title: Utility of a very high IRT/No mutation referral category in cystic fibrosis newborn screening.
abstract: Newborn screening for Cystic Fibrosis (CF) began in New York in October, 2002 using immunoreactive trypsinogen (IRT)/DNA methodology. Infants with at least one CFTR mutation or very high IRT and no mutations (VHIRT) are referred for sweat testing. In a preliminary analysis, we noted a very low positive predictive value (PPV) and preponderance of Hispanic infants in the group of infants with CF referred for VHIRT, which led to a decision to revise, but not eliminate, the VHIRT category. Automatic referral for specimens with VHIRT collected on the day of birth was eliminated, and the VHIRT threshold was raised from 0.2% to 0.1%. In this report, we describe outcomes from VHIRT referrals among 2.4 million infants screened between March 2003 and February 2013. Following the algorithm change, referrals decreased by 37.8% overall (annual mean 1,485 vs. 923), and the VHIRT PPV improved (0.6-1.0%). The number of infants diagnosed has remained consistent at 1 in 4,400 births. The proportion of Black/Hispanic/Asian/Other infants with confirmed CF, CFTR-related metabolic syndrome (CRMS), or possible CF/CRMS was 21.3% in infants with 1-2 mutations, but 75.8% in the VHIRT group. In conclusion, although the PPV among VHIRT referrals remains low, had this category never been implemented, 24 infants with confirmed CF, and 9 infants with CRMS or possible CF/CRMS, most of whom were Hispanic, would have been missed over the 10 years. Information from this study may be helpful in assessing the need for the VHIRT category and algorithm changes in other screening programs.
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Kay
authors.affiliation: The Cystic Fibrosis Center, Mount Sinai Beth Israel, New York, New York.
authors.forename: Elinor
authors.initials: E
authors.lastname: Langfelder-Schwind
authors.affiliation: Cohen Children's Medical Center of New York, Great Neck, New York.
authors.forename: Joan
authors.initials: J
authors.lastname: DeCelie-Germana
authors.affiliation: Departments of Pediatrics, Duke University, Durham, NC and State University of New York (SUNY) at Buffalo, Buffalo, New York.
authors.forename: Jack K
authors.initials: JK
authors.lastname: Sharp
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Breanne
authors.initials: B
authors.lastname: Maloney
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.|Department of Biomedical Sciences, University at Albany, Albany, New York.
authors.forename: Norma P
authors.initials: NP
authors.lastname: Tavakoli
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Saavedra-Matiz
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Lea M
authors.initials: LM
authors.lastname: Krein
authors.affiliation: Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Michele
authors.initials: M
authors.lastname: Caggana
authors.affiliation: University Medical Center at Stony Brook, Stony Brook, New York.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kier
mesh_terms: D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D003550:Cystic Fibrosis / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D019005:Cystic Fibrosis Transmembrane Conductance Regulator / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009154:Mutation; D015997:Neonatal Screening; D009518:New York; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D014362:Trypsinogen / Q000097:blood*
chemical_list: D015415:Biomarkers; D019005:Cystic Fibrosis Transmembrane Conductance Regulator; D014362:Trypsinogen
keywords: CFTR mutation; high IRT; immunoreactive trypsinogen; positive predictive value (PPV)