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Neonatal screening program for congenital adrenal hyperplasia: adjustments to the recall protocol
L Gruñeiro-Papendieck1, L Prieto, A Chiesa
1Fundación de Endocrinología Infantil, Centro de Investigaciones Endocrinológicas CEDIE, División de Endocrinología Hospital de Niños R. Gutiérrez, Capital Federal, Argentina. protir@cedie.guti.gov.ar
Objective:
To evaluate the influence of gestational age (GA) and birth weight (BW) on 17 alpha-OH-progesterone (17-OHP) levels with respect to their impact on the recall rate of neonatal screening programs for congenital adrenal hyperplasia (CAH).
Patients And Methods:
In June 1997 we began a pilot screening program for CAH measuring 17-OHP using a fluoroimmunoassay method (DELFIA) on dried blood spots. Until September 1999, 24,153 babies were screened. Among them, we analyzed the levels of 17-OHP in 1,313 samples from healthy preterm babies (23-36 weeks) and 1,500 term babies (>37 weeks), grouped according to GA and BW. All preterm babies underwent another sampling in their 2nd week of life.
Results:
5 CAHs were detected. The 30-nmol/l cutoff limit for 17-OHP in blood corresponded to the calculated 99th percentile in term newborns, while in preterm babies higher levels were found. GA and BW correlated inversely with 17-OHP levels.
Conclusion:
GA and BW were useful tools to adjust cutoff levels, obtaining a significant reduction in follow-up testing and psychological stress for families. The high false-positive recall rate in preterm babies can be substantially lowered with adjusted GA and/or BW criteria.