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Romanelli Tavares VL, Mendonça RH, Toledo MS, Hadachi SM, Grindler CM, Zanoteli E, Marques W, Oliveira ASB, Breinis P, Morita MDPA, França MC. Integrated Approaches and Practical Recommendations in Patient Care Identified with 5q Spinal Muscular Atrophy through Newborn Screening. Genes (Basel) 2024; 15:858. [PMID: 39062637 PMCID: PMC11276409 DOI: 10.3390/genes15070858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
In recent years, significant progress has been made in 5q Spinal Muscular Atrophy therapeutics, emphasizing the importance of early diagnosis and intervention for better clinical outcomes. Characterized by spinal cord motor neuron degeneration, 5q-SMA leads to muscle weakness, swallowing difficulties, respiratory insufficiency, and skeletal deformities. Recognizing the pre-symptomatic phases supported by screening and confirmatory genetic tests is crucial for early diagnosis. This work addresses key considerations in implementing 5q-SMA screening within the Brazilian National Newborn Screening Program and explores Brazil's unique challenges and opportunities, including genetic tests, time-to-patient referral to specialized centers, program follow-up, and treatment algorithms. We aim to guide healthcare professionals and policymakers, facilitating global discussions, including Latin American countries, and knowledge-sharing on this critical subject to improve the care for newborns identified with 5q SMA.
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Affiliation(s)
| | - Rodrigo Holanda Mendonça
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo 05403-010, Brazil
| | - Maytê S. Toledo
- Newborn Screening Reference Center, Instituto Jô Clemente (IJC), São Paulo 04040-033, Brazil
| | - Sônia M. Hadachi
- Newborn Screening Reference Center, Instituto Jô Clemente (IJC), São Paulo 04040-033, Brazil
| | - Carmela M. Grindler
- Secretaria de Estado da Saúde (Governo do Estado de São Paulo), São Paulo 01027-000, Brazil
| | - Edmar Zanoteli
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo 05403-010, Brazil
| | - Wilson Marques
- Hospital das Clínicas da Faculdade de Medicina da USP de Ribeirão Preto (HC/FMUSP-RP, São Paulo), Ribeirão Preto 14015-010, Brazil
| | - Acary S. B. Oliveira
- Motor Neuron Disease Unit, Division of Neuromuscular Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo 04039-060, Brazil
| | - Paulo Breinis
- Faculdade de Medicina do ABC, Santo André 09060-870, Brazil
- Department of Pediatric Neurology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil
| | | | - Marcondes C. França
- Department of Neurology, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-888, Brazil
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Dias LR, Tomasi YT, Boing AF. The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019. J Pediatr (Rio J) 2024; 100:296-304. [PMID: 38169234 PMCID: PMC11065651 DOI: 10.1016/j.jped.2023.11.008] [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: 08/08/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. METHODS This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saúde (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. RESULTS In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. CONCLUSIONS The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.
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Affiliation(s)
- Letícia R Dias
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva (PPGSC), Florianópolis, SC, Brazil.
| | - Yaná T Tomasi
- Universidade do Estado de Santa Catarina (UDESC), Departamento de Enfermagem, Florianópolis, SC, Brazil
| | - Antonio F Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
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Pinel J, Bellanger A, Jamet C, Moreau C. Information and Parental Consent for French Neonatal Screening: A Qualitative Study on Parental Opinion. Int J Neonatal Screen 2023; 9:ijns9020026. [PMID: 37218891 DOI: 10.3390/ijns9020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Neonatal screening has excellent coverage in France. Data from the foreign literature raise questions about the informed consent to this screening. The Neonatal Screening and Informed Consent Dépistage Néonatal Information et Consentement Eclairé (DENICE) study was designed to assess whether information on neonatal screening provided for families in Brittany allows for informed consent. A qualitative methodology was chosen to collect parents' opinions on this topic. Twenty semi-structured interviews were conducted with twenty-seven parents whose children had positive neonatal screening for one of six diseases. The five main themes from the qualitative analysis were knowledge of neonatal screening, information received by parents, parental choice, the experience of the screening process, and parents' perspectives and wishes. Informed consent was weakened by parents' lack of knowledge regarding choice and the absence of a parent after birth. The study found that more information about screening during pregnancy would be preferable. The information should be repeated and accessible and should make it clear that neonatal screening is not mandatory, but informed consent should be obtained from parents who choose to screen their newborns.
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Affiliation(s)
- Julia Pinel
- Departement of Paediatrics, Rennes University Hospital, 35000 Rennes, France
| | - Amandine Bellanger
- Department of Neonatal Special Care, Rennes University Hospital, 35000 Rennes, France
| | - Carole Jamet
- Department of General Practice, Rennes University Hospital, 35000 Rennes, France
| | - Caroline Moreau
- Biochemistry and Toxicology Laboratory, Rennes University Hospital, 35000 Rennes, France
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Five-year performance analysis of a cystic fibrosis newborn screening program in northeastern Brazil. J Pediatr (Rio J) 2023; 99:23-30. [PMID: 35679883 PMCID: PMC9875232 DOI: 10.1016/j.jped.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To analyze the performance of the cystic fibrosis (CF) newborn screening (NBS) program over its first five years in a Brazilian northeastern state. METHOD A population-based study using a screening algorithm based on immunoreactive trypsinogen (IRT)/IRT. Data were retrieved from the state referral screening center registry. The program performance was evaluated using descriptive indicators such as the results of an active search, coverage, newborn's age at the time of blood sampling, the time between sample collection and its arrival at the laboratory, and the child's age at diagnosis of disease. RESULTS The public CF screening program covered 82.6% of the 1,017,576 births that occurred, with an accumulated five-year incidence of 1:20,767 live births. The median (25th-75th) age at diagnosis was 3.5 (2.3-7.3) months. The sampling before 7 days of life for the first IRT (IRT1) increased between 2013 and 2017 from 42.2 to 48.3%. Around 5% of IRT1 samples and 30% of the second samples were collected after 30 days of life. In the first and second stages of screening, 23.6% and 19.9% of the infants, respectively, were lost to follow-up. In both stages of screening, the samples were retained at the health units for a median (25th-75th) of 9.0 (7.0-13.0) days. CONCLUSIONS The coverage by the CF-NBS program was satisfactory as compared to other Brazilian state rates and the percentage of IRT1 samples collected within the first week of life increased progressively. However, time of samples retention at the health units, inappropriate sampling, inherent methodological problems, and loss of follow-up need to improve.
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Sadigurschi G, Vaz Micherino B, Assunção Mendes da Cunha MB, Antão Paiva CL, da Silva E Sá GR. Analysis of national coverage of neonatal cystic fibrosis screening in Brazil from 2008 to 2017. J Matern Fetal Neonatal Med 2021; 35:5204-5209. [PMID: 33491525 DOI: 10.1080/14767058.2021.1875443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Brazilian neonatal screening program established in 2001 included the investigation of cystic fibrosis (CF) in the phase III of the program. For this purpose, the immunoreactive trypsin (IRT) measurement was added to the newborn screening test. The purpose of National Neonatal Screening Program is to reach 100% of live births in Brazil. The aim of this study was to analyze the coverage of neonatal Screening for Cystic Fibrosis (CF) in Brazil from 2008 to 2017. MATERIALS AND METHODS This is an ecological study design based on data collected from the Brazilian Outpatient Information System regarding the detection of IRT as a component of the heel stick test from 2008 to 2017. Moreover, we gathered data from the Brazilian Live Birth Information System referring to live births from 2008 to 2017. We calculated the coverage of IRT measurement for every 100 live births, using the number of IRT measurement procedures as the numerator and the number of live births stratified by federative units (states), as well as by the Brazilian regions as the denominator. These regions correspond to the divisions of the national territory based on criteria such as natural, social, cultural and economic aspects. RESULTS From 2008 to 2017, the regions presented the following coverage medians: South (84.1%), Southeast (71.4%), Midwest (47.3%) Northeast (12.3%) and North (10.9%). In the analysis of federative units, in the years 2013 to 2017, Paraná and Distrito Federal presented the highest median of coverage (100%), while the states with the lowest median were Rio Grande do Norte (12.1%), Amazonas (16.8%) and Paraíba (27.5%). Highest coverage was found in the South region, where are located most of the states with high socioeconomic development and high supply of health services, while the lowest coverage was found in the North region, where are located manly the states with low socioeconomic development and low supply of health services. According to data from the Brazilian Ministry of Health, the universalization of neonatal screening for cystic fibrosis occurred in 2013, however, at the end of this year, most states in the North and Northeast regions had not registered IRT measurements in the Outpatient Information System. CONCLUSION Although the coverage of neonatal screening for CF has improved nationwide over the years of the study, the disparity in the coverage of IRT measurements at the interregional and interstate levels is notable. Systematic implementation of neonatal screening for cystic fibrosis with equity and access to the entire population is suggested, leading to a greater number of children benefiting from treatment and a better quality of life.
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Affiliation(s)
- Gabriela Sadigurschi
- Escola de Medicina e Cirurgia do Rio de Janeiro, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Vaz Micherino
- Escola de Medicina e Cirurgia do Rio de Janeiro, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Carmen Lucia Antão Paiva
- Programa de Pós Graduação em Biologia Molecular e Celular, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Buckley MMM, Aguilar LB, Lainez RC, Valenzuela HJA, Ponce F, Melo DG. Neonatal screening program for five conditions in Honduras. J Community Genet 2021; 12:389-395. [PMID: 33462772 DOI: 10.1007/s12687-021-00506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
We present the initial results of a neonatal screening program in part of the public health system in Honduras, that is, the Honduran Social Security Institute. The program design includes steps from neonatal bloodspot in the first newborn days to evaluation and treatment when necessary. In 2018 and 2019, 19,911 newborns were tested for hypothyroidism, cystic fibrosis, galactosemia, phenylketonuria, and adrenal hyperplasia. Abnormalities were identified in 18 newborns, corresponding to a prevalence of 9:10,000. Considering all births in Honduras, the estimated coverage of screening ranged between 4.4 and 5.7%. These results reinforce the need to expand and consolidate neonatal screening.
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Affiliation(s)
| | - Lindsay Borjas Aguilar
- Immunology Laboratory, Department of Clinical Laboratory, Hospital Escuela, Tegucigalpa, Honduras
| | - Rosibel Colindres Lainez
- Clinical Analysis Laboratory, Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, Honduras
| | | | - Fernando Ponce
- Statistics Department, Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, Honduras
| | - Débora Gusmão Melo
- Postgraduate Nursing Program, Federal University of São Carlos (UFSCar), São Paulo, Brazil. .,Department of Medicine, Federal University of São Carlos (UFSCar), São Paulo, Brazil. .,Departamento de Medicina, Campus da UFSCar, Rod. Washington Luís (SP-310), Km 235, São Carlos, SP, CEP 13565-905, Brasil.
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Mallmann MB, Tomasi YT, Boing AF. Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mallmann MB, Tomasi YT, Boing AF. Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities. J Pediatr (Rio J) 2020; 96:487-494. [PMID: 31009617 PMCID: PMC9432296 DOI: 10.1016/j.jped.2019.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/20/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify the prevalence and associated factors with the performance of the Guthrie test, hearing, and red reflex screening tests in Brazil. METHODS This was a population-based, cross-sectional study that analyzed data on 5,231 children under 2 years of age participating in the National Health Survey of 2013. The study described the prevalence and Confidence Intervals (95% CI) of the three neonatal screening tests performed, in any period, and their association with the country's regions, skin color/ethnicity, private health insurance, and per capita household income. Logistic regression models were used, and odds ratios were calculated by incorporating sample weights. RESULTS The prevalence of Guthrie test screening in Brazil at any time of life was 96.5%, that of the newborn hearing screening was 65.8% and that of the red reflex screening test was 60.4%. The performance of the three screening tests was significantly higher among children whose mothers/guardians reported higher per capita household income, who lived in the South and Southeast regions, and who had private health insurance (p<0.001). There was no statistically significant difference regarding the performance of the tests according to skin color/ethnicity (p>0.05). The same inequalities were verified when the tests were performed during the recommended periods, with a strong socioeconomic gradient. CONCLUSIONS There are inequalities in the performance of neonatal screening tests in the country, and also in the performance of these tests during the periods established in the governmental guidelines. The guarantee of the performance of these tests in a universal and public health system, as in Brazil, should promote equity and access to the entire population.
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Affiliation(s)
- Mariana B Mallmann
- Universidade Federal de Santa Catarina (UFSC), Faculdade de Medicina, Florianópolis, SC, Brazil
| | - Yaná T Tomasi
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil.
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Howson CP, Cedergren B, Giugliani R, Huhtinen P, Padilla CD, Palubiak CS, Santos MD, Schwartz IVD, Therrell BL, Umemoto A, Wang J, Zeng X, Zhao X, Zhong N, McCabe ERB. Universal newborn screening: A roadmap for action. Mol Genet Metab 2018; 124:177-183. [PMID: 29884465 DOI: 10.1016/j.ymgme.2018.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
Newborn screening (NBS) prevents morbidity and mortality by screening babies for selected disorders in the first days of life so that early diagnosis and treatment can be initiated. Congenital disorders impact an estimated 8 million or 6% of annual births worldwide, and of the top five that contribute 25% to the global burden of these disorders, three can be identified and managed by NBS. There are determined pockets of activity in Latin America, Sub-Saharan Africa, and the Asia Pacific region, where partnerships among government, non-governmental organizations, academia, the private sector and civil society are developing novel NBS programs that are both saving lives and preventing disability in those who survive.
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Affiliation(s)
- C P Howson
- Howson & Partners for Global Health, Santa Fe, NM, USA.
| | - B Cedergren
- Evans School of Public Policy & Governance, University of Washington, Seattle, WA, USA
| | - R Giugliani
- Medical Genetics Service, HCPA, Brazil; Department of Genetics, UFRGS, Porto Alegre, Brazil
| | - P Huhtinen
- International Society for Neonatal Screening (ISNS), Turku, Finland
| | - C D Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila, Philippines
| | | | - M D Santos
- PerkinElmer Diagnostics, Inc., São Paulo, SP, Brazil
| | - I V D Schwartz
- Medical Genetics Service, HCPA, Brazil; Department of Genetics, UFRGS, Porto Alegre, Brazil
| | - B L Therrell
- National Newborn Screening and Global Resource Center (NNSGRC), University of Texas Health Science Center at San Antonio, Austin, TX, USA
| | - A Umemoto
- Westchester Children's Association, White Plains, NY, USA
| | - J Wang
- China Alliance of Translational Medicine for Maternal and Children Health, Hainan Provincial Hospital for Maternal and Children's Health, Haikou, China
| | - X Zeng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Zhao
- Peking University Center of Medical Genetics, China Alliance of Translational Medicine for Maternal and Children Health, Beijing, China
| | - N Zhong
- Southern Medical University, Guangzhou, China; China Alliance of Translational Medicine for Maternal and Children Health, Beijing, China; New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - E R B McCabe
- Department of Pediatrics, UCLA School of Medicine, Los Angeles, CA, USA
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Silva CDA, Baldim LB, Nhoncanse GC, Estevão IDF, Melo DG. [Neonatal screening for hemoglobinopathies in São Carlos, São Paulo, Brazil: analysis of a series of cases]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:19-27. [PMID: 25623728 PMCID: PMC4436952 DOI: 10.1016/j.rpped.2014.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE: To analyze the neonatal screening program for hemoglobinopathies in São Carlos,
Southeast Brazil, by investigating a series of cases in which the screening test
was abnormal. More specifically, it was aimed to know the information regarding
the neonatal screening received by mothers at the hospital and at primary health
care, in addition to information related to genetic counseling. METHODS: A descriptive study that enrolled 119 mothers, accounting for 73% of all children
born between 2010 and 2011 with abnormal results of neonatal screening for
hemoglobinopathies. The mothers completed a questionnaire that assessed the
information received at hospital and primary health care, and issues related to
genetic counseling. Descriptive statistics was performed. RESULTS: Of the 119 participating mothers, 69 (58%) had children with sickle cell trait,
22 (18.5%) with hemoglobin C trait, 18 (15.1%) with alpha thalassemia trait and,
in 10 cases (8.4%), the result was inconclusive. At the hospital, 118 mothers
(99.2%) received information about where to go to collect the test and 115 (96.6%)
were informed about the correct time to collect the test. Only 4 mothers (3.4%)
were informed about which diseases are investigated and the risks of not
performing the screening. Seventeen mothers (14.3%) recognized the difference
between trait and disease, and 42 (35.3%) considered that a positive screening
test could have implications for future pregnancies. In 70 cases (58.8%), the
child's physician was not informed about the screening test results. CONCLUSIONS: The neonatal screening program needs further improvement. In both scenarios
investigated, health professionals demonstrated a lack of training in providing
information to mothers and families.
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Soares ACN, Samico IC, Araújo AS, Bezerra MAC, Hatzlhofer BLD. Follow-up of children with hemoglobinopathies diagnosed by the Brazilian Neonatal Screening Program in the State of Pernambuco. Rev Bras Hematol Hemoter 2014; 36:250-5. [PMID: 25031163 PMCID: PMC4207915 DOI: 10.1016/j.bjhh.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/14/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the geographical distribution of hemoglobinopathies in the State of Pernambuco, to characterize the children with these diseases and to describe factors associated with their follow-up at the referral center during the period from 2003 to 2010. METHODS A retrospective, cross-sectional, descriptive study was carried out of 275 medical records from a total of 302 children with hemoglobinopathies diagnosed by the National Neonatal Screening Program in the State of Pernambuco in the study period. Microsoft Excel was used for data processing and analysis. The chi-square and the Fisher test were used for statistical analysis. The level of significance was set at 5%. Terra View software was used to analyze the geographical distribution of hemoglobinopathies in the State. RESULTS A total of 8.9% of the cases of hemoglobinopathies detected in the period were not followed up at the referral center. For the mothers of children with diseases, this was their second or third or more pregnancy in 64.2% and 30.2%, respectively. Regarding the influence of region of residence and regular medical appointments, the study demonstrated that children from the Zona da Mata, Sertão and Vale do São Francisco regions did not attend 45.2%, 50% and 55.6% of their appointments in the outpatient department, respectively. CONCLUSIONS This study shows that a significant number of children do not begin consultations in the outpatient clinic and even those who started treatment early and who have the most severe form of the disease, usually miss medical appointments.
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Affiliation(s)
| | | | - Aderson Silva Araújo
- Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE, Brazil
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da Fonseca SF. National neonatal screening program for hemoglobinopathies: how far have we advanced? Rev Bras Hematol Hemoter 2014; 36:243-4. [PMID: 25031161 PMCID: PMC4207923 DOI: 10.1016/j.bjhh.2014.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Barbosa CP, Griz SMS. Educação em saúde com vistas à triagem neonatal e audição: uma revisão integrativa. REVISTA CEFAC 2014. [DOI: 10.1590/1982-0216201413012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste trabalho foi investigar estudos sobre educação em saúde e capacitação que abordassem o tema triagem neonatal e/ou audição. Trata-se de uma revisão integrativa, realizada em agosto de 2011, com busca na Biblioteca Virtual em Saúde, a partir dos Descritores em Ciências da Saúde: “Audição”;, “Capacitação”;, “Educação em Saúde”; e “Triagem Neonatal”;. A amostra final constituiu-se por 10 estudos. A base de dados com maior número de artigos foi a Medline e a maioria dos artigos (n=07) foi classificado com nível de evidência três. Nesta revisão integrativa, pode-se observar o quão é interessante adotar as estratégias de educação em saúde e/ou capacitação nos serviços de saúde como uma forma de educação permanente ou continuada. A população mais frequentemente estudada foi mães/pais e médicos. Ações educativas podem empoderar a população em relação à audição, englobando aspectos sobre a Triagem Auditiva Neonatal e seus procedimentos.
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Mendes LC, Santos TTD, Bringel FDA. [Evolution of the neonatal screening program in the state of Tocantins]. ACTA ACUST UNITED AC 2014; 57:112-9. [PMID: 23525288 DOI: 10.1590/s0004-27302013000200003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/01/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the Neonatal Screening Program in the State of Tocantins from 1995 to 2011. MATERIALS AND METHODS Data collection was conducted by means of interviews with those responsible for the service, by the analysis of medical records of patients diagnosed with phenylketonuria (PKU) and congenital hypothyroidism (CH) that were enrolled in the program, and by interviews with parents and/or guardians of the patients monitored. RESULTS Program coverage increased from 32.3% to 76.6% after the implementation of the National Newborn Screening Program (PNTN). The prevalence of PKU and CH was 1:28,309 and 1:4,632 live births, respectively. The mean ages at the collection of the first blood sample (PKU: 9.6 ± 6.3 days; CH: 13.3 ± 10.3 days) and at the beginning of the treatment (PKU: 57.0 ± 17.6 days; CH: 95,6 ± 57.6 days) were greater than recommended by the Ministry of Health. The quality of monitoring was considered satisfactory by 100% of the parents. CONCLUSION Although there have been great developments in neonatal screening program in this state, there is need for greater government incentives to optimize the program and to make the PNTN advance to its next phases.
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Affiliation(s)
- Lucas Corrêa Mendes
- Faculdade de Ciências Humanas, Econômicas e da Saúde de Araguaína, Instituto Tocantinense Presidente Antônio Carlos (FAHESA/ITPAC), Araguaína, TO, Brasil
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15
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Botler J, Camacho LAB, Cruz MMD. [Performance analysis of the Rio de Janeiro State Neonatal Screening Program, 2005-2007]. CAD SAUDE PUBLICA 2012; 27:2419-28. [PMID: 22218584 DOI: 10.1590/s0102-311x2011001200013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 08/22/2011] [Indexed: 11/22/2022] Open
Abstract
Guidelines emphasize that the appropriate time frame for neonatal screening with the heel stick test is from the 3rd to 7th day of life, in 100% of newborns. Treatment for congenital hypothyroidism and phenylketonuria, when initiated in the first two weeks of life, is capable of preventing the neurological sequelae of these diseases. The Rio de Janeiro State Neonatal Screening Program was accredited for Phase 2 of the National Neonatal Screening Program, with two program models (A and B). A performance analysis was conducted for the Neonatal Screening Program, for the years 2005 to 2007. Coverage increased from 2002 to 2007, reaching 80.4%, with 33.8% of the blood samples drawn in the first 7 days of life. The two models showed similar performance, short of the targets, with 50% of the confirmed cases receiving their diagnosis at more than 48 days of life. The delays accumulated in the various stages of the process can impede the benefits of early detection, the cornerstone of neonatal screening. The deleterious long-term effects transcend the individual sphere, with an impact on the health system and a major social burden.
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Affiliation(s)
- Judy Botler
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, Brazil.
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16
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Guedes C. [Reproductive decisions and newborn screening: the perspective of female caregivers of children with sickle cell disease]. CIENCIA & SAUDE COLETIVA 2012; 17:2367-76. [PMID: 22996887 DOI: 10.1590/s1413-81232012000900017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 04/06/2012] [Indexed: 11/22/2022] Open
Abstract
One of the goals of the Brazilian Newborn Screening Program created in 2001 was to inform couples with the possibility of having children with sickle cell diseases regarding reproductive decision-making. This article presents the reproductive choices and analyzes the notion of biomedical reproductive risk of female caregivers of children with sickle cell disease participating in a newborn screening program. Qualitative data collected between 2006 and 2008 was based on interviews with 50 female caregivers of children with sickle cell disease participating on the Federal District Newborn Screening Program. The research revealed the following perceptions underlying reproductive decisions: women who want to have other children even with the risk of recurrence of the disease; women who do not want to have any more children; and women whose reproductive plans are still being considered on the basis of the information provided by the newborn screening program. The study revealed that women's reproductive choices are based on the experience of child care and self care. The notion of reproductive risk is built in order to strengthen women's decisions together with their family and other social groups to which they belong.
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Affiliation(s)
- Cristiano Guedes
- Universidade de Brasília, Caixa Postal 8011, Setor Sudoeste, 70673-970 Brasilia DF.
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17
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Botler J, Camacho LAB, Cruz MMD. Phenylketonuria, congenital hypothyroidism and haemoglobinopathies: public health issues for a Brazilian newborn screening program. CAD SAUDE PUBLICA 2012; 28:1623-31. [DOI: 10.1590/s0102-311x2012000900002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 06/25/2012] [Indexed: 11/22/2022] Open
Abstract
In this study, the frequency of detected congenital hypothyroidism, phenylketonuria and haemoglobinopathies in the State of Rio de Janeiro's (Brazil) Newborn Screening Program (NBSP) was analyzed between the years of 2005 and 2007. There were two Newborn Screening Reference Centers (named NSRC A and B) with programmatic differences. In 2007, overall detection coverage reached 80.7%. The increase in the incidence of congenital hypothyroidism (1:1,030 in 2007) was attributed to the reduction of neonatal TSH value limits over time. The incidence discrepancy of phenylketonuria between NSRC A (1:28,427) and B (1:16,522) might be partially explained by the small number of cases. The incidence of sickle cell disease and its traits were uniformly high (1:1,288 and 1:21, respectively). This was coherent with the ethnic composition of the population. The differences in laboratory methods and critical values, in addition to other programmatic issues, may explain the variances in the results and limited analysis of the role of biological and environmental determinants in the occurrence of these diseases.
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18
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Vieira Neto E, Fonseca AA, Almeida RF, Figueiredo MP, Porto MAS, Ribeiro MG. Analysis of acylcarnitine profiles in umbilical cord blood and during the early neonatal period by electrospray ionization tandem mass spectrometry. Braz J Med Biol Res 2012; 45:546-56. [PMID: 22488223 PMCID: PMC3854303 DOI: 10.1590/s0100-879x2012007500056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/21/2012] [Indexed: 11/22/2022] Open
Abstract
Acylcarnitine profiling by electrospray ionization tandem mass spectrometry (ESI-MS/MS) is a potent tool for the diagnosis and screening of fatty acid oxidation and organic acid disorders. Few studies have analyzed free carnitine and acylcarnitines in dried blood spots (DBS) of umbilical cord blood (CB) and the postnatal changes in the concentrations of these analytes. We have investigated these metabolites in healthy exclusively breastfed neonates and examined possible effects of birth weight and gestational age. DBS of CB were collected from 162 adequate for gestational age neonates. Paired DBS of heel-prick blood were collected 4-8 days after birth from 106 of these neonates, the majority exclusively breastfed. Methanol extracts of DBS with deuterium-labeled internal standards were derivatized before analysis by ESI-MS/MS. Most of the analytes were measured using a full-scan method. The levels of the major long-chain acylcarnitines, palmitoylcarnitine, stearoylcarnitine, and oleoylcarnitine, increased by 27, 12, and 109%, respectively, in the first week of life. Free carnitine and acetylcarnitine had a modest increase: 8 and 11%, respectively. Propionylcarnitine presented a different behavior, decreasing 9% during the period. The correlations between birth weight or gestational age and the concentrations of the analytes in DBS were weak (r ≤ 0.20) or nonsignificant. Adaptation to breast milk as the sole source of nutrients can explain the increase of these metabolites along the early neonatal period. Acylcarnitine profiling in CB should have a role in the early detection of metabolic disorders in high-risk neonates.
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Affiliation(s)
- E Vieira Neto
- Serviço de Genética Médica, Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Brasil.
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Abreu IS, Braguini WL. Triagem neonatal: o conhecimento materno em uma maternidade no interior do Paraná, Brasil. Rev Gaucha Enferm 2011; 32:596-601. [DOI: 10.1590/s1983-14472011000300023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo transversal, quantitativo, realizado no Alojamento Conjunto de um hospital de médio porte, no interior do Paraná do qual fizeram parte 40 puérperas maiores de 18 anos. Teve como objetivo analisar o conhecimento desta população sobre a finalidade e importância da realização do "teste do pezinho" e caracterizá-la sócio-demograficamente. Os dados foram coletados em maio e junho de 2010, através de um questionário semi-estruturado elaborado e aplicado pelos próprios pesquisadores. A finalidade da triagem neonatal era conhecida por 65% (n=26) das participantes, observando-se que a maioria conhecia a finalidade e sabia sobre a importância da realização do "teste do pezinho", fato este que denota a importância das orientações que devem ser dispensadas a estas mães sobre o referido assunto, mesmo antes do nascimento do bebê, com enfoque ainda no pré-natal, destacando-se a importância do papel do enfermeiro neste contexto.
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