1
|
Seed L, Scott A, Pichini A, Peter M, Tadros S, Sortica da Costa C, Hill M. Perceptions of genomic newborn screening: a cross-sectional survey conducted with UK medical students. BMJ Open 2024; 14:e089108. [PMID: 39317512 PMCID: PMC11423729 DOI: 10.1136/bmjopen-2024-089108] [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: 05/24/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND With the potential to identify a vast number of rare diseases soon after birth, genomic newborn screening (gNBS) could facilitate earlier interventions and improve health outcomes. Designing a gNBS programme will involve balancing stakeholders' opinions and addressing concerns. The views of medical students-future clinicians who would deliver gNBS-have not yet been explored. METHODS We conducted a nationwide online survey of UK medical students via the REDCap platform. Perceptions of gNBS, including scope of testing and potential benefits and drawbacks, were explored using a mix of multiple-choice questions, Likert scales, visual analogue scales and free-text questions. RESULTS In total, 116 medical students across 16 universities participated. Overall, 45% supported gNBS, with a positively skewed mean support score of 3.24 (SD 1.26, range: 1.0-5.0), and 55% felt it relevant to their future practice. Almost all agreed that infant-onset and childhood-onset diseases and conditions with effective treatments should be included. Most felt that earlier interventions and personalised care would be the most important benefit of gNBS. Other perceived benefits included earlier diagnoses, diagnosing more patients and enabling research for new treatments. However, several perceived challenges were highlighted: risk of genomic discrimination, incidental or uncertain findings, data security and breaching children's future autonomy. Students expressed conflicting opinions on the psychological impact on families, but most were concerned about a lack of support due to current resource limitations in health services. Students frequently reported having insufficient knowledge to form an opinion, which may reflect gaps in genomics education at medical school and the current lack of evidence base for gNBS. CONCLUSION Although some support for gNBS was demonstrated, ethicolegal and social challenges were raised, emphasising a need for ongoing discussions about the implications of gNBS.
Collapse
Affiliation(s)
- Lydia Seed
- Infection, Immunity and Inflammation Department, University College London Great Ormond Street Institute of Child Health, London, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Scott
- Infection, Immunity and Inflammation Department, University College London Great Ormond Street Institute of Child Health, London, UK
- School of Medicine, University of Southampton, Southampton, UK
| | | | - Michelle Peter
- NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Shereen Tadros
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Cristine Sortica da Costa
- Infection, Immunity and Inflammation Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North Thames Regional Genetics Service, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Genetic and Genomic Medicine, University College London Great Ormond Street Institute of Child Health Library, London, UK
| |
Collapse
|
2
|
Unnikumaran Y, Lietsch M, Brower A. Charting the Ethical Frontier in Newborn Screening Research: Insights from the NBSTRN ELSI Researcher Needs Survey. Int J Neonatal Screen 2024; 10:64. [PMID: 39311366 PMCID: PMC11417897 DOI: 10.3390/ijns10030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/15/2024] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
From 2008 to 2024, the Newborn Screening Translational Research Network (NBSTRN), part of the National Institute of Child Health and Human Development (NICHD) Hunter Kelly Newborn Screening Program, served as a robust infrastructure to facilitate groundbreaking research in newborn screening (NBS), public health, rare disease, and genomics. Over its sixteen years, NBSTRN developed into a significant international network, supporting innovative research on novel technologies to screen, diagnose, treat, manage, and understand the natural history of more than 280 rare diseases. The NBSTRN tools and resources were used by a variety of stakeholders including researchers, clinicians, state NBS programs, parents, families, and policy makers. Resources and expertise for the newborn screening community in ethical, legal, and social issues (ELSI) has been an important area of focus for the NBSTRN and this includes efforts across the NBS system from pilot studies of candidate conditions to public health implementation of screening for new conditions, and the longitudinal follow-up of NBS-identified individuals to inform health outcomes and disease understanding. In 2023, the NBSTRN conducted a survey to explore ELSI issues in NBS research, specifically those encountered by the NBS community. Since NBS research involves collaboration among researchers, state NBS programs, clinicians, and families, the survey was broadly designed and disseminated to engage all key stakeholders. With responses from 88 members of the NBS community, including researchers and state NBS programs, the survey found that individuals rely most on institutional and collegial resources when they encounter ELSI questions. Most survey responses ranked privacy as extremely or very important in NBS research and identified the need for policies that address informed consent in NBS research. The survey results highlight the need for improved collaborative resources and educational programs focused on ELSI for the NBS community. The survey results inform future efforts in ELSI and NBS research in the United States (U.S.) and the rest of the world, including the development of policies and expanded ELSI initiatives and tools that address the needs of all NBS stakeholders.
Collapse
Affiliation(s)
- Yekaterina Unnikumaran
- American College of Medical Genetics and Genomics (ACMG), Bethesda, MD 20814, USA; (Y.U.); (M.L.)
| | - Mei Lietsch
- American College of Medical Genetics and Genomics (ACMG), Bethesda, MD 20814, USA; (Y.U.); (M.L.)
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Amy Brower
- American College of Medical Genetics and Genomics (ACMG), Bethesda, MD 20814, USA; (Y.U.); (M.L.)
- Genetic Medicine, Munore-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68106, USA
- Department of Health Professions., Creighton University School of Medicine, Omaha, NE 68178, USA
| |
Collapse
|
3
|
IJzebrink A, van Dijk T, Franková V, Loeber G, Kožich V, Henneman L, Jansen M. Informing Parents about Newborn Screening: A European Comparison Study. Int J Neonatal Screen 2021; 7:ijns7010013. [PMID: 33652810 PMCID: PMC7930998 DOI: 10.3390/ijns7010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Knowledge about newborn screening (NBS) is an important factor for parents to make an informed decision about participation. In Europe, countries inform parents differently about their NBS program, potentially including different knowledge aspects in their information. The aim of this study was to assess twenty-six European parental information products and to analyze their knowledge aspects through a content analysis. The analyzed aspects were compared to a list of eight knowledge aspects from scientific literature. The list includes aspects important for parents' decision-making, such as the purpose of screening. The study showed that most of the eight knowledge aspects are included in NBS information products of the majority of countries. However, there were differences between countries, for example in the amount of detail and phrasing of the information. Additional relevant knowledge aspects have also been identified and are recommended to optimize information products, such as the handling of residual bloodspot samples. This study only assessed knowledge aspects in information products meant for printing, but many countries also use other communication methods, and the impact on knowledge of the delivery of the information needs further study. Preferences of parents on alternative communication methods need to be considered and evaluated on their effectiveness.
Collapse
Affiliation(s)
- Amber IJzebrink
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Tessa van Dijk
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Věra Franková
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital Praque, 128 08 Prague 2, Czech Republic; (V.F.); (V.K.)
- Institute for Medical Humanities, First Faculty of Medicine, Charles University Praque, 128 08 Praque 2, Czech Republic
| | - Gerard Loeber
- International Society for Neonatal Screening, 3721CK Bilthoven, The Netherlands;
| | - Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University First Faculty of Medicine and General University Hospital Praque, 128 08 Prague 2, Czech Republic; (V.F.); (V.K.)
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
| | - Marleen Jansen
- Department of Clinical Genetics, Section Community Genetics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1007 MB Amsterdam, The Netherlands; (A.IJ.); (T.v.D.); (L.H.)
- Centre for Health Protection, National Institue for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
- Correspondence: ; Tel.: +31-20-444-3869
| |
Collapse
|
4
|
Chan K, Petros M. Simple Test, Complex System: Multifaceted Views of Newborn Screening Science, Technology, and Policy. Glob Pediatr Health 2019; 6:2333794X19894812. [PMID: 31903414 PMCID: PMC6926981 DOI: 10.1177/2333794x19894812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/08/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023] Open
Abstract
Newborn screening (NBS) is a public health service provided for all babies born in the United States and in most countries of the developed world. A series of tests are applied to the blood taken from newborn babies to detect genetic and metabolic disorders that can be treated if identified early. With early treatment and therapy, the affected babies can usually live a normal, healthy life. Timing for sampling, testing, and reporting is vital for NBS to function as an effective system. In order to be an effective system, the evolution of science, technology, and policy gradually had to come into a synchronous partnership, where the discovery of new genetic disorders led to timely development of technology for screening, which is supported by policy and implemented into practice. The timely "dance" of these partnerships in an era of personalized health and medicine forms the integrated approach supporting NBS. This review will include a brief history of scientific development, policymaking, and the economic consideration in the expansion of the NBS.
Collapse
Affiliation(s)
- Kee Chan
- University of Illinois, Chicago, IL, USA
| | | |
Collapse
|
5
|
Baker M, Griggs R, Byrne B, Connolly AM, Finkel R, Grajkowska L, Haidet-Phillips A, Hagerty L, Ostrander R, Orlando L, Swoboda K, Watson M, Howell RR. Maximizing the Benefit of Life-Saving Treatments for Pompe Disease, Spinal Muscular Atrophy, and Duchenne Muscular Dystrophy Through Newborn Screening. JAMA Neurol 2019; 76:978-983. [DOI: 10.1001/jamaneurol.2019.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mei Baker
- University of Wisconsin School of Medicine, Madison
| | - Robert Griggs
- University of Rochester School of Medicine, Rochester, New York
| | | | - Anne M. Connolly
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | | | | | | | - Robert Ostrander
- State University of New York Upstate Medical University, Rushville
| | | | - Kathryn Swoboda
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Watson
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | | |
Collapse
|
6
|
Langan TJ, Barczykowski A, Jalal K, Sherwood L, Allewelt H, Kurtzberg J, Carter RL. Survey of quality of life, phenotypic expression, and response to treatment in Krabbe leukodystrophy. JIMD Rep 2019; 47:47-54. [PMID: 31240167 PMCID: PMC6498827 DOI: 10.1002/jmd2.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/27/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To develop a quality of life (QOL) survey for Krabbe disease (KD), and to thereby improve understanding of its phenotypic expression and response to treatment. METHODS The survey, the Leukodystrophy Quality of Life Assessment (LQLA) and the Vineland Adaptive Behavior Scales were co-administered to 33 patients or their caretakers. These included the phenotypes of early infantile KD (EIKD; 0-6 months old at onset), late infantile cases (LIKD; 7-12 months old at onset), and cases that emerged after 12 months old, late onset (LOKD). The sample included cases with and without stem cell transplantation (SCT). Reliability and concurrent validity were assessed for overall and subscale scores. Analysis of variance tested differences in QOL between phenotypes and transplant groups (none, pre-, post-symptom). RESULTS Good concurrent validity with the Vineland was shown for total, communication, daily activity, social, and motor scales and good reliability was observed. LOKD cases had better communication skills than either EIKD or LIKD and better overall QOL than EIKD. Analyses of individual items showed that communication items, mostly, contributed significantly to phenotype differences. Presymptomatic SCT significantly improved QOL compared to postsymptomatic SCT or no treatment. Presymptomatically treated patients had near-normal total scores. CONCLUSIONS The LQLA is valid and reliable. Despite small sample size, phenotypic demarcation was determined to be due mainly to differences in communication skills. There was a relative enhancement of QOL in LOKD patients, and in those who had presymptomatic SCT. These results apply to the current controversy about recommendations for newborn screening for this condition.
Collapse
Affiliation(s)
- Thomas J. Langan
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Amy Barczykowski
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Kabir Jalal
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Laura Sherwood
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Heather Allewelt
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Joanne Kurtzberg
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Randy L. Carter
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| |
Collapse
|
7
|
Development of a newborn screening tool based on bivariate normal limits: using psychosine and galactocerebrosidase determination on dried blood spots to predict Krabbe disease. Genet Med 2018; 21:1644-1651. [DOI: 10.1038/s41436-018-0371-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/07/2018] [Indexed: 11/08/2022] Open
|
8
|
The New York pilot newborn screening program for lysosomal storage diseases: Report of the First 65,000 Infants. Genet Med 2018; 21:631-640. [PMID: 30093709 PMCID: PMC6369014 DOI: 10.1038/s41436-018-0129-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/27/2018] [Indexed: 01/05/2023] Open
Abstract
Purpose: We conducted a consented pilot newborn screening (NBS) for Pompe,
Gaucher, Niemann Pick A/B, Fabry, and MPS 1 to assess the suitability of
these lysosomal storage disorders (LSD) for public health mandated
screening. Methods: At five participating high-birth-rate, ethnically diverse New York
City hospitals, recruiters discussed the study with post-partum parents and
documented verbal consent. Screening on consented samples was performed
using multiplexed tandem mass spectrometry. Screen-positive infants
underwent confirmatory enzymology, DNA testing, and biomarker quantitation
when available. Affected infants are being followed for clinical management
and long term outcome. Results: 65,605 infants participated over four years, representing an overall
consent rate of 74%. Sixty-nine infants were screen-positive. Twenty-three
were confirmed true positives, all of whom were predicted to have late-onset
phenotypes. Six of the 69 currently have undetermined disease status. Conclusion: Our results suggest that NBS for LSDs is much more likely to detect
individuals at risk for late-onset disease, similar to results from other
NBS programs. This work has demonstrated the feasibility of using a novel
consented pilot NBS study design that can be modified to include other
disorders under consideration for public health implementation as a means to
gather critical evidence for evidence-based NBS practices.
Collapse
|
9
|
Jansen ME, Lister KJ, van Kranen HJ, Cornel MC. Policy Making in Newborn Screening Needs a Structured and Transparent Approach. Front Public Health 2017; 5:53. [PMID: 28377917 PMCID: PMC5359248 DOI: 10.3389/fpubh.2017.00053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/01/2017] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Newborn bloodspot screening (NBS) programs have expanded significantly in the past years and are expected to expand further with the emergence of genetic technologies. Historically, NBS expansion has often occurred following ad hoc consideration of conditions, instead of a structured and transparent approach. In this review, we explore issues pertinent to NBS policy making, through the lens of the policy cycle: (a) agenda setting, (b) policy advice, (c) policy decision, (d) implementation, and (e) evaluation. METHODS A literature search was conducted to gather information on the elements specific to NBS and its policy making process. RESULTS The review highlighted two approaches to nominate a condition: a structured approach through horizon scanning; and an ad hoc process. For assessment of a condition, there was unanimous support for a robust process based on criteria. While the need to assess harms and benefits was a repeated theme in the articles, there is no agreed-upon threshold for benefit in decision-making. Furthermore, the literature was consistent in its recommendation for an overarching, independent, multidisciplinary group providing recommendations to government. An implementation plan focusing on the different levels on which NBS operates and the information needed on each level is essential for successful implementation. Continuously monitoring, and improving a program is vital, particularly following the implementation of screening for a new condition. An advisory committee could advise on implementation, development, review, modification, and cessation of (parts of) NBS. CONCLUSION The results highlight that there are a wave of issues facing NBS programs that policy makers must take into account when developing policy processes. What conditions to screen, and the technologies used in NBS, are both up for debate.
Collapse
Affiliation(s)
- Marleen E Jansen
- Section Community Genetics, Department of Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Institute for Public Health Genomics, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Karla J Lister
- Screening Policy Section, Office of Population Health Genomics, Department of Health, Government of Western Australia , Perth, WA , Australia
| | - Henk J van Kranen
- Institute for Public Health Genomics, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands; Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Martina C Cornel
- Section Community Genetics, Department of Clinical Genetics, Amsterdam Public Health Research Institute , Amsterdam , Netherlands
| |
Collapse
|
10
|
Binns C, Lee MK, Kagawa M. Ethical Challenges in Infant Feeding Research. Nutrients 2017; 9:E59. [PMID: 28085057 PMCID: PMC5295103 DOI: 10.3390/nu9010059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023] Open
Abstract
Infants have a complex set of nutrient requirements to meet the demands of their high metabolic rate, growth, and immunological and cognitive development. Infant nutrition lays the foundation for health throughout life. While infant feeding research is essential, it must be conducted to the highest ethical standards. The objective of this paper is to discuss the implications of developments in infant nutrition for the ethics of infant feeding research and the implications for obtaining informed consent. A search was undertaken of the papers in the medical literature using the PubMed, Science Direct, Web of Knowledge, Proquest, and CINAHL databases. From a total of 9303 papers identified, the full text of 87 articles that contained discussion of issues in consent in infant feeding trials were obtained and read and after further screening 42 papers were included in the results and discussion. Recent developments in infant nutrition of significance to ethics assessment include the improved survival of low birth weight infants, increasing evidence of the value of breastfeeding and evidence of the lifelong importance of infant feeding and development in the first 1000 days of life in chronic disease epidemiology. Informed consent is a difficult issue, but should always include information on the value of preserving breastfeeding options. Project monitoring should be cognisant of the long term implications of growth rates and early life nutrition.
Collapse
Affiliation(s)
- Colin Binns
- John Curtin Distinguished Emeritus Professor of Public Health, Curtin University, Perth 6845, Australia.
| | - Mi Kyung Lee
- Department, School of Health Professions, Murdoch University, Perth 6150, Australia.
| | - Masaharu Kagawa
- Institute of Nutrition Sciences, Kagawa Nutrition University, Saitama 350-0214, Japan.
| |
Collapse
|
11
|
Etchegary H, Nicholls SG, Tessier L, Simmonds C, Potter BK, Brehaut JC, Pullman D, Hayeems R, Zelenietz S, Lamoureux M, Milburn J, Turner L, Chakraborty P, Wilson B. Consent for newborn screening: parents' and health-care professionals' experiences of consent in practice. Eur J Hum Genet 2016; 24:1530-1534. [PMID: 27302842 PMCID: PMC5110054 DOI: 10.1038/ejhg.2016.55] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 12/26/2022] Open
Abstract
Consent processes for newborn bloodspot screening (NBS) are variable, with a lack of descriptive research that depicts how the offer of NBS is made to parents. We explored the experience, in practice, of consent for NBS. Semistructured interviews in two Canadian provinces were held with: (1) parents of children offered NBS (n=32); and (2) health-care professionals involved in the NBS process (n=19). Data on recollections of NBS, including consent processes, were utilized to identify emerging themes using the method of constant comparison. Three themes were relevant to NBS consent: (1) The 'offer' of NBS; (2) content and timing of information provision; and (3) the importance of parental experiences for consent decisions. Recollections of consent for NBS were similar between jurisdictions. Excepting midwives and their patients, NBS was viewed as a routine part of giving birth, with little evidence of an informed consent process. Although most parents were satisfied, all respondents suggested information about NBS be provided long before the birth. Accounts of parents who declined screening highlight the influence of parental experiences with the heel prick process in screening decisions. Findings further our understanding of consent in practice and highlight areas for improvement in parent-provider interactions.
Collapse
Affiliation(s)
- Holly Etchegary
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Stuart G Nicholls
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daryl Pullman
- Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Robyn Hayeems
- Institute of Health Policy Management and Evaluation, University of Toronto; Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Sari Zelenietz
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lesley Turner
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brenda Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
12
|
Hinton CF, Homer CJ, Thompson AA, Williams A, Hassell KL, Feuchtbaum L, Berry SA, Comeau AM, Therrell BL, Brower A, Harris KB, Brown C, Monaco J, Ostrander RJ, Zuckerman AE, Kaye C, Dougherty D, Greene C, Green NS. A framework for assessing outcomes from newborn screening: on the road to measuring its promise. Mol Genet Metab 2016; 118:221-9. [PMID: 27268406 PMCID: PMC4970906 DOI: 10.1016/j.ymgme.2016.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Newborn screening (NBS) is intended to identify congenital conditions prior to the onset of symptoms in order to provide early intervention that leads to improved outcomes. NBS is a public health success, providing reduction in mortality and improved developmental outcomes for screened conditions. However, it is less clear to what extent newborn screening achieves the long-term goals relating to improved health, growth, development and function. We propose a framework for assessing outcomes for the health and well-being of children identified through NBS programs. The framework proposed here, and this manuscript, were approved for publication by the Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). This framework can be applied to each screened condition within the Recommended Uniform Screening Panel (RUSP), recognizing that the data elements and measures will vary by condition. As an example, we applied the framework to sickle cell disease and phenylketonuria (PKU), two diverse conditions with different outcome measures and potential sources of data. Widespread and consistent application of this framework across state NBS and child health systems is envisioned as useful to standardize approaches to assessment of outcomes and for continuous improvement of the NBS and child health systems. SIGNIFICANCE Successful interventions for newborn screening conditions have been a driving force for public health newborn screening for over fifty years. Organizing interventions and outcome measures into a standard framework to systematically assess outcomes has not yet come into practice. This paper presents a customizable outcomes framework for organizing measures for newborn screening condition-specific health outcomes, and an approach to identifying sources and challenges to populating those measures.
Collapse
Affiliation(s)
- Cynthia F Hinton
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Charles J Homer
- Office of the Assistant Secretary for Planning and Evaluation, Washington, DC, United States
| | - Alexis A Thompson
- Department of Pediatrics, Northwestern University, Chicago, IL, United States
| | - Andrea Williams
- Children's Sickle Cell Foundation, Inc., Pittsburgh, PA, United States
| | | | - Lisa Feuchtbaum
- California Department of Public Health, Richmond, CA, United States
| | - Susan A Berry
- Department of Pediatrics, University of Minnesota, United States
| | - Anne Marie Comeau
- New England Newborn Screening Program and Department of Pediatrics, University of Massachusetts Medical School, Boston, MA, United States
| | - Bradford L Therrell
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX, United States
| | - Amy Brower
- American College of Medical Genetics and Genomics, Bethesda, MD, United States
| | | | | | - Jana Monaco
- Organic Acidemia Association, Woodbridge, VA, United States
| | - Robert J Ostrander
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Alan E Zuckerman
- Department of Pediatrics and Department of Family Medicine, Georgetown University, Washington, DC, United States
| | - Celia Kaye
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Denise Dougherty
- Agency for Healthcare Research and Quality, Rockville, MD, United States
| | - Carol Greene
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Nancy S Green
- Department of Pediatrics, Columbia University, New York, NY, United States
| |
Collapse
|
13
|
Fost N. Informed Consent Should Be a Required Element for Newborn Screening, Even for Disorders with High Benefit-Risk Ratios. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:241-255. [PMID: 27338600 DOI: 10.1177/1073110516654118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Over-enthusiastic newborn screening has often caused substantial harm and has been imposed on the public without adequate information on benefits and risks and without parental consent. This problem will become worse when genomic screening is implemented. For the past 40 years, there has been broad agreement about the criteria for ethically responsible screening, but the criteria have been systematically ignored by policy makers and practitioners. Claims of high benefit and low risk are common, but they require precise definition and documentation, which has often not occurred, undermining claims that involuntary testing is justified. Even when the benefits and risks are well established, it does not automatically follow that involuntary testing is justified, a position supported by the widespread tolerance for parental refusal of immunizations and newborn screening.
Collapse
Affiliation(s)
- Norman Fost
- Norman Fost, M.D., M.P.H., Professor Emeritus of Pediatrics at the University of Wisconsin, founded the Bioethics Program and the Child Protection Team at UW in 1973. He was been Chair of the Hospital Ethics Committee since 1984, and, for 31 years, chaired the Health Sciences Institutional Review Board. Dr. Fost has received lifetime achievement awards from the American Academy of Pediatrics and the Office of Human Subjects Protection, and was the first recipient of the Patricia Price Browne Prize in Bioethics. He has served on the FDA Pediatric Advisory Committee and is a member of the NIH Recombinant DNA Advisory Committee
| |
Collapse
|
14
|
Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Cressman C, Painter-Main M, Wilson B, Little J, Allanson J, Avard D, Giguere Y, Chakraborty P, Carroll JC. Using Newborn Screening Bloodspots for Research: Public Preferences for Policy Options. Pediatrics 2016; 137:peds.2015-4143. [PMID: 27244855 DOI: 10.1542/peds.2015-4143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Retaining residual newborn screening (NBS) bloodspots for medical research remains contentious. To inform this debate, we sought to understand public preferences for, and reasons for preferring, alternative policy options. METHODS We assessed preferences among 4 policy options for research use of residual bloodspots through a bilingual national Internet survey of a representative sample of Canadians. Fifty percent of respondents were randomly assigned to select reasons supporting these preferences. Understanding of and attitudes toward screening and research concepts, and demographics were assessed. RESULTS Of 1102 respondents (94% participation rate; 47% completion rate), the overall preference among policy options was ask permission (67%); this option was also the most acceptable choice (80%). Assume permission was acceptable to 46%, no permission required was acceptable to 29%, and no research allowed was acceptable to 26%. The acceptability of the ask permission option was reduced among participants assigned to the reasoning exercise (84% vs 76%; P = .004). Compared with assume/no permission required, ordered logistic regression showed a significant reduction in preference for the ask permission option with greater understanding of concepts (odds ratio, 0.87; P < .001), greater confidence in science (odds ratio, 0.16; P < .001), and a perceived responsibility to contribute to research (odds ratio, 0.39; P < .001). CONCLUSIONS Surveyed Canadians prefer that explicit permission is sought for storage and research use of NBS bloodspots. This preference was diminished when reasons supporting and opposing routine storage, and other policy options, were presented. Findings warrant consideration as NBS communities strategize to respond to shifting legislative contexts.
Collapse
Affiliation(s)
- Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;
| | - Carolyn J Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Celine Cressman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Painter-Main
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Wilson
- School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology, Public Health & Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Judith Allanson
- Departments of Genetics, Children's Hospital of Eastern Ontario, and Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Denise Avard
- Centre for Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Yves Giguere
- Departments of Medical Biology, CHU de Québec, and Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Montreal, Quebec, Canada; and
| | - Pranesh Chakraborty
- Departments of Genetics, Children's Hospital of Eastern Ontario, and Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Kelly N, Makarem DC, Wasserstein MP. Screening of Newborns for Disorders with High Benefit-Risk Ratios Should Be Mandatory. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:231-240. [PMID: 27338599 PMCID: PMC5381153 DOI: 10.1177/1073110516654133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Newborn screening has evolved to include an increasingly complex spectrum of diseases, raising concerns that screening should be optional and require parental consent. Early detection of disorders like PKU and MCAD is essential to prevent serious disability and death in affected children. These are examples of high benefit-risk ratio disorders because of the irrefutable health benefits of early detection, coupled with the low risks of treatment. The dire consequences of not diagnosing an infant with a treatable disorder because of parental refusal to screen are wholly unacceptable. Thus, we believe that newborn screening for disorders with high benefit-risk ratios should continue to be mandatory.
Collapse
Affiliation(s)
- Nicole Kelly
- Nicole Kelly, M.P.H., is the Research Program Manager for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Albert Einstein College of Medicine. She is the Research Manager for the Division of Pediatric Genetic Medicine at the Children's Hospital at Montefiore. Dalia Chehayeb Makarem, M.P.H., is the Clinical Research Coordinator for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Icahn School of Medicine at Mount Sinai. Melissa P. Wasserstein, M.D., is an Associate Professor of Pediatrics at the Albert Einstein College of Medicine and the Chief of Pediatric Genetic Medicine at The Children's Hospital at Montefiore in the Bronx, NY. She is a clinical biochemical geneticist, specializing in the care of individuals with rare inborn errors of metabolism
| | - Dalia Chehayeb Makarem
- Nicole Kelly, M.P.H., is the Research Program Manager for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Albert Einstein College of Medicine. She is the Research Manager for the Division of Pediatric Genetic Medicine at the Children's Hospital at Montefiore. Dalia Chehayeb Makarem, M.P.H., is the Clinical Research Coordinator for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Icahn School of Medicine at Mount Sinai. Melissa P. Wasserstein, M.D., is an Associate Professor of Pediatrics at the Albert Einstein College of Medicine and the Chief of Pediatric Genetic Medicine at The Children's Hospital at Montefiore in the Bronx, NY. She is a clinical biochemical geneticist, specializing in the care of individuals with rare inborn errors of metabolism
| | - Melissa P Wasserstein
- Nicole Kelly, M.P.H., is the Research Program Manager for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Albert Einstein College of Medicine. She is the Research Manager for the Division of Pediatric Genetic Medicine at the Children's Hospital at Montefiore. Dalia Chehayeb Makarem, M.P.H., is the Clinical Research Coordinator for the Pilot Newborn Screening for Lysosomal Storage Disorders at the Icahn School of Medicine at Mount Sinai. Melissa P. Wasserstein, M.D., is an Associate Professor of Pediatrics at the Albert Einstein College of Medicine and the Chief of Pediatric Genetic Medicine at The Children's Hospital at Montefiore in the Bronx, NY. She is a clinical biochemical geneticist, specializing in the care of individuals with rare inborn errors of metabolism
| |
Collapse
|
16
|
Beckmann JS. Can we afford to sequence every newborn baby's genome? Hum Mutat 2015; 36:283-6. [PMID: 25546530 DOI: 10.1002/humu.22748] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/17/2014] [Indexed: 01/19/2023]
Abstract
Whole-exome sequencing and whole-genome sequencing are gradually entering into the clinical arena. Drops in sequencing prices have led some to suggest that these analyses could be extended to the screening of whole populations or subsets thereof. Herein, we argue that this optimism is presently still unfounded. While cost estimates take into account the generation of sequence data, they fail to properly evaluate both the price of accurate and efficient interpretation and of the proper return of genomic information to the consulting individuals. Thus, short of inventing new, cost-effective ways of achieving these goals, the latter are likely to ruin our healthcare systems. We posit that due to lack of available resources, generalization of this practice remains, for the time being, unrealistic.
Collapse
Affiliation(s)
- Jacques S Beckmann
- Clinical Bioinformatics, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| |
Collapse
|
17
|
Abstract
Whole-genome and whole-exome sequencing for clinical applications is now an integral part of medical genetics practice. The term newborn screening refers to public health programs designed to screen newborns for various treatable metabolic conditions, by measuring levels of circulating blood metabolites. The availability and significant decrease in sequencing costs has raised the question of whether metabolic newborn screening should be replaced by whole-genome or whole-exome sequencing. While newborn genome sequencing can potentially increase the number of disorders identified by newborn screening, the generalization of its practice raises a number of important ethical issues. This short article argues that there are medical, psychological, ethical and economic reasons why widespread dissemination of newborn screening is still premature.
Collapse
|
18
|
Qian Y, McGraw S, Henne J, Jarecki J, Hobby K, Yeh WS. Understanding the experiences and needs of individuals with Spinal Muscular Atrophy and their parents: a qualitative study. BMC Neurol 2015; 15:217. [PMID: 26499462 PMCID: PMC4619513 DOI: 10.1186/s12883-015-0473-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical features of SMA, which range along a spectrum of severity, are relatively well described. In contrast, the literature on how individuals with SMA and their families experience this condition is limited. To address this gap, we undertook a qualitative study with individuals affected by SMA Types I, II and III, parents of those affected, and clinicians. METHODS We completed 16 focus group sessions and 37 interviews in the US with 96 participants including: 21 with individuals with SMA; 64 parents of individuals affected by SMA; and 11 clinicians who specialize in the care of SMA patients. RESULTS The Diagnostic Journey: Families reported substantial diagnostic delays owing to: 1) lack of awareness and knowledge about SMA; 2) the difficulty of distinguishing normal from abnormal development; and 3) the challenge of differential diagnosis. Lack of sensitivity in how clinicians communicated this potentially devastating diagnosis compounded parents' negative impressions. Newborn Screening: Parents generally held positive views about adding SMA to newborn screening panels. For example, it would: 1) enable earlier access to care; 2) shorten the diagnostic journey; and 3) give families more time to prepare to care for a disabled child. Some noted negative outcomes such as prematurely affecting a parent's relationship with a child before symptoms are evident. The Psychosocial Impact of Living with SMA: Ten thematic areas characterized the impact: 1) confronting premature death; 2) making difficult treatment choices; 3) fearing the loss of functional ability; 4) coming to terms with lost expectations; 5) loss of sleep and stress; 6) stigma; 7) limitations on social activities; 8) independence; 9) uncertainty and helplessness; and 10) family finances. CONCLUSIONS The results of this study suggest high levels of burden experienced by individuals with SMA and their families. The difficulties of living with SMA begin with the long and often arduous process of finding a diagnosis for their child. Newborn screening for SMA is seen as an important step toward shortening this journey. The psychosocial effects of coping with SMA are substantial and wide ranging both for the individual living with this condition and family members of affected individuals.
Collapse
Affiliation(s)
- Ying Qian
- SMA Foundation, 888 7th Ave #400, New York, NY, 10106, USA.
| | - Sarah McGraw
- The Henne Group, 116 New Montgomery Street, Suite 812, San Francisco, California, 94105, USA.
| | - Jeff Henne
- The Henne Group, 116 New Montgomery Street, Suite 812, San Francisco, California, 94105, USA.
| | - Jill Jarecki
- Cure SMA, 925 Busse Rd, Elk Grove Village, IL, 60007, USA.
| | - Kenneth Hobby
- Cure SMA, 925 Busse Rd, Elk Grove Village, IL, 60007, USA.
| | - Wei-Shi Yeh
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
| |
Collapse
|
19
|
Abstract
BACKGROUND The aim of newborn bloodspot screening (NBS) is to identify rare genetic and non-genetic conditions in children soon after birth in order to commence therapies that prevent the development of progressive, serious, and irreversible disabilities. Universal NBS programmes have been implemented in most countries, with minor adaptations to target conditions most relevant to the local healthcare environment. AIMS In this article, we describe the initiatives of international and Australian governments to develop policies to address the expansion of NBS in their healthcare systems. METHODS We have reviewed published public policies and literature to formulate recommendations based on clinical, social, legal, and ethical principles to inform a national governance and policy framework for Australia. RESULTS Australian policy makers have been slow to develop a coordinated plan. While the experience from other governments can guide our national policy, there are specific areas that require further consideration by Australian health experts. Key reforms involve the separation of policy and operational activities, multidisciplinary decision-making and oversight by the Australian Health Ministers' Advisory Council for policy direction. CONCLUSION A formal national policy framework will guide the coordination of NBS services that can adapt to the needs of Australian children and families.
Collapse
Affiliation(s)
- Peter O'Leary
- Research and Graduate Studies, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Susannah Maxwell
- Research and Graduate Studies, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| |
Collapse
|
20
|
Lillie SE, Tarini BA, Janz NK, Zikmund-Fisher BJ. Framing optional genetic testing in the context of mandatory newborn screening tests. BMC Med Inform Decis Mak 2015; 15:50. [PMID: 26123051 PMCID: PMC4485334 DOI: 10.1186/s12911-015-0173-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/12/2015] [Indexed: 02/04/2023] Open
Abstract
Background Parents are increasingly faced with decisions about optional newborn bloodspot screening (NBS) despite no consistent policy for communicating information about such testing. We examined whether framing optional NBS alongside mandatory NBS influenced intention to participate in optional NBS. Methods For this Internet-administered study, 2,991 adults read a hypothetical vignette in which optional NBS for Duchenne muscular dystrophy (DMD) was either presented by itself (in isolation), alongside a description including the total number of mandatory NBS tests (“bundled” mandatory context), or alongside a listing of each mandatory NBS test (“unbundled” mandatory context). We assessed associations with participants’ intended participation using ordered logistic regression models, and associations with attitudes towards optional DMD NBS and subjective norms using Analysis of Variance. Results Participants were more likely to choose optional DMD NBS if they also read information about mandatory NBS (either bundled or unbundled) versus when DMD NBS was presented in isolation. Participants who read about optional DMD NBS in isolation also reported such testing to be less important and that they would worry more about the results than those who also saw mandatory NBS information. Conclusions Future NBS programs should pay attention to the framing of optional testing communication, as it influences parental behavior. Predictors of NBS uptake will become increasingly important as NBS programs continue expanding. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0173-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sarah E Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA.
| | - Beth A Tarini
- Child Health Evaluation and Research (CHEAR) Unit, Department of Pediatrics, University of Michigan, Ann Arbor, USA.,Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Nancy K Janz
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Brian J Zikmund-Fisher
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.,Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA.,Risk Science Center, School of Public Health, University of Michigan, Ann Arbor, USA
| |
Collapse
|
21
|
Therrell BL, Padilla CD, Loeber JG, Kneisser I, Saadallah A, Borrajo GJC, Adams J. Current status of newborn screening worldwide: 2015. Semin Perinatol 2015; 39:171-87. [PMID: 25979780 DOI: 10.1053/j.semperi.2015.03.002] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Newborn screening describes various tests that can occur during the first few hours or days of a newborn's life and have the potential for preventing severe health problems, including death. Newborn screening has evolved from a simple blood or urine screening test to a more comprehensive and complex screening system capable of detecting over 50 different conditions. While a number of papers have described various newborn screening activities around the world, including a series of papers in 2007, a comprehensive review of ongoing activities since that time has not been published. In this report, we divide the world into 5 regions (North America, Europe, Middle East and North Africa, Latin America, and Asia Pacific), assessing the current NBS situation in each region and reviewing activities that have taken place in recent years. We have also provided an extensive reference listing and summary of NBS and health data in tabular form.
Collapse
Affiliation(s)
- Bradford L Therrell
- National Newborn Screening and Genetics Resource Center (NNSGRC), Austin, TX; Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Carmencita David Padilla
- College of Medicine, University of the Philippines Manila, Manila, Philippines; Newborn Screening Reference Center, National Institutes of Health (Philippines), Manila, Ermita, Philippines
| | - J Gerard Loeber
- International Society for Neonatal Screening, Bilthoven, Netherlands
| | - Issam Kneisser
- Newborn Screening Unit, Medical Genetic Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Amal Saadallah
- Newborn Screening and Biochemical Genetics Laboratory, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gustavo J C Borrajo
- Programa de Detección de Errores Congénitos, Fundación Bioquímica Argentina, La Plata, Argentina
| | - John Adams
- Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Kwan A, Hu D, Song M, Gomes H, Brown DR, Bourque T, Gonzalez-Espinosa D, Lin Z, Cowan MJ, Puck JM. Successful newborn screening for SCID in the Navajo Nation. Clin Immunol 2015; 158:29-34. [PMID: 25762520 DOI: 10.1016/j.clim.2015.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/18/2022]
Abstract
Newborn screening (NBS) for severe combined immunodeficiency (SCID) identifies affected infants before the onset of life-threatening infections, permitting optimal treatment. Navajo Native Americans have a founder mutation in the DNA repair enzyme Artemis, resulting in frequent Artemis SCID (SCID-A). A pilot study at 2 Navajo hospitals assessed the feasibility of SCID NBS in this population. Dried blood spots from 1800 infants were assayed by PCR for T-cell receptor excision circles (TRECs), a biomarker for naïve T cells. Starting in February 2012, TREC testing transitioned to standard care throughout the Navajo Area Indian Health Service, and a total of 7900 infants were screened through July 2014. One infant had low TRECs and was diagnosed with non-SCID T lymphopenia, while 4 had undetectable TRECs due to SCID-A, all of whom were referred for hematopoietic cell transplantation. This report establishes the incidence of SCID-A and demonstrates effectiveness of TREC NBS in the Navajo.
Collapse
Affiliation(s)
- Antonia Kwan
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Diana Hu
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Miran Song
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Heidi Gomes
- Department of Pediatrics, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Denise R Brown
- Department of Pediatrics, Tuba City Regional Health Care Center, Tuba City, AZ 86045, USA
| | - Trudy Bourque
- Department of Pediatrics, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Diana Gonzalez-Espinosa
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Zhili Lin
- Research and Development, PerkinElmer Genetics, Inc., Bridgeville, PA 15017, USA
| | - Morton J Cowan
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA
| | - Jennifer M Puck
- Allergy Immunology and Blood and Marrow Transplant Division, Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco, San Francisco, CA 94143, USA.
| |
Collapse
|