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Knöpfli S, Goeschl B, Zeyda M, Baghdasaryan A, Baumgartner-Kaut M, Baumgartner MR, Herle M, Margreitter J, Poms M, Wortmann SB, Konstantopoulou V, Huemer M. The Benefit of Detecting Reduced Intracellular B12 Activity through Newborn Screening Remains Unclear. Int J Neonatal Screen 2024; 10:40. [PMID: 38920847 PMCID: PMC11203543 DOI: 10.3390/ijns10020040] [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: 05/12/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
Vitamin B12 (B12) deficiency (B12D) can have detrimental effects on early growth and development. The Austrian newborn screening (NBS) program targets inborn errors of cobalamin metabolism and also detects B12D. Of 59 included neonates with B12D suspected by NBS, B12D was not further investigated in 16 (27%) retrospectively identified cases, not confirmed in 28 (48%), and confirmed in 15 (25%) cases. NBS and recall biomarkers were recorded. Age at sampling of the dried blood spots for NBS and the 1st-tier methionine/phenylalanine ratio were the strongest parameters to predict B12D (67.4% correct allocations). No differences between cases with confirmed, unconfirmed, or unknown B12D or differences to norms were observed for growth and psychomotor development (Vineland III scales, phone interviews with parents of children between months 10 and 14 of life). B12 intake was below recommendations in most mothers. NBS can detect reduced intracellular B12 activity. No advantage of NBS detection and treatment regarding infant cognitive development or growth could be proven. Since conspicuous NBS findings cannot be ignored, and to prevent exposing newborns to invasive diagnostics, assessment of maternal B12 status during pregnancy seems advisable.
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Affiliation(s)
- Stella Knöpfli
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
| | - Bernadette Goeschl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Maximilian Zeyda
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Anna Baghdasaryan
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Margot Baumgartner-Kaut
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias R. Baumgartner
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
- Newborn Screening Switzerland, Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Julian Margreitter
- Department of Child and Adolescent Health, Division of Pediatrics I—Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Poms
- Newborn Screening Switzerland, Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Division of Clinical Chemistry and Biochemistry, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Saskia B. Wortmann
- University Children’s Hospital, Salzburger Landeskliniken and Paracelsus Medical University, 5020 Salzburg, Austria
| | - Vassiliki Konstantopoulou
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Martina Huemer
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
- Department of Pediatrics, LKH Bregenz, 6900 Bregenz, Austria
- Vorarlberg University of Applied Sciences, Competence Area Healthcare and Nursing, 6850 Dornbirn, Austria
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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [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: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Deleanu C, Nicolescu A. NMR Spectroscopy in Diagnosis and Monitoring of Methylmalonic and Propionic Acidemias. Biomolecules 2024; 14:528. [PMID: 38785935 PMCID: PMC11117674 DOI: 10.3390/biom14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Although both localized nuclear magnetic resonance spectroscopy (MRS) and non-localized nuclear magnetic resonance spectroscopy (NMR) generate the same information, i.e., spectra generated by various groups from the structure of metabolites, they are rarely employed in the same study or by the same research group. As our review reveals, these techniques have never been applied in the same study of methylmalonic acidemia (MMA), propionic acidemia (PA) or vitamin B12 deficiency patients. On the other hand, MRS and NMR provide complementary information which is very valuable in the assessment of the severity of disease and efficiency of its treatment. Thus, MRS provides intracellular metabolic information from localized regions of the brain, while NMR provides extracellular metabolic information from biological fluids like urine, blood or cerebrospinal fluid. This paper presents an up-to-date review of the NMR and MRS studies reported to date for methylmalonic and propionic acidemias. Vitamin B12 deficiency, although in most of its cases not inherited, shares similarities in its metabolic effects with MMA and it is also covered in this review.
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Affiliation(s)
- Calin Deleanu
- “Costin D. Nenitescu” Institute of Organic and Supramolecular Chemistry, Spl. Independentei 202-B, RO-060023 Bucharest, Romania
- “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41-A, RO-700487 Iasi, Romania
| | - Alina Nicolescu
- “Costin D. Nenitescu” Institute of Organic and Supramolecular Chemistry, Spl. Independentei 202-B, RO-060023 Bucharest, Romania
- “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41-A, RO-700487 Iasi, Romania
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Wirthensohn M, Wehrli S, Ljungblad UW, Huemer M. Biochemical, Nutritional, and Clinical Parameters of Vitamin B12 Deficiency in Infants: A Systematic Review and Analysis of 292 Cases Published between 1962 and 2022. Nutrients 2023; 15:4960. [PMID: 38068819 PMCID: PMC10708449 DOI: 10.3390/nu15234960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Pooled data from published reports on infants with clinically diagnosed vitamin B12 (B12) deficiency were analyzed with the purpose of describing the presentation, diagnostic approaches, and risk factors for the condition to inform prevention strategies. An electronic (PubMed database) and manual literature search following the PRISMA approach was conducted (preregistration with the Open Science Framework, accessed on 15 February 2023). Data were described and analyzed using correlation analyses, Chi-square tests, ANOVAs, and regression analyses, and 102 publications (292 cases) were analyzed. The mean age at first symptoms (anemia, various neurological symptoms) was four months; the mean time to diagnosis was 2.6 months. Maternal B12 at diagnosis, exclusive breastfeeding, and a maternal diet low in B12 predicted infant B12, methylmalonic acid, and total homocysteine. Infant B12 deficiency is still not easily diagnosed. Methylmalonic acid and total homocysteine are useful diagnostic parameters in addition to B12 levels. Since maternal B12 status predicts infant B12 status, it would probably be advantageous to target women in early pregnancy or even preconceptionally to prevent infant B12 deficiency, rather than to rely on newborn screening that often does not reliably identify high-risk children.
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Affiliation(s)
- Miriam Wirthensohn
- Department of Pediatrics, Landeskrankenhaus Bregenz, 6900 Bregenz, Austria
| | - Susanne Wehrli
- Department of Psychosomatics and Psychiatry, University Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- University Research Priority Program “ITINERARE—Innovative Therapies in Rare Diseases”, University of Zurich, 8032 Zurich, Switzerland
| | - Ulf Wike Ljungblad
- Department of Pediatrics, Vestfold Hospital Trust, NO-3168 Tønsberg, Norway
| | - Martina Huemer
- Department of Pediatrics, Landeskrankenhaus Bregenz, 6900 Bregenz, Austria
- Division of Metabolism and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Vorarlberg University of Applied Sciences, Competence Area Healthcare and Nursing, 6850 Dornbirn, Austria
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