Neonatal Screening for Congenital Adrenal Hyperplasia in Denmark: 10 Years of Experience

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Dokumenter

  • Fulltext

    Accepteret manuskript, 904 KB, PDF-dokument

  • Marie Lind-Holst
  • Marie Bækvad-Hansen
  • Agnethe Berglund
  • Arieh S. Cohen
  • Lars Melgaard
  • Kristin Skogstrand
  • Morten Duno
  • Main, Katharina Maria
  • David Michael Hougaard
  • Claus Højbjerg Gravholt
  • Dorte Hansen

Introduction: Early detection of salt-wasting congenital adrenal hyperplasia (SW-CAH) is important to reduce CAH-related morbidity. However, neonatal screening has shown to have a low positive predictive value (PPV), especially among preterm newborns. Here, the Danish CAH screening is evaluated by comparing incidence and morbidity of SW-CAH 10 years before and after introduction of screening. Furthermore, sensitivity, specificity, and PPV are determined. Methods: All newborns in Denmark born during 1999-2018 and diagnosed with SW-CAH were identified in the Danish National Patient Registry and/or at the Department of Clinical Genetics, Rigshospitalet. Newborns with a positive neonatal CAH screening were identified at Statens Serum Institut. Correct diagnosis was evaluated by medical record review. Results: A total of 65 newborns with SW-CAH were identified. The incidence of SW-CAH was 5:100,000 both before and after introduction of screening. Performance of sensitivity and specificity of the screening were 97% and 100%, respectively, and the PPV was 55% for the given period. Stratified according to gestational age, the PPV was 33% and 61% for pre -and fullterm newborns, respectively. Though not significant, the proportion of newborns presenting with SW-crisis decreased after introduction of screening from 29% versus 10% (p = 0.07). Discussion and Conclusion: Neonatal screening for SW-CAH has not led to an increase in the incidence of newborns diagnosed with SW-CAH. The screening algorithm has effectively identified newborns with SW-CAH. After 2009, there was a tendency toward a lower proportion of newborns with SW-crisis at diagnosis. Finally, the study emphasizes the benefits of using second-tier screening as well as repeated screening of premature newborns.

OriginalsprogEngelsk
TidsskriftHormone Research in Paediatrics
Vol/bind95
Udgave nummer1
Sider (fra-til)35-42
ISSN1663-2818
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
The study was supported by research grants from the International Fund of Congenital Adrenal Hyperplasia (IFCAH), the Health Research Fund of Central Denmark Region, the Aase and Einar Danielsen Fund, and “Fonden til Lægevidenskabens Fremme.” None of the above funders had a role in any aspects of the study.

Publisher Copyright:
© 2022 S. Karger AG, Basel. Copyright: All rights reserved.

ID: 319600562