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Published on: June 3, 2013
Newborn screening for homocystinurias: Recent recommendations versus current practice
Rebecca Keller1,2, Petr Chrastina3, Markéta Pavlíková3,4
1Division of Metabolism and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland.
Newborn screening (NBS) for homocystinurias varies globally, with many programs not using recommended markers or decision limits. Revising these limits and incorporating specific markers can improve NBS accuracy and efficiency.
Area of Science:
- Biochemistry
- Medical Genetics
- Public Health
Background:
- Homocystinurias are a group of genetic disorders.
- Newborn screening (NBS) is crucial for early detection and treatment.
- Current NBS practices for homocystinurias lack standardization.
Purpose of the Study:
- To evaluate current newborn screening (NBS) practices for homocystinurias against established recommendations.
- To identify variations in screening methods and decision limits across different NBS programs.
Main Methods:
- Analyzed NBS data from 22 programs in 18 countries for cystathionine beta-synthase deficiency (CBSD), methionine adenosyltransferase I/III deficiency (MATI/IIID), and remethylation disorders (cRMD, iRMD).
- Converted screening markers and decision limits to multiples of the median (MoM) for comparative analysis.
- Adapted decision limits using data from 15,000 healthy newborns to enhance sensitivity and reduce costs.
Main Results:
- Significant variability observed in NBS algorithms and decision limits among programs.
- Only nine centers utilized the recommended second-tier marker, total homocysteine (tHcy).
- Existing decision limits showed variable sensitivity for detecting different types of homocystinurias, missing some cases.
Conclusions:
- NBS for homocystinurias is recommended due to favorable outcomes with early treatment.
- Revision of NBS decision limits, considering population medians, is necessary.
- Implementing relevant markers, combining them, utilizing postanalytical tools (like CLIR), and adding tHcy and methylmalonic acid as second-tier markers are recommended for improved NBS.
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