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Patel S, Verma N, Padhi P, Shah S, Nanda R, Mohapatra E. An Approach to Re-evaluate the Reference Cutoff of the Parameters of Newborn Screening: An Observational Study. Cureus 2023; 15:e45139. [PMID: 37842412 PMCID: PMC10570011 DOI: 10.7759/cureus.45139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Unless a cutoff level of the parameters of newborn screening (NBS) is defined, a screening test's results would end in high recall rates and apprehensive parents. The study aimed to establish a cutoff level of the healthy term newborns. Materials and methods The study was a retrospective observational data analysis on a cohort of 1158 term newborns who underwent NBS in our institute. The percentile distribution of the NBS parameters was computed and the 99th percentile value was considered the new cutoff. For lower values, such as neonatal glucose 6-phosphate dehydrogenase (nG6PD) and neonatal biotinidase (nBIOT), low percentile values were regarded as new cutoff value. Results Neonatal thyroid stimulating hormone (nTSH), nG6PD, neonatal immunoreactive trypsinogen (nIRT), and nBIOT showed a wide variation in the distribution. Most newborns had neonatal galactose (nGAL), nIRT, and nBIOT values above the median. The 99th percentile value of nTSH was 14.5 mIU/L, and that of neonatal 17-hydroxyprogesterone (n17-OHP) was 43.7 nmol/L. The 1.0th percentile value for nG6PD was decreased to 2.18 IU/gHb. The new cutoff values for nBIOT, nIRT, neonatal phenylketonuria (nPKU) and nGAL were 48.59 U, 95.3 µg/L, 2.3 mg/dL and 15.9 mg/dL. The mean and median nTSH values did not significantly differ (p=0.99) in the first five days of birth. On the contrary, the study population depicted considerably raised levels of n17-OHP on day 3, followed by a sharp decrease (p=0.029). Similarly, nIRT displayed significant differences in the first five days (p=0.017). Conclusion Using the 99th percentile values of the NBS parameters as the new cutoff levels might be beneficial in terms of the recall rates and cost burden.
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Affiliation(s)
- Suprava Patel
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Neharani Verma
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Phalguni Padhi
- Neonatology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Seema Shah
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Rachita Nanda
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Eli Mohapatra
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Xue A, Lénárt I, Kincs J, Szabó H, Párniczky A, Balogh I, Deák A, Monostori PB, Hegedűs K, Szabó AJ, Szatmári I. Neonatal Screening for Cystic Fibrosis in Hungary-First-Year Experiences. Int J Neonatal Screen 2023; 9:47. [PMID: 37754773 PMCID: PMC10531581 DOI: 10.3390/ijns9030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/28/2023] Open
Abstract
The aim of this study is to evaluate the strategy of the cystic fibrosis newborn screening (CFNBS) programme in Hungary based on the results of the first year of screening. A combined immunoreactive trypsinogen (IRT) and pancreatitis-associated protein (PAP) CFNBS protocol (IRT/IRT×PAP/IRT) was applied with an IRT-dependent safety net (SN). Out of 88,400 newborns, 256 were tested screen-positive. Fourteen cystic fibrosis (CF) and two cystic fibrosis-positive inconclusive diagnosis (CFSPID) cases were confirmed from the screen-positive cases, and two false-negative cases were diagnosed later. Based on the obtained results, a sensitivity of 88% and a positive predictive value (PPV) of 5.9% were calculated. Following the recognition of false-negative cases, the calculation method of the age-dependent cut-off was changed. In purely biochemical CFNBS protocols, a small protocol change, even after a short period, can have a significant positive impact on the performance. CFNBS should be monitored continuously in order to fine-tune the screening strategy and define the best local practices.
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Affiliation(s)
- Andrea Xue
- Paediatric Centre, MTA Centre of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - István Lénárt
- Department of Paediatrics, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary
| | - Judit Kincs
- Paediatric Centre, MTA Centre of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Hajnalka Szabó
- Department of Paediatrics, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary
| | | | - István Balogh
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Anna Deák
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Péter Béla Monostori
- Department of Paediatrics, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary
| | - Krisztina Hegedűs
- Paediatric Centre, MTA Centre of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Attila J. Szabó
- Paediatric Centre, MTA Centre of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Ildikó Szatmári
- Paediatric Centre, MTA Centre of Excellence, Semmelweis University, 1083 Budapest, Hungary
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Impact of Pancreatitis-Associated Protein on Newborn Screening Outcomes and Detection of CFTR-Related Metabolic Syndrome (CRMS)/Cystic Fibrosis Screen Positive, Inconclusive Diagnosis (CFSPID): A Monocentric Prospective Pilot Experience. Int J Neonatal Screen 2022; 8:ijns8030046. [PMID: 35997436 PMCID: PMC9397086 DOI: 10.3390/ijns8030046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 01/14/2023] Open
Abstract
Pancreatitis-Associated Protein (PAP)-based Cystic Fibrosis (CF) newborn bloodspot screening (NBS) protocols detect less CFTR-Related Metabolic Syndrome (CRMS)/CF Screen Positive, Inconclusive Diagnosis (CFSPID). We prospectively evaluated the impact of PAP as the second step of the CF NBS protocol, before the CFTR genetic analysis, on NBS outcomes and CRMS/CFSPID detection in the Tuscany region, Italy. In parallel to the usual protocol (IRT/DNA, protocol 1), PAP was analyzed in IRT-positive infants (IRT/PAP/DNA, protocol 2) from 1 June 2020 until 31 May 2022. We defined an infant as NBS positive if PAP was >1.8 μg/L for IRT value 99th percentile-100 μg/L or >0.6 μg/L for IRT value >100 μg/L. To increase the positive predictive value (PPV) of protocol 2, we retrospectively lowered the upper IRT range value from 100 to 90 μg/L (modified protocol 2). We identified 8 CF and 13 CRMS/CFSPID with protocol 1, 5 CF and 5 CRMS/CFSPID with protocol 2 and 8 CF and 5 CRMS/CFSPID with modified protocol 2. With the PAP-based protocols, we observed a reduction of sweat tests, healthy carrier detection and a significant increase in PPV to 15.38%. Further data are needed in order to evaluate the outcomes of CRMS/CFSPID after a long follow-up.
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