Impact of Newborn Screening on Clinical Presentation of Congenital Adrenal Hyperplasia

Rūta Navardauskaitė; Kornelija Banevičiūtė; Jurgita Songailienė; Kristina Grigalionienė; Darius Čereškevičius; Marius Šukys; Giedrė Mockevicienė; Marija Smirnova; Algirdas Utkus; Rasa Verkauskienė

doi:10.3390/medicina57101035

Impact of Newborn Screening on Clinical Presentation of Congenital Adrenal Hyperplasia

Medicina (Kaunas). 2021 Sep 29;57(10):1035. doi: 10.3390/medicina57101035.

Affiliations

¹ Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
² Medical Faculty, Institute of Biomedical Sciences, Vilnius University, LT-03101 Vilnius, Lithuania.
³ Centre for Medical Genetics, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania.
⁴ Department of Genetics and Molecular Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
⁵ Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.

Abstract

Background and Objectives: The main reason for Newborn screening (NBS) for congenital adrenal hyperplasia (CAH) is to prevent adrenal insufficiency that can lead to life-threatening conditions. On the other hand, screening programs are not always sensitive and effective enough to detect the disease. We aimed to evaluate impact of the national NBS on the clinical presentation of patients with CAH in Lithuania. Materials and Methods: A retrospective study was performed on data of 88 patients with CAH from 1989 to 2020. Patients with confirmed CAH were divided into two groups: (1) 75 patients diagnosed before NBS: 52 cases with salt-wasting (SW), 21 with simple virilising (SV) and two with non-classical (NC) form; (2) 13 patients diagnosed with NBS: 12 cases with SW and 1 case with SV form. For the evaluation of NBS effectiveness, data of only male infants with salt-wasting CAH were analysed (n = 36, 25 unscreened and nine screened). Data on gestational age, birth weight, weight, symptoms, and laboratory tests (serum potassium and sodium levels) on the day of diagnosis, were analysed. Results: A total of 158,486 neonates were screened for CAH from 2015 to 2020 in Lithuania and CAH was confirmed in 13 patients (12 SW, one-SV form), no false negative cases were found. The sensitivity and specificity of NBS program for classical CAH forms were 100%; however, positive predictive value was only 4%. There were no significant differences between unscreened and screened male infant groups in terms of age at diagnosis, serum potassium, and serum sodium levels. Significant differences were found in weight at diagnosis between the groups (-1.67 ± 1.12 SDS versus 0.046 ± 1.01 SDS of unscreened and screened patients respectively, p = 0.001). Conclusions: The sensitivity and specificity of NBS for CAH program were 100%, but positive predictive value-only 4%. Weight loss was significantly lower and the weight SDS at diagnosis was significantly higher in the group of screened patients.

Keywords: CAH; NBS; congenital adrenal hyperplasia; newborn; screening.

MeSH terms

Adrenal Hyperplasia, Congenital* / diagnosis
Adrenal Hyperplasia, Congenital* / epidemiology
Birth Weight
Humans
Infant
Infant, Newborn
Male
Neonatal Screening
Retrospective Studies
Sensitivity and Specificity