopulations. CONCLUSIONS CF populations diagnosed by NBS are associated with reduced treatment compared with age- and genotype-matched CD control subjects.
Collapse
Affiliation(s)
- Erika J Sims
- United Kingdom Cystic Fibrosis Database, Division of Maternal and Child Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | | | | | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Cystic fibrosis (CF) is the most common lethal genetic disorder in the United States to be identified in childhood. In November 2003 the US Cystic Fibrosis Foundation and the Centers for Disease Control and Prevention convened an expert panel to review the indications for CF newborn screening. In this review we discuss the information during the year leading up to this meeting as well as publications since the meeting. RECENT FINDINGS During the past several years an increasing number of CF patients have been diagnosed with newborn screening. These patients have demonstrated several benefits to screening while also uncovering new challenges. Health benefits have included improved nutrition persisting for many years and the avoidance of nutritional complications. Early identification has also meant that these often clinically healthy infants are being followed in CF centers for care. This has added to the need for avoiding infection risks to which these patients might not have otherwise been exposed. Psychosocial benefits include the avoidance of stress due to delayed diagnosis as well as assistance with family planning. Psychosocial challenges include carrier identification and detection of patients with mild disease or without a clear diagnosis. SUMMARY Although no study has definitively shown reduced lung disease or prolonged survival in CF patients detected by newborn screening, the general consensus is that improved nutrition and cognitive potential, in addition to the reduced costs for hospitalization and intensive therapies, support the benefits of screening.
Collapse
Affiliation(s)
- Jeffrey S Wagener
- University of Colorado Medical School, Department of Pediatrics, Denver, Colorado, USA.
| | | | | | | |
Collapse
|
18
|
Sangiuolo F, D'Apice MR, Gambardella S, Di Daniele N, Novelli G. Toward the pharmacogenomics of cystic fibrosis – an update. Pharmacogenomics 2004; 5:861-78. [PMID: 15469408 DOI: 10.1517/14622416.5.7.861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disorder in Caucasians, with a frequency of ∼ 1 in 3000 live births. The mutated gene is a defective chloride channel in epithelial cells, named cystic fibrosis transmembrane conductance regulator (CFTR). Several different protocols for the scanning of the entire gene have aided molecular diagnosis and improved our understanding of the disorder’s pathophysiology, but also showed the disease’s complexity. Therefore, CF phenotype remains difficult to predict from CFTR mutation data alone: several studies have suggested that additional genes could modulate its clinical outcome. Gene replacement therapy is still far from being used in patients with CF, mostly due to the difficulties with targeting the appropriate cells. In this review, we summarize recent advances, both in the pharmacological and gene therapy field, aimed for the treatment of the disease.
Collapse
Affiliation(s)
- Federica Sangiuolo
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Roma, Italy
| | | | | | | | | |
Collapse
|