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Published on: January 22, 2021
Early diagnosis from newborn screening maximises survival in severe cystic fibrosis
Gloria Tridello1, Carlo Castellani1,2, Ilaria Meneghelli1
1Centre for Cystic Fibrosis, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Insights
Newborn screening for cystic fibrosis (CF) significantly improves long-term survival. Early detection through CF newborn screening leads to better outcomes, especially for infants with severe symptoms.
Area of Science:
- Medical Genetics
- Pediatrics
- Public Health
Background:
- Newborn screening (NBS) for cystic fibrosis (CF) is increasingly implemented globally.
- Limited data exist on the long-term survival impact of CF NBS.
- Early diagnosis is crucial for managing CF progression.
Purpose of the Study:
- To evaluate the long-term effects of cystic fibrosis newborn screening on patient survival.
- To compare survival rates between patients diagnosed via NBS and those diagnosed symptomatically.
- To assess the impact of NBS on different severity groups.
Main Methods:
- Retrospective analysis of 586 patients diagnosed and followed between 1971 and 2014.
- Categorization of patients into NBS, meconium ileus, and symptomatic diagnosis groups.
- Grouping based on initial hospitalizations (mild, moderate, severe) to assess long-term outcomes.
Main Results:
- The 30-year survival probability for the NBS group was 80.1%, compared to 71.0% for the symptomatic group.
- Significantly higher 20-year survival rates were observed in the NBS group versus the symptomatic group for severe (85% vs. 64%) and moderate (94% vs. 86%) cases.
- Cox-model analysis confirmed the survival benefits associated with NBS.
Conclusions:
- Newborn screening for cystic fibrosis demonstrates a positive long-term impact on overall survival.
- NBS effectively mitigates the poorer outcomes associated with early, severe CF presentations.
- Implementing CF NBS is crucial for improving long-term prognosis in affected children.
Abstract:
Newborn screening (NBS) for cystic fibrosis (CF) has been gradually established in several countries, but scant data are available on its long-term effects on survival. Our objective was to evaluate the long-term effects of CF NBS on survival. 586 patients, diagnosed and followed between 1971 and 2014 at the Verona CF Centre were analysed. Eligibility was confirmed in 342 cases diagnosed by NBS, 101 with meconium ileus and 143 through symptoms (44 out of 143 were NBS false negatives). The primary end-point was the 30-year overall survival in patients diagnosed by NBS. Patients were grouped according to the number of hospitalisations for respiratory or nutritional symptoms in the first 3 years of life: 0 (mild), 1-2 (moderate) and ≥3 (severe). Survival in NBS and symptoms groups was compared. The 30-year survival probability of the NBS group was 80.1% (95% CI 71.4-86.4%); in the symptoms group it was 71.0% (95% CI 62.2-78.2%). The 20-year survival was significantly higher in the NBS versus symptoms group in the severe (85% versus 64%, p=0.007) and moderate (94% versus 86%, p=0.016) groups. An adjusted Cox-model estimation confirmed differences in both the groups. Poor outcome associated with early severe presentation of CF is tempered by NBS.
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