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Chudleigh J, Holder P. Psychosocial Impact of False-Positive Newborn Screening Results: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:507. [PMID: 38790502 PMCID: PMC11120117 DOI: 10.3390/children11050507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
Psychosocial consequences of false-positive results following newborn bloodspot screening have been identified as a potential risk to this highly successful public health initiative. A scoping review was undertaken in October 2023 underpinned by the Arksey and O'Malley framework. Twenty-four papers were included in the review, many of which focused on cystic fibrosis. The results indicated that impact of false-positive results is variable; some studies suggest false-positive results have the potential to result in negative sequelae including increased stress and changes in parental perceptions of their child, while others suggest these impacts are transient and, in some instances, may even lead to positive outcomes. Further evidence is needed to ensure the representation of other conditions included in newborn bloodspot screening and to support strategies to overcome potential negative sequela.
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Affiliation(s)
- Jane Chudleigh
- Cicely Saunders Institute, King’s College London, London SE5 9PJ, UK;
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Bani M, Caviglia S, Bensi G, Carcereri MS, Greco B, Lastrucci E, Massa P, Vissani S, Cazzorla C. Availability of psychological resources for parents receiving communication of positivity at newborn screening for metabolic diseases in Italy. Eur J Pediatr 2024; 183:965-969. [PMID: 37975942 DOI: 10.1007/s00431-023-05337-x] [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: 07/17/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
Receiving information in the case of a positive or false-positive expanded newborn screening (ENBS) result for metabolic diseases is a stressful event. The availability of psychological support to families is crucial across the different communication steps and is recommended by different guidelines and position papers. However, more information is needed about the availability of psychological resources in the ENBS process. This national survey aimed to provide an overview of the availability of psychological resources for parents who received communication of positivity at the ENBS in the 23 Italian centers and how the support is provided to parents. An online survey was sent to the Heads of the ENBS centers asking about the availability of a clinical psychologist, their involvement in the ENBS process, and an estimation of parents receiving psychological support. More than 60% of the centers report having a clinical psychologist in the ENBS team; however, in more than 50% of cases, the psychologist does not participate in the consultation with parents (nor for the first consultation post-positivity or at confirmation of diagnosis). Furthermore, nearly 60% of the centers reported the experience of parental rejection of psychological sessions. Conclusion: There is a need for harmonization among the Italian ENBS centers concerning the availability of psychological resources and how these resources are provided to families. Parents' needs remained only partially fulfilled. What is Known: • Receiving communication of positivity at the ENBS can be highly stressful for parents and requires adequate psychological support. • The guidelines recommend psychological support for parents during the ENBS process. What is New: • Only 14/23 (60.9%) of Italian ENBS centers have a clinical psychologist within the team. • In half of the consultations with parents receiving communication of positivity, the clinical psychologist is never involved.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy.
| | - Stefania Caviglia
- Clinical Psychology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Bensi
- Pediatrics and Neonatology Unit and Pediatric Neuropsychiatric Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Mirsada Sarah Carcereri
- Inherited Metabolic Diseases Unit and Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Benedetta Greco
- Division of Metabolic Diseases, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Pamela Massa
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, Padua University Hospital, Padua, Italy
| | - Sofia Vissani
- Pediatric Unit, Program of Pediatric Endocrinology, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Chiara Cazzorla
- Division of Inherited Metabolic Diseases, Department of Diagnostic Services, Padua University Hospital, Padua, Italy
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3
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Bani M, Russo S, Raggi E, Gasperini S, Motta S, Menni F, Furlan F, Cefalo G, Paci S, Banderali G, Marchisio P, Biondi A, Strepparava MG. Parents' experience of the communication process of positivity at newborn screening for metabolic diseases: A qualitative study. Child Care Health Dev 2023; 49:961-971. [PMID: 36787987 DOI: 10.1111/cch.13105] [Citation(s) in RCA: 3] [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: 07/26/2022] [Revised: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The process of receiving a communication of positivity for metabolic diseases at expanded newborn screening (ENBS) is extremely articulated, involves a variety of actors (parents, maternal and child departments, clinical centres and laboratories) and is open to a variety of outcomes from false positive to true positive cases. Receiving communication of positivity can be highly stressful for parents and requires an adequate communication process to give clear and reliable information without causing excessive worry. This qualitative study describes the parents' experience of receiving a communication of positivity to metabolic diseases at ENBS, and their assessment of the quality of the communication process and steps, with the main aim to identify the process' strengths and weaknesses and to advance tailored recommendations to improve the communication process. METHOD Fourteen in-depth, semi-structured phone interviews were conducted with parents whose children resulted positive to the ENBS. As part of the ENBS communication process, parents received a first phone call communication of positivity and a second in-person communication at metabolic clinical centres (MCC). The framework analysis method was used to organize the data and identify emerging themes. RESULTS Parents were largely dissatisfied with the quality and depth of the information received and with the way the healthcare staff delivered the first communication phone call, which failed to create a caring, empathic and safe setting. Many parents tried to reduce the uncertainty by searching online information or consulting with other providers. Nevertheless, the majority of parents described the in-person visit at MCC as clear, welcoming and reassuring. CONCLUSION More efforts are needed to improve the quality of the communication process of the ENBS. Guidelines, recommendations and standard scripts to communicate positivity are needed along with programmes and educational resources to train tailored communication skills.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Erika Raggi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Serena Gasperini
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Francesca Menni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Francesca Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Graziella Cefalo
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Sabrina Paci
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Giuseppe Banderali
- Pediatric Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Metabolic Reference Center, Milan, Italy
| | - Andrea Biondi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Clinical Psychology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Wu Y, Lan Y, Mao J, Shen J, Kang T, Xie Z. The interaction between the nervous system and the stomatognathic system: from development to diseases. Int J Oral Sci 2023; 15:34. [PMID: 37580325 PMCID: PMC10425412 DOI: 10.1038/s41368-023-00241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
The crosstalk between the nerve and stomatognathic systems plays a more important role in organismal health than previously appreciated with the presence of emerging concept of the "brain-oral axis". A deeper understanding of the intricate interaction between the nervous system and the stomatognathic system is warranted, considering their significant developmental homology and anatomical proximity, and the more complex innervation of the jawbone compared to other skeletons. In this review, we provide an in-depth look at studies concerning neurodevelopment, craniofacial development, and congenital anomalies that occur when the two systems develop abnormally. It summarizes the cross-regulation between nerves and jawbones and the effects of various states of the jawbone on intrabony nerve distribution. Diseases closely related to both the nervous system and the stomatognathic system are divided into craniofacial diseases caused by neurological illnesses, and neurological diseases caused by an aberrant stomatognathic system. The two-way relationships between common diseases, such as periodontitis and neurodegenerative disorders, and depression and oral diseases were also discussed. This review provides valuable insights into novel strategies for neuro-skeletal tissue engineering and early prevention and treatment of orofacial and neurological diseases.
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Affiliation(s)
- Yuzhu Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yanhua Lan
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiajie Mao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiahui Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Ting Kang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Lastrucci E, Daniotti M, Procopio E, Scaturro G, Tubili F, Martin R, la Marca G. Communicating a Positive Result at Newborn Screening and Parental Distress. Int J Neonatal Screen 2023; 9:38. [PMID: 37489491 PMCID: PMC10366888 DOI: 10.3390/ijns9030038] [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: 04/27/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
The assumption of this study is strictly connected to the need to focus and to know more about the impact on the psychological state of the parents whose newborn babies get a positive result at Expanded Newborn Screening (ENS). As clinical experience shows us, this aspect seems to have a potentially lasting resonance on the way the disease will be managed and handled in the family, leading to potential negative effects and repercussions on the child's wellbeing and on the quality of life within the family. On the basis of this and on the evidence emerging from a review of the literature, this study aims to investigate and objectify possible distress indicators elicited at the moment of the communication of a positive result at ENS. Questionnaires containing the Beck Depression Inventory-II, the State-Trait Anxiety Inventory-Y, and the Short Form 36 Health Survey tests were administered to the parents of 87 newborns who received positive results at ENS. The parents of 32 babies expressed the presence of discomfort potentially related to the communication of a positive result at ENS.
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Affiliation(s)
- Elisa Lastrucci
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50019 Florence, Italy;
| | - Marta Daniotti
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Elena Procopio
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Giusi Scaturro
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Flavia Tubili
- Metabolic Diseases Unit, Neuroscience Department, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (M.D.); (E.P.); (G.S.); (F.T.)
| | - Rosanna Martin
- Psychology Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
| | - Giancarlo la Marca
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50019 Florence, Italy;
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy
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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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Lee MS, Chung HS, Kim JS. Analysis of online parenting community posts on expanded newborn screening for metabolic disorders using topic modeling: a quantitative content analysis. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2023; 29:20-31. [PMID: 37037448 PMCID: PMC10085666 DOI: 10.4069/kjwhn.2023.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/21/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose: As more newborns have received expanded newborn screening (NBS) for metabolic disorders, the overall number of false-positive results has increased. The purpose of this study was to explore the nature of the psychological impacts experienced by mothers related to the NBS process. Methods: An online parenting community in Korea was selected, and questions regarding NBS were collected using web crawling for the period from October 2018 to August 2021. In total, 634 posts were analyzed. The collected unstructured text data were preprocessed, and keyword analysis, topic modeling, and visualization were performed. Results: Of 1,057 words extracted from posts, the top keyword based on ‘term frequency-inverse document frequency’ values was “hypothyroidism,” followed by “discharge,” “close examination,” “thyroid-stimulating hormone levels,” and “jaundice.” The top keyword based on the simple frequency of appearance was “XXX hospital,” followed by “close examination,” “discharge,” “breastfeeding,” “hypothyroidism,” and “professor.” As a result of LDA topic modeling, posts related to inborn errors of metabolism (IEMs) were classified into four main themes: “confirmatory tests of IEMs,” “mother and newborn with thyroid function problems,” “retests of IEMs,” and “feeding related to IEMs.” Mothers experienced substantial frustration, stress, and anxiety when they received positive NBS results. Conclusion: The online parenting community played an important role in acquiring and sharing information, as well as psychological support related to NBS in newborn mothers. Nurses can use this study’s findings to develop timely and evidence-based information for parents whose children receive positive NBS results to reduce the negative psychological impact.
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Kölbel H, Modler L, Blaschek A, Schara-Schmidt U, Vill K, Schwartz O, Müller-Felber W. Parental Burden and Quality of Life in 5q-SMA Diagnosed by Newborn Screening. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121829. [PMID: 36553273 PMCID: PMC9776462 DOI: 10.3390/children9121829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the psychosocial burden in parents of children with spinal muscular atrophy (SMA), detected by newborn screening (NBS), for which first pilot projects started in January 2018 in Germany. The survey, performed 1-2 years after children's diagnosis of SMA via NBS, included 3 parent-related questionnaires to evaluate the psychosocial burden, quality of life (QoL)/satisfaction and work productivity and activity impairment in the families. 42/44 families, detected between January 2018 and February 2020, could be investigated. Interestingly, statistical analysis revealed a significant difference between families with children that received SMN-targeted therapy vs. children with a wait-and-see strategy as to social burden (p = 0.016) and personal strain/worries about the future (p = 0.02). However, the evaluation of QoL showed no significant differences between treated vs. untreated children. Fathers of treated children felt more negative impact regarding their productivities at work (p = 0.005) and more negative effects on daily activities (p = 0.022) than fathers of untreated children. Thus, NBS in SMA has a psychosocial impact on families, not only in terms of diagnosis but especially in terms of treatment, and triggers concerns about the future, emphasizing the need for comprehensive multidisciplinary care. Understanding the parents' perspective allows genetic counselors and NBS programs to proactively develop a care plan for parents during the challenging time of uncertainty, anxiety, frustration, and fear of the unknown.
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Affiliation(s)
- Heike Kölbel
- Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-201-723-2176; Fax: +49-201-723-5389
| | - Laura Modler
- Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany
| | - Astrid Blaschek
- Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany
| | - Ulrike Schara-Schmidt
- Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, LMU–University of Munich, 80337 Munich, Germany
| | - Oliver Schwartz
- Department of Pediatric Neurology, Muenster University Hospital, 48149 Münster, Germany
| | - Wolfgang Müller-Felber
- Centre for Neuromuscular Disorders, Center for Translational Neuro and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany
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Boychuk NA, Mulrooney NS, Kelly NR, Goldenberg AJ, Silver EJ, Wasserstein MP. Parental Depression and Anxiety Associated with Newborn Bloodspot Screening for Rare and Variable-Onset Disorders. Int J Neonatal Screen 2022; 8:ijns8040059. [PMID: 36412585 PMCID: PMC9680490 DOI: 10.3390/ijns8040059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
The ability to screen newborns for a larger number of disorders, including many with variable phenotypes, is prompting debate regarding the psychosocial impact of expanded newborn bloodspot screening (NBS) on parents. This study compares psychological outcomes of parents of children with a range of NBS/diagnostic experiences, with a particular focus on lysosomal storage disorders (LSDs) and X-linked adrenoleukodystrophy (X-ALD) as representative disorders with complex presentations. An online cross-sectional survey with six domains was completed in 2019 by a volunteer sample of parents with at least one child born between 2013 and 2018. Parents were classified in the analysis stage into four groups based on their child's rare disorder and means of diagnosis. Stress and depression were estimated using dichotomous measures of the depression subscale of the Hospital Anxiety and Depression Scale and the Parental Stress Scale. Logistic regression models were estimated for the relationship between the parent group and stress/depression, controlling for demographic variables (region of the US, income, education, major life events, relationship to the child, number of children, parent age, and race/ethnicity). One hundred seventy-four parents were included in this analysis. Parents of children with an LSD or X-ALD diagnosis clinically may have higher odds of depression (OR: 6.06, 95% CI: 1.64-24.96) compared to parents of children with the same disorders identified through NBS, controlling for covariates. Although a similar pattern was observed for parental stress (OR: 2.85, 95% CI: 0.82-10.37), this did not reach statistical significance. Ethically expanding NBS and genome sequencing require an understanding of the impacts of early detection for complex disorders on families. These initial findings are reassuring, and may have implications as NBS expands. Given our small sample size, it is difficult to generalize these findings to all families. These preliminary trends warrant further investigation in larger and more diverse populations.
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Affiliation(s)
- Natalie A. Boychuk
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Niamh S. Mulrooney
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Nicole R. Kelly
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Aaron J. Goldenberg
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Ellen J. Silver
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - Melissa P. Wasserstein
- Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY 10467, USA
- Correspondence:
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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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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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Pereira S, Smith HS, Frankel LA, Christensen KD, Islam R, Robinson JO, Genetti CA, Blout Zawatsky CL, Zettler B, Parad RB, Waisbren SE, Beggs AH, Green RC, Holm IA, McGuire AL. Psychosocial Effect of Newborn Genomic Sequencing on Families in the BabySeq Project: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:1132-1141. [PMID: 34424265 PMCID: PMC8383160 DOI: 10.1001/jamapediatrics.2021.2829] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Newborn genomic sequencing (nGS) may provide health benefits throughout the life span, but there are concerns that it could also have an unfavorable (ie, negative) psychosocial effect on families. OBJECTIVE To assess the psychosocial effect of nGS on families from the BabySeq Project, a randomized clinical trial evaluating the effect of nGS on the clinical care of newborns from well-baby nurseries and intensive care units. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted from May 14, 2015, to May 21, 2019, at well-baby nurseries and intensive care units at 3 Boston, Massachusetts, area hospitals, 519 parents of 325 infants completed surveys at enrollment, immediately after disclosure of nGS results, and 3 and 10 months after results disclosure. Statistical analysis was performed on a per-protocol basis from January 16, 2019, to December 1, 2019. INTERVENTION Newborns were randomized to receive either standard newborn screening and a family history report (control group) or the same plus an nGS report of childhood-onset conditions and highly actionable adult-onset conditions (nGS group). MAIN OUTCOMES AND MEASURES Mean responses were compared between groups and, within the nGS group, between parents of children who received a monogenic disease risk finding and those who did not in 3 domains of psychosocial impact: parent-child relationship (Mother-to-Infant Bonding Scale), parents' relationship (Kansas Marital Satisfaction Scale), and parents' psychological distress (Edinburgh Postnatal Depression Scale anxiety subscale). RESULTS A total of 519 parents (275 women [53.0%]; mean [SD] age, 35.1 [4.5] years) were included in this study. Although mean scores differed for some outcomes at singular time points, generalized estimating equations models did not show meaningful differences in parent-child relationship (between-group difference in adjusted mean [SE] Mother-to-Infant Bonding Scale scores: postdisclosure, 0.04 [0.15]; 3 months, -0.18 [0.18]; 10 months, -0.07 [0.20]; joint P = .57) or parents' psychological distress (between-group ratio of adjusted mean [SE] Edinburgh Postnatal Depression Scale anxiety subscale scores: postdisclosure, 1.04 [0.08]; 3 months, 1.07 [0.11]; joint P = .80) response patterns between study groups over time for any measures analyzed in these 2 domains. Response patterns on one parents' relationship measure differed between groups over time (between-group difference in adjusted mean [SE] Kansas Marital Satisfaction Scale scores: postdisclosure, -0.19 [0.07]; 3 months, -0.04 [0.07]; and 10 months, -0.01 [0.08]; joint P = .02), but the effect decreased over time and no difference was observed on the conflict measure responses over time. We found no evidence of persistent negative psychosocial effect in any domain. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of nGS, there was no persistent negative psychosocial effect on families among those who received nGS nor among those who received a monogenic disease risk finding for their infant. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02422511.
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Affiliation(s)
- Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Leslie A. Frankel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Kurt D. Christensen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts,Department of Population Medicine, Harvard Medical School, Boston, Massachusetts,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Rubaiya Islam
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Jill Oliver Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Casie A. Genetti
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Carrie L. Blout Zawatsky
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Bethany Zettler
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Richard B. Parad
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan E. Waisbren
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alan H. Beggs
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert C. Green
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Precision Population Health Initiative, Ariadne Labs, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Ingrid A. Holm
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
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13
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Kariyawasam DS, D'Silva AM, Vetsch J, Wakefield CE, Wiley V, Farrar MA. " We needed this": perspectives of parents and healthcare professionals involved in a pilot newborn screening program for spinal muscular atrophy. EClinicalMedicine 2021; 33:100742. [PMID: 33842861 PMCID: PMC8020144 DOI: 10.1016/j.eclinm.2021.100742] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Newborn screening (NBS) for spinal muscular atrophy (SMA) is a recognised model through which health outcomes can be improved. However, perspectives of parents and healthcare professionals (HCPs) involved in such programs are largely unknown. METHODS A pilot program for SMA ran from August 2018-July 2020. Using a mixed-methods convergent methodology, we used a self-administered questionnaire to understand parents' perceptions and psychological impact of the program from diagnosis to treatment. We thematically analysed successes/challenges encountered by HCPs and recommendations for service improvement from both participant groups. FINDINGS 202,388 infants were screened for SMA and the perceptions of 44 parents and HCPs affected by a positive result in eighteen newborns was ascertained. Parents (n=29, 100%) were satisfied with NBS for SMA. Although screen-positive result was distressing for all parents, quality of life improved over time [CarerQoL-7D baseline median score 4 (SD=1.4) vs six-month median score 8 (SD=1.3), p<0.001)]. Challenges for HCPs included managing the time-critical nature of the pathway whilst remaining cognisant of limitations associated with the predictive screening test. INTERPRETATION Interpretation: NBS for SMA fulfils criteria for population-wide screening. Net benefits are acknowledged by stakeholders to optimise lifelong outcomes. Harms including psychological distress associated with a screen-positive result may be managed by targeted psychosocial support, information provision and a personalised model of care together strengthening healthcare systems. FUNDING The NSW Pilot NBS study was funded by Luminesce Alliance. Dr Kariyawasam received funding from the RTP Scholarship, University of New South Wales and The Freedman Family Foundation Scholarship, Sydney Children's Hospital Foundation.
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Affiliation(s)
- Didu S.T. Kariyawasam
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Arlene M. D'Silva
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Veronica Wiley
- NSW Newborn Screening Program, Children's Hospital Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle A. Farrar
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
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14
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Mikami-Saito Y, Maekawa M, Wada Y, Kanno T, Kurihara A, Sato Y, Yamamoto T, Arai-Ichinoi N, Kure S. Essential oils can cause false-positive results of medium-chain acyl-CoA dehydrogenase deficiency. Mol Genet Metab Rep 2020; 25:100674. [PMID: 33204637 PMCID: PMC7653163 DOI: 10.1016/j.ymgmr.2020.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Abstract
Newborn screening is a public health care program worldwide to prevent patients from critical illness or conditions. Tandem mass spectrometry allows multiplex, inexpensive, and rapid newborn screening. However, mass spectrometry used for newborn screening to date is not able to separate peaks of compounds with similar m/z, which could lead to false-positive results without additional second-tier tests, such as fragmentation. We experienced three neonatal cases with high levels of markers, octanoylcarnitine and octanoylcarnitine/decanoylcarnitine ratio used to pick up possible cases of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. The babies were born consecutively in a maternity hospital. Their second acylcarnitine profiles were normal, and the genetic tests for ACADM were negative. Analysis of samples extracted from their first Guthrie cards where blood was not stained also showed peaks equivalent to octanoylcarnitine and decanoylcarnitine, indicating contamination. Environmental surveillance in the maternity ward suggested that essential oils used there might contain the contaminated compound. LC-HRMS/MS and in silico analysis revealed that false-positive results might be due to contamination with the essential oils in Guthrie cards, and causal agents were sphinganine (d17:0) and 2-[2-hydroxyethyl(pentadecyl)amino]ethanol. Thus, health care providers should be cautioned about use of essential oils when collecting blood samples on Guthrie cards. False-positive results can waste costly social resources and cause a physical and psychological burden for children and parents.
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Key Words
- C10, decanoylcarnitine,
- C8, octanoylcarnitine,
- Decanoylcarnitine
- Essential oils
- FAOD, fatty acid oxidation disorder,
- False-positive
- LC-HRMS/MS, liquid chromatography-high resolution-tandem mass spectrometry
- LC-MS/MS, liquid chromatography-tandem mass spectrometry,
- MCAD deficiency
- MCAD, medium-chain acyl-CoA dehydrogenase,
- NBS, newborn screening
- Newborn screening
- Octanoylcarnitine
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Affiliation(s)
- Yasuko Mikami-Saito
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Masamitsu Maekawa
- Department of Pharmaceutical Sciences, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Yoichi Wada
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
- Corresponding author.
| | - Tomoe Kanno
- Public Health Society of Miyagi Prefecture, 7-1 Tsutsumishita, Matsumori, Izumi-ku, Sendai, Miyagi 981-3111, Japan
| | - Ai Kurihara
- Public Health Society of Miyagi Prefecture, 7-1 Tsutsumishita, Matsumori, Izumi-ku, Sendai, Miyagi 981-3111, Japan
| | - Yuko Sato
- Public Health Society of Miyagi Prefecture, 7-1 Tsutsumishita, Matsumori, Izumi-ku, Sendai, Miyagi 981-3111, Japan
| | - Toshio Yamamoto
- Public Health Society of Miyagi Prefecture, 7-1 Tsutsumishita, Matsumori, Izumi-ku, Sendai, Miyagi 981-3111, Japan
| | - Natsuko Arai-Ichinoi
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573, Japan
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15
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Bosfield K, Regier DS, Viall S, Hicks R, Shur N, Grant CL. Mucopolysaccharidosis type I newborn screening: Importance of second tier testing for ethnically diverse populations. Am J Med Genet A 2020; 185:134-140. [PMID: 33098355 DOI: 10.1002/ajmg.a.61930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 11/09/2022]
Abstract
Mucopolysaccharidosis type I (MPS I)/Hurler syndrome newborn screening was added to the recommended uniform screening panel (RUSP) in 2016. As states have added screening for MPS I, programs have reported increased rates of false positives. Reasons for false positive screens include carrier status, true false positive, late-onset/attenuated forms, and in about half of cases, pseudodeficiency alleles. These alleles have DNA variants that can cause falsely decreased enzyme activity on biochemical enzyme studies and have increased frequency in individuals of African American and African descent. We describe the District of Columbia (DC) experience with MPS I screening from December 2017 to February 2019. In the context of a review of the literature on newborn screening and family experiences and this DC-based experience, we offer potential solutions to address preliminary concerns regarding this screening. The impact of overrepresentation of screen positives in a minority group and unintentional creation of health disparities and community wariness regarding medical genetics evaluations must be considered to improve the newborn screen programs nationally and internationally.
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Affiliation(s)
| | | | - Sarah Viall
- Children's National Hospital, Washington, DC, USA
| | | | - Natasha Shur
- Children's National Hospital, Washington, DC, USA
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