Inconclusive Diagnosis of Cystic Fibrosis After Newborn Screening
| Autor: | Louise Taylor, Kylie-Ann Malitt, Sonia Volpi, Richard van Wylick, Melinda Solomon, Peter R. Durie, April Price, Margaret Boland, Steven Kent, Candice Bjornson, Tanja Gonska, Carlo Castellani, Tom Kovesi, Felix Ratjen, Katherine Keenan, Lenna Morgan, Julie Avolio, Chee Y. Ooi, Karen Tam, Mark A. Chilvers |
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| Rok vydání: | 2015 |
| Předmět: |
Newborn screening
medicine.medical_specialty Pathology medicine.diagnostic_test biology business.industry Trypsinogen medicine.disease biology.organism_classification Cystic fibrosis Gastroenterology chemistry.chemical_compound Stenotrophomonas maltophilia chemistry Interquartile range Internal medicine Pediatrics Perinatology and Child Health Genotype Medicine Immunoreactive trypsinogen business Sweat test |
| Zdroj: | PEDIATRICS. 135:e1377-e1385 |
| ISSN: | 1098-4275 0031-4005 |
| Popis: | OBJECTIVES: To prospectively study infants with an inconclusive diagnosis of cystic fibrosis (CF) identified by newborn screening (NBS; “CF screen positive, inconclusive diagnosis” [CFSPID]) for disease manifestations. METHODS: Infants with CFSPID and CF based on NBS from 8 CF centers were prospectively evaluated and monitored. Genotype, phenotype, repeat sweat test, serum trypsinogen, and microbiology data were compared between subjects with CF and CFSPID and between subjects with CFSPID who did (CFSPID→CF) and did not (CFSPID→CFSPID) fulfill the criteria for CF during the first 3 years of life. RESULTS: Eighty-two subjects with CFSPID and 80 subjects with CF were enrolled. The ratio of CFSPID to CF ranged from 1:1.4 to 1:2.9 in different centers. CFTR mutation rates did not differ between groups; 96% of subjects with CFSPID and 93% of subjects with CF had 2 mutations. Subjects with CFSPID had significantly lower NBS immunoreactive trypsinogen (median [interquartile range]:77 [61–106] vs 144 [105–199] μg/L; P Pseudomonas aeruginosa and Stenotrophomonas maltophilia were isolated in 12% and 5%, respectively, of subjects with CFSPID. CF was diagnosed in 9 of 82 (11%) subjects with CFSPID (genotype and abnormal sweat chloride = 3; genotype alone = 4; abnormal sweat chloride only = 2). Sweat chloride was abnormal in CFSPID→CF patients at a mean (SD) age of 21.3 (13.8) months. CFSPID→CF patients had significantly higher serial sweat chloride ( P P = .009) levels than did CFSPID→CFSPID patients. CONCLUSIONS: A proportion of infants with CFSPID will be diagnosed with CF within the first 3 years. These findings underscore the need for clinical monitoring, repeat sweat testing at age 2 to 3 years, and extensive genotyping. |
| Databáze: | OpenAIRE |
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