NBS_GEP - Mount Sinai Hospital

advertisement
Newborn Screening:
Ontario’s Expanded Screening Program
Prepared by:
June C. Carroll, MD, CCFP, FCFP
Sydney G. Frankfort Chair in Family Medicine
Associate Professor, Department of Family Medicine
Mount Sinai Hospital, University of Toronto
Andrea L. Rideout, MS, CCGC, CGC
Project Manager / Genetic Counsellor
The Genetics Education Project
Funded by:
Ontario Women’s Health Council
Version: August 2007
The Genetics Education Project
Acknowledgments
 Reviewers:
Members of The Genetics Education Project
Ontario Newborn Screening Program: Dr. Michael
Geraghty, Mireille Cloutier MSC., Christina Honeywell
MSc., Sari Zelenietz MSc.
 Funded by:
Ontario Women’s Health Council as part of its funding to
The Genetics Education Project
* Health care providers must use their own clinical judgment in addition to the
information presented herein. The authors assume no responsibility or
liability resulting from the use of information in this presentation.
The Genetics Education Project
Newborn Screening – What’s new?
 Previously:
– PKU, congenital hypothyroidism, hearing loss
 Beginning April 2006:
– Progressive expansion to 29 disorders by the
end of 2008
– NBS includes hearing screening but, the focus of
this module will be on metabolic, endocrine and
hematologic conditions
The Genetics Education Project
Expanded NBS – 29 conditions
 20 inborn errors of metabolism
– 9 organic acid disorders
– 5 fatty acid oxidation disorders
– 6 amino acid disorders
 3 hemoglobinopathies
– Sickle cell and related disorders
 2 endocrine disorders
 3 other metabolic disorders
 1 hearing loss
The Genetics Education Project
Benefits of NBS
 Identification
 Early intervention
 Reduced morbidity and mortality
 Family planning
The Genetics Education Project
Risks of NBS





Parental anxiety (false positives)
Missed diagnosis (false negatives)
The right ‘not to know’
Unanticipated outcomes
Labelling – diagnosis of benign conditions
The Genetics Education Project
Public’s attitude to NBS
 Study of 200 Australian new mothers
–
–
–
–
–
» Quinlivan 2006 J Pscyhosomatic Ob/Gyn
Supported NBS where outcomes used to prevent
or reduce severity of disease (85%)
Less support if screening used for future family
planning (65%)
Parental consent should be mandatory (86%)
Majority concerned re discrimination, difficulty
getting insurance/employment for those with
genetic condition
1/3 had similar concerns for carriers
The Genetics Education Project
Why Changes to NBS now?







Reagent for PKU test unavailable
Tandem Mass Spectrometry more efficient
2 infants diagnosed post-mortem with MCAD
Ombudsman’s report 2005
Consumer lobbying
Geneticist lobbying
Political will
The Genetics Education Project
NBS: What’s NOT changing?
 Heel prick method for sample collection
NBS: What’s changing?
 New screening card
 Location: Children’s Hospital of Eastern Ontario
 Transportation – sample cards are sent via
Canada Post courier service to Ontario NBS
Program
The Genetics Education Project
Timing of Testing
 Acceptable samples
– between 1 day (24 hours) and 7 days after birth
 Best time for sample:
– between 2 days (48 hours) and 3 days (72 hours) after
birth
 If tested before 1 day (24 hours) of age, REPEAT
the test within 5 days*
 If the baby is >5 days, screening is still available
– Contact Ontario NBS program for details
* Repeat sample within 5 days has been the Ontario
standard of care since 2001
The Genetics Education Project
Special Considerations
 Prematurity or illness
– If <37 weeks - collect specimen at 5-7 days old
– Indicate this on NBS card
– i.e. associated with false +ve congenital hypothyroidism
screens
 Total Parenteral Nutrition (TPN)
– Certain amino acids and organic acids will be elevated
– Indicate this on NBS card
 Transfusion
– Disorders may be missed
– Ideally complete card before transfusion
The Genetics Education Project
The Heel Test
The Genetics Education Project
What makes
a good
spot?
The Genetics Education Project
NBS: What’s New?
 Location
– Children’s Hospital of Eastern Ontario (CHEO)
 Tandem Mass Spectrometry
–
–
–
–
Allows to screen for multiple conditions concurrently
Same cost to screen for one condition as multiple
Increased sensitivity and specificity
Screening for some metabolites can give information
about several diseases
 Educational materials
– MOH & CHEO have developed materials for the
public and healthcare providers
Parents will ask you about
NBS
The Genetics Education Project
NBS Report
 Cystic fibrosis
- 2008
The Genetics Education Project
Screen Positive Results
 Screen positive means:
– Further testing is required to confirm the diagnosis
– Does NOT mean that the infant is affected
 NBS laboratory will immediately notify regional
treatment centre
 Regional treatment centre will notify the infant’s
healthcare provider and parents and arrange
confirmatory testing
 If diagnosis is confirmed, regional treatment centre will
provide management counselling & follow up
 Report will be mailed to referring hospital and HCP,
provided that correct information is completed on the
screening card.
The Genetics Education Project
Results of Expanded NBS by MS/MS
Schulze et al. Pediatrics 2003
 250,000 neonates screened for 23 IEM
– 106 newborns with confirmed metabolic disorder
 70 required treatment
–
–
–
–
Overall prevalence of metabolic disorder = 1/2400
825 false positives (0.33% false positive rate)
Overall specificity = 99.67% (PPV = 11.3%)
Overall sensitivity = 100% for classic forms of disorders
= 92.6% for variants
– 61 /106 were judged to have benefited from screening
and treatment
 58% of true positives
 1/4100 newborns
The Genetics Education Project
Results
 Results will go to:
– Submitting health care professional /hospital
– Infant’s health care professional – if this information is
completed on the screening card
The Genetics Education Project
Expanded NBS – 29 conditions
 20 inborn errors of metabolism
– 9 organic acid disorders
– 5 fatty acid oxidation disorders
– 6 amino acid disorders
 3 hemoglobinopathies
– Sickle cell and related disorders
 2 endocrine disorders
 3 other metabolic disorders
 1 hearing loss
The Genetics Education Project
Inborn errors of metabolism
 Rare
 Usually autosomal recessive inheritance
– consanguinity is more common
 Symptoms secondary to a problem in the
metabolic pathway
 Usually not significant dysmorphism
 Early recognition and intervention can be
lifesaving
The Genetics Education Project
Frequency of Inborn Errors of Metabolism
using MS/MS Tandem Mass Spectrometry
 Amino Acid Disorders
1/5,100
 Organic Acid Disorders
1/20,000
 Fatty Acid Oxidation Defects
1/12,500
 IEM combined frequency
~1/4,000
 All NBS: IEM, CF, CAH,
biotinidase, galactosemia
~1/1,500
The Genetics Education Project
Organic Acid Disorders









Isovaleric acidemia (IVA)
Glutaric acidemia type 1 (GA1)
Hydrodroxymethylglutaric acidemia (HMG)
Multiple carboxylase deficiency (MCD)
Methylmalonic acidemia (MUT)
Methylmalonic acidemia (Cbl A, B)
3-methylcrotonyl glycinuria (3MCG)
Propionic acidemia (PROP)
Β-ketothiolase deficiency (BKT)
The Genetics Education Project
Organic Acid Disorders
 What are organic acid disorders?
– Body cannot metabolize certain amino acids and fats
– Accumulation of organic acids in blood and urine
– Serious potentially preventable effects on health and
development, including death
 Symptoms
– acute encephalopathy, vomiting, metabolic acidosis,
ketosis, hyperammonemia, hypoglycemia, coma
– dehydration, failure to thrive, hypotonia, GDD
– sepsis, death
 Treatment
– Low protein diet / restrict amino acids,
– Supplements: carnitine, biotin, riboflavin, glycine
The Genetics Education Project
– Avoid fasting
Fatty Acid Oxidation Disorders
 Medium-chain acyl-CoA dehydrogenase
(MCAD) deficiency
 Very long-chain acyl-CoA dehydrogenase
deficiency (VLCAD)
 Long-chain L-3-OH acyl-CoA dehydrogenase
deficiency (LCHAD)
 Trifunctional protein deficiency (TFP)
– catalyzes 3 steps in mitochondrial beta-oxidation of
fatty acids
 Carnitine uptake defect (CUD)
The Genetics Education Project
Disorders of Fatty Acid Oxidation
 What are disorders of fatty acid oxidation?
– Breakdown of fatty acids in mitochondria is essential
part of body’s ability to produce energy
– Disorder: inability to break down fatty acids
 Symptoms
– Decompensate with any catabolic stress
 fever, fasting, intercurrent illness
– Hypoketotic hypoglycemia, liver, muscle, heart disease
– Lethargy, seizures, coma, sudden death (SIDS)
 Treatment
– Avoid fasting
– Frequent feeding
– IV glucose when ill to prevent hypoglycemia
The Genetics Education Project
Amino Acid Disorders
 Phenylketonuria (PKU)
 Maple syrup urine disease (MSUD)
 Tyrosinemia type 1 (TYR 1)
– Common in French Canadians
 Homocystinuria (HCY)
 Citrullinemia (CIT)
 Argininosuccinic aciduria (ASA)
The Genetics Education Project
Amino Acid Disorders
 What are Amino acid disorders?
– Occur when the body cannot either metabolize or
produce certain amino acids
– Results in toxic accumulation of substances
– Serious potentially preventable effects on health and
development including death
 Symptoms -example PKU
– Hyperphenylalaninemia (neurotoxic)
– Microcephaly, epilepsy, MR, behaviour problems
 Treatment
– Diet: reduce phenylalanine, low protein, supplement
cofactors or essential amino acids
– Avoid fasting
The Genetics Education Project
Endocrine Disorders: CH
Congenital Hypothyroidism (CH)
 What is CH?
– inadequate thyroid hormone production
– Anatomic defect in gland, IEM, iodine deficiency
 Symptoms
– MR, ↓ growth & bone maturation, neurologic problems:
spasticity, gait abn, dysarthria, autistic behaviour
 Treatment
– Thyroid hormone replacement
– Diagnosis made before 13 days to prevent symptoms
The Genetics Education Project
Endocrine Disorders: CAH
Congenital Adrenal Hyperplasia (CAH)
 What is CAH?
– Impaired synthesis of cortisol by the adrenal cortex leads to ↑↑↑
androgen biosynthesis
– Inability to maintain adequate energy & blood glucose level to
meet stress of injury & illness
 Symptoms
– Virilization (♀ ambiguous genitalia), precocious puberty,
infertility, short stature
– Renal salt wasting leads to FTT, vomiting, dehydration,
hypotension, hyponatremia, & hyperkalemia
 Treatment
– Glucocorticoid replacement therapy
The Genetics Education Project
Hemoglobinopathies
 Sickle cell disease (Hb SS)
 Hemoglobin SC disease
 Sickle-β thalassemia (Hb S/β-thal)
 Other hemoglobin variants may be
picked up as variants
The Genetics Education Project
Sickle Cell Disease
 What is sickle cell disease? (Hb SS)
– Change in the shape of the betaglobin component of the
hemoglobin molecule that interferes with hemoglobin’s ability to
carry oxygen
 Symptoms
– Painful vaso-occlusive crises, hemolytic anemia, frequent
infections, tissue ischemia, chronic organ dysfunction
 Diagnosis
– Quantitative hemoglobin electrophoresis
– Do not rely on solubility testing methods (Sickledex etc)
 Treatment
– Prophylactic penicillin (84% reduction in infection)
– Vaccinations (pneumococcal, influenza)
The Genetics Education Project
Other Hemoglobinopathies
 Hemoglobin C disease (Hb-CC)
– ‘benign’ hemoglobinopathy
– mild hemolytic anemia, retinopathy & dental
infarctions, gallstones, splenomegaly, joint pain
 Sickle cell and C trait (carriers) (Hb AS, Hb AC)
– > 50% normal hemoglobin – generally asymptomatic
no clinical symptoms
 Other hemoglobin variants
 Autosomal recessive inheritance
The Genetics Education Project
Other Disorders:
Biotinidase deficiency
 What is biotinidase deficiency?
– Biotinidase is responsible for recycling biotin – a
cofactor for 4 dependant carboxylases
 Symptoms
– Metabolic ketoacidosis, organic aciduria, mild
hyperammonemia
– Seizures, hypotonia, ataxia, developmental delay, vision
problems, hearing loss, cutaneous abnormalities
 Treatment
– 5-10mg of oral biotin per day, long term treatment
prevents all symptoms
The Genetics Education Project
Other Disorders: Galactosemia
 What is galactosemia?
– Lactose is main sugar in breast milk & infant formulas
– Metabolized into glucose and galactose in the intestine
– Unable to break down galactose
 Symptoms
– Feeding problems, FTT, bleeding, infection, liver failure,
cataracts, MR
 Treatment
– Lactose-galactose-restricted diet
 must be started in first 10 days of life to prevent symptoms
– Even with treatment - ↑ developmental delay, speech
problems, abn motor function, premature ovarian failure
The Genetics Education Project
Other Disorders: Cystic fibrosis
 What is cystic fibrosis?
– Due to mutations in the CFTR gene which is responsible for
chloride regulation and other transport pathways.
 Symptoms
–
–
–
–
–
Chronic sinopulmonary disease
Gastrointestinal/nutritional abnormalities
Azoospermia (males)
Salt loss syndrome
Shortened life span – but improving with treatment
 Treatment
– Pulmonary: oral, inhaled, or IV antibiotics, bronchodilators, antiinflammatory agents, mucolytic agents, chest physiotherapy
– Gastrointestinal: Nutritional therapy special formulas for weight
gain via improved intestinal absorption, and additional fat-soluble
vitamins & zinc to prevent deficiencies
The Genetics Education Project
Cases
The Genetics Education Project
Case 1
 Carmen and George bring Amy into your office
for 1 week visit
 Healthy 1 week old
 Parents worried re risk of SIDS
 First daughter died of SIDS 5 years earlier
 Carmen’s cousin died of SIDS at 18 months
The Genetics Education Project
Case 1: Amy – 5 days old
 You receive a call that Amy has screened
positive for MCAD deficiency
– Medium chain acyl-CoA dehydrogenase deficiency
 You ask Carmen and George to bring her in that
day
 Healthy 5 day old
 Parents worried about risk of SIDS
 First daughter died of SIDS 5 years earlier
 Carmen’s cousin died of SIDS at 13 months
The Genetics Education Project
Legend
Case 1
Prostate
cancer
SIDS
British / French
Irish / German
MI – died 69
A&W
37
39
A&W Schizophrenic
35
George
A&W
32
Carmen
A&W
A&W
5
A&W
A&W
29
A&W
P
C
7
72
79
Prost Ca Dx 74
65
25
A&W
49
Accident
SIDS
13 months
S
1 wk
SIDS
8 months
Amy
A& W
The Genetics Education Project
Case 1
 Amy’s expanded newborn screening
report is the following:
– Screen positive for medium chain acylCoA deficiency
The Genetics Education Project
MCAD (medium chain acyl-CoA deficiency)
 Incidence
– 1 in 4,900 – 1 in 17,000
– most prevalent in North Europeans
 Inheritance
– Autosomal recessive (Gene: ACADM)
 Enzyme
– Medium-chain acyl-coenzyme A dehydrogenase
 Function
– Mitochrondrial fatty acid β-oxidation
– Energy source once hepatic glycogen stores become
depleted
– Important during prolonged fasting
The Genetics Education Project
MCAD: Symptoms
 Usually presents at 3 to 24 months
 Triggered by fever, illness, or fasting
 Symptoms:
– Hypoglycemia, vomiting
– Lethargy → coma → death
– Encephalopathy, respiratory arrest, hepatomegaly,
seizures
 Long term outcomes: developmental &
behavioural disabilities, chronic muscle
weakness, seizures, cerebral palsy, ADD
The Genetics Education Project
MCAD: a preventable cause of SIDS
 Sudden death is the first symptom in 25% of
MCAD cases
 Early diagnosis and treatment of MCAD can
prevent sudden death
 MCAD responsible for ~1% of SIDS cases, all
FAO disorders ~4%
– Opdal et al. Pediatrics 2004;114:506-512
The Genetics Education Project
MCAD: Management
 Infants require frequent feedings
– Formulas containing medium chain triglycerides as
the primary source of fat should be avoided
 Toddlers: 2g/kg of uncooked cornstarch at
bedtime to ensure sufficient glucose overnight
 High carbohydrate, low fat diet
 Carnitine supplementation
 Avoid fasting, hypoglycemia
The Genetics Education Project
Case 2
 Peter and Tina come to your office for a routine
newborn visit
 Kechia is a healthy 1 week old newborn
 Her NBS results show that she is a carrier of
hemoglobin S - sickle cell trait
How would you proceed?
The Genetics Education Project
Hemoglobin S Carriers
 Carriers of sickle cell trait (HbAS)
– no clinical symptoms
– should they be notified?
 Benefits
– Sequential testing and identification of carriers/ affected in family
– Reproductive counselling/prenatal diagnosis
 Risks
–
–
–
–
–
–
–
Exposure of non-paternity
Fear of chronic illness
Fear of sickle cell disease in future pregnancies
Stigmatization
Diminished self esteem
Potential discrimination
Misdiagnosis
The Genetics Education Project
Legend
HbAS- Sickle
cell trait
HbSS – Sickle
cell disease
Case 2 – sequential testing
of family members
Barbados
Jamaica
Hb - AA
Hb - AA
Hb - AS
Hb - AS
Hb - AS
24
Hb - AS
22
Hb - AS Hb - AA
Hb - AS
Hb - AA
P
Hb - AA
Hb - AA
Hb - AA
1 week
Hb - AS
Hb - AA
3months
Hb - SS
The Genetics Education Project
Prevalence : Hemoglobinopathies
Ethnicity
Hb S trait
Hb C trait β thal trait
Mediterranean
1/30 -50
Rare
1/20 – 30
1/30-50
African American
1/12
1/50
1/75
1/30
Non-Hispanic
Caribbean
1/12
1/30
1/50 -75
1/30
West African
1/6
1/20-30
1/50
1/30
Hispanic Caribbean
1/30
Rare
1/75
Variable
Mexican, Central
American
1/30-200
Rare
1/30-50
Variable
Asian
Rare
Rare
1/50
1/20 *
Southeast Asian
Rare
Rare
1/30
>1/20*
Asian subcontinent
1/50–100
Rare
1/30-50
Variable
Middle Eastern
1/50-100
Rare
1/50
variable
*In cis – 2 α thal deletions on same chromosome
Source: March of Dimes
α thal trait
The Genetics Education Project
NBS – Bottom Line






Offer newborn screening
Discuss the benefits
Discuss how testing is done
Discuss timing
Repeat sample sometimes required
Discuss difference between screening and
diagnostic test
 Discuss possible results
 Answer questions/brochure
The Genetics Education Project
MOH Educational Materials
 www.health.gov.on.ca/newbornscreening
 MOHLTC INFOline at 1-866-532-3161 / TTY: 1-800-3875559
 Contact the Ontario Newborn Screening Program at:
Department of Genetics
Children’s Hospital of Eastern Ontario
Room 3127, 401 Smyth Road
Ottawa, ON K1H 8L1
(613) 738-3222
 Educational materials are available free-of-charge and
can be ordered through www.health.gov.on.ca or by
calling 1-877-844-1944
The Genetics Education Project
Education:
http://www.health.gov.on.ca
The Genetics Education Project
Disorder Fact
Sheets
www.health.gov.on.ca
/newbornscreening
The Genetics Education Project
Resources
 CHEO’s Newborn Screening Website:
http://www.newbornscreening.on.ca/bins/index.asp
 March of Dimes:
www.marchofdimes.com
 Genetests:
www.genetests.org
 National Newborn Screening & Genetics
Resource Center:
genes-r-us.uthscsa.edu
 Pediatrix – US private lab offering NBS
– www.pediatrix.com
The Genetics Education Project
The Genetics Education Project
Committee
 June Carroll MD CCFP
 Judith Allanson MD FRCP
FRCP(C) FCCMG FABMG
 Sean Blaine MD CCFP
 Mary Jane Esplen PhD RN
 Sandra Farrell MD FRCPC
FCCMG
 Judy Fiddes
 Gail Graham MD FRCPC
FCCMG
 Jennifer MacKenzie MD
FRCPC FAAP FCCMG
 Wendy Meschino MD FRCPC
FCCMG
 Fiona Miller PhD
 Ms. Joanne Miyazaki
 Andrea Rideout MS CGC
CCGC
 Linda Spooner RN BScN
 Cheryl Shuman MS CGC
 Anne Summers MD FCCMG
FRCPC
 Sherry Taylor PhD FCCMG
 Brenda Wilson BSc MB ChB
MSc MRCP(UK) FFPH
The Genetics Education Project
References
1.
2.
3.
Ontario Ministry of Health and Long Term Care, News release November
2, 2005: Ontario becomes national leader in newborn screening, New
state-of-the-art testing program means that children will have a better start
on life
http://www.health.gov.on.ca/english/media/news_releases/archives/nr_05/
nr_110205.html
Ontario Ministry of Health and Long Term Care, News release November
23, 2006: McGuinty government expands newborn screening, Screening
for cystic fibrosis brings total number of tests to 28.
http://www.health.gov.on.ca/english/media/news_releases/archives/nr_06/
nov/nr_112306.html
Bellis MA, Hughes K, Hughes S, Aston JR. Measuring parent discrepancy
and its public health consequences. J Epidemiol Community Health 2005;
59: 749-754.
4. Quinlivan 2006 J Pscyhosomatic Ob/Gyn
5.
Holtzman NA, Faden R, Chwalow AJ, Horn SD. Effect of informed
parental consent on mothers' knowledge of newborn screening.
Pediatrics. 1983; 72:807-812.
The Genetics Education Project
References
6.
7.
8.
9.
Tymstra T. False positive results in screening tests: experiences of
parents of children screened for congenital hypothyroidism. Fam
Pract. 1986; 3:92-96.
Tluczek A, Mischler EH, Bowers B, Peterson NM, Morris ME,
Farrell PM, Bruns WT, Colby H, McCarthy C, Fost N, et al.
Psychological impact of false-positive results when screening for
cystic fibrosis. Pediatr Pulmonol Suppl. 1991;7:29-37.
Waisbren SE, Albers S, Amato S, Ampola M, Brewster TG,
Demmer L, Eaton RB, Greenstein R, Korson M, Larson C,
Marsden D, Msall M, Naylor EW, Pueschel S, Seashore M, Shih
VE, Levy HL. Effect of expanded newborn screening for
biochemical genetic disorders on child outcomes and parental
stress. JAMA. 2003;290:2564-2572.
Tluczek A, Koscik RL, Farrell PM, Rock MJ. Psychosocial risk
associated with newborn screening for cystic fibrosis: parents'
experience while awaiting the sweat-test appointment. Pediatrics.
2005;115:1692-1703.
The Genetics Education Project
References
10. Mischler EH, Wilfond BS, Fost N, Laxova A, Reiser C, Sauer CM,
Makholm LM, Shen G, Feenan L, McCarthy C, Farrell PM. Cystic fibrosis
newborn screening: impact on reproductive behavior and implications for
genetic counseling. Pediatrics. 1998; 102:44-52.
11. Dudding T, Wilcken B, Burgess B, Hambly J, Turner G. Reproductive
decisions after neonatal screening identifies cystic fibrosis. Arch Dis Child
Fetal Neonatal Ed. 2000; 82:F124-127.
12. Martin, A. Ontario Ombudsman Report: The Right to be impatient.
September 2005.
13. Ontario Ministry of Health and Long Term Care, Newborn Screening
website:
http://www.health.gov.on.ca/english/providers/program/child/screening/scr
een_sum.html
www.health.gov.on.ca/english/providers/program/child/screening/screen_s
um.html
14. NCCLS (National Committee for Clinical Laboratory Standards now
known as CLSI – Clinical Laboratory Standards Institute) LAR-A3 “Blood
collection on filter paper for neonatal screening programs: approved
standard, third edition.”
The Genetics Education Project
References
15. “Simple Spot Check” 04/03/02 Lit. #718 produced by Schleicher &
Schuell BioScience Inc. 10 Optical Ave, Keene NH 03431 USA.
Scheicher & Schuell BioScience GmbH P.O. Box 1160, D-37582
Dassel, Germany.
16. Waston MS, Mann MY, Lloyd-Puryear MA, Rinaldo P, Howell RR.
Executive summary: Newborn screening panel and system. Genet
Med 2006; 8 (5, supplement): 1s-11s.
17. Schulze A, Lindner M, Kohlmuller D, Olgemoller K, Mayatepek E,
Hoffmann GF. Expanded newborn screening for inborn errors of
metabolism by electrospray ionization-tandem mass spectrometry:
Results, outcome and implications. Pediatrics 2003; 111:1399-1406.
18. Applegarth Da, Toone JR, Lowry RB. Incvidence of inborn errors of
metabolism in British Columbia, 1969 – 1996. Pediatrics 2000:
105:e10-e16.
19. Frazier DM, Millington DS, McCandless SE, Keoberl DD, Weavil Sd,
Chaing SH, Muenzer J. The tandem mass spectrometry newborn
screening experience in North Carolina: 1997-2005. J Inhert Metab
Dis 2006; 29:76-85.
20. Marsden D, Larson C, Levy Hl. Newborn screening for metabolic
disorders. J Pediatr 2006; 148:577-584.
The Genetics Education Project
References
21. Seashore MA. Genetest Reviews: The organic acidemias: An
overview. Last updated 27 december 2006. www.genetests.org.
22. Ogier de Baulny HO, Saudubray JM. Branched-chain organic
acidurias. Semin Neonatol. 2002; 7:65-74.
23. Venditti CP. Genetests Reviews: Methylmalonic Acidemia. Last
updated 18 January 2007. www.genetests.org.
24. Korman SH. Inborn errors of isoleucine degradation: A review. Mol
Genet Metab. 1006: 89:289-299.
25. Gibson KM, Breuer J, Kiaser K, Nylan WL, McCoy EE, Ferreira P,
Greene CL, Blitzer MG, Shapira E, Reverte F, Conde C, Bagnell P,
Cole DEC. 3-hydroy-3-methylglutaryl-coenzyme A lyase
deficiency: Report of five new patients. J Inhert Metab Dis 1988;
11:76-87.
26. Roth KS. Holocarboxylase Deficiency. Last updated 22 September
2005. http://www.emedicine.com/ped/topic1020.htm
The Genetics Education Project
References
27. Angelini C, Federico A, Reichmann H, Lombes, Chinnery P, Turnbull D.
Task force guidelines handbook: EFNS guidelines on diagnosis and
management of fatty acid mitochondrial disorders. Eur J Neurol. 2006;
13:923-929.
28. Saudubray JM, Martin D, deLonlay P, Touati G, Poggi-Travert F, bonnet
D, Jouvet P, Boutron M, Slama A, Vianey-saban C, Bonnefont JP,
Rabier, Kamoun P, Brivet M. Recognition and management of fatty
acid oxidation defects: A series of 107 patients. J Inherit Metabo Dis.
1999; 22:488-502.
29. Hellekson KL; National Institutes of Health. Am Fam Physician. 2001
63:1430 1432.
30. National Institutes of Health Consensus Development Panel. National
institutes of Health consensus development conference statement:
Phenylketonuria screening and management, October 16-18 2000.
Pediatrics 2001; 108: 972-982.
31. Mitchell JJ, Scriver CR. Genetests Reviews: Phenylalanine
hydroxylase deficiency. Last updated 19 July 2005.
www.genetests.org.
32. Morton DH, Strauss KA, Robinson DL, Puffenberger EG, Kelley RI.
Diagnosis and treatment of maple syrup urine disease: A study of 36
patients. Pediatrics 2002; 109:999-1008.
The Genetics Education Project
References
33. Le Roux C, Murphy E, Liblurn M. The longest surviving patient with
classical maple syrup urine disease. J Inherit Metab Dis 2006;
29:190-194.
34. Strauss KA, Puffenberger EG, Morton DH. Genetests Reviews:
Maple Syrup Urine Disease. Last updated 30 January 2006.
www.genetests.org.
35. Scott CR. The genetic tyrosinemias. Am J Med Genet Part C
Semin Med Genet 2006; 142C:121-126.
36. Russo PA, Mitchell GA, Tanguay RM. Tyrosinemia: a review.
Pediatr Dev Pathol. 2001; 4:212-221.
37. Sniderman King L, Trahms C Scott R. Genetests Reviews:
Tyrosinemia Type I. Last updated 24 July 2006.
www.genetests.org.
38. Walter JH, Wraith JE, White FJ, Bridge C, Till J. Strategies for the
treatment of cystathionine β-synthase deficiency: the experience of
the Wilink Biochemical Genetics Unit over the past 30 years. Eur J
Pediatr. 1998; 157(Suppl 2):s71-s76.
The Genetics Education Project
References
39. De Franchis R, Sperendeo MP, Sebastio G, Andria G. The Italian
Study group on Homocystinuria. Clinical aspects of the
cynstathionine β-synthase deficiency: how wide is the clinical
spectrum? Eur J Pediatr. 1998; 157(Suppl 2):s67-s70.
40. Picker JD. Levy HL. Genetests Reviews: Homocystinuria Caused
by Cystathionine Beta-Synthase Deficiency. Last updated 29
March 2006. www.genetests.org.
41. Summar M, Tuchman M. Proceeding of a consensus conference
for the management of patients with urea acid cycle disorders. J
Pediatr. 2001; 138(Suppl1):s6-s10.
42. The Urea Cycle Disorders Conference Group. Consensus
statement from a conference for the management of patients with
urea cycle disorders. J Pediatr. 2001; 138(Suppl1):s1-s5.
43. Summar, ML. Genetests Reviews: Urea Cycle Disorders Overview.
Last updated 11 August 2005. www.genetests.org.
44. Thoene, JG. Genetests Reviews: Citrullinemia Type I. Last
updated 22 December 2006. www.genetests.org
The Genetics Education Project
References
45. Roth KS. Argininosuccinate Lyase Deficiency. Last Updated 7 July
2005. www.emedicine.com - free registration is required. If you
are already registered the direct link is:
http://www.emedicine.com/ped/topic2745.htm
46. American Academy of Pediatrics; Rose SR; Section on
Endocrinology and Committee on Genetics, American Thyroid
Association; Brown RS; Public Health Committee, Lawson Wilkins
Pediatric Endocrine Society; Foley T, Kaplowitz PB, Kaye CI,
Sundararajan S, Varma SK. Update of newborn screening and
therapy for congenital hypothyroidism. Pediatrics. 2006
Jun;117:2290-2303.
47. Postellon D, Bourgeois MJ, Varma S. eMedicine: Congenital
Hypothyroidism. Last Updated: 23 August 2006
http://www.emedicine.com/ped/topic501.htm
48. Merke DP, Bornstein SR. Congenital adrenal hyperplasia. Lancet.
2005; 365: 2125-2136.
The Genetics Education Project
References
49. New MI, Nimkarn S. GeneTests Reviews: Congenital Adrenal
Hyperplasia, last update 7 September 2006.
http://www.genetests.org.
50. Wethers DL. Sickle cell disease in childhood: Part II. Diagnosis
and treatment of major complications and recent advances in
treatment. Am Fam Physician. 2000; 62: 1309-1314.
51. Bender MA. GeneTests Reviews: Sickle cell Disease, last update 7
March 2006. http://www.genetests.org
52. Wolf B. Worldwide survey of neonatal screening for biotinidase
deficiency. J Inherit Metab Dis. 1991; 14:923-927.
53. Wolf B. GeneTests Reviews: Biotinidase Deficiency, last update 2
March 2006. http://www.genetests.org.
54. Bosch AM. Classical galatosemia revisited. J Inherit. Metab. Dis.
2006; 29:516-529.
The Genetics Education Project
References
55. Schweitzer-Krantz S. Early diagnosis of inherited metabolic
disorders improving outcome: the controversial issue of
galactosemia. Eur J Pediatr. 2003; 162:s50-s503.
56. Elsas LJ. GeneTests Reviews: Galactosemia, last update 2 May
2005. http://www.genetests.org
57. Moskowitz SM, Gibson RL, Sternen DL, Cutting GR. Genetests
Reviews: CFTR-Related Disorders. Last updated 24 August 2005.
www.genetests.org.
58. Yankaskas JR, Marshall BC, Sufian B, Simon RH, Rodman D.
Cystic fibrosis adult care: Consensus conference report. Chest
2004;125:s1-s39.
59. Saiman L, Siegel J. Infection control recommendations for patients
with cystic fibrosis: Microbiology, important pathogens and
infection control to prevent patient to patient transmission, Cystic
fibrosis consensus conference on infection control participants. Am
J Infection Control 2003; 31:s1-s62.
The Genetics Education Project
References
60. Cystic Fibrosis Trust Clinical Standards and Accreditation Group.
Standards of care for children and adults with cystic fibrosis in the
UK. May 2001.
61. Matern D, Rinaldo P. GeneTests Reviews: Medium-Chain AcylCoenzyme A Dehydrogenase Deficiency. Last update 3 February
2005. http://www.genetests.org
62. Opdal SH, Rognum TO. The sudden infant death gene: does it
exist? Pediatrics 2004; 114:506-512.
63. American Academy of Pediatrics, Newborn Screening Fact Sheets
Kaye CL and the Committee on Genetics. Newborn screening fact
sheets. Pediatrics 2006; 118:e934-e963.
64. Pass K A, Lane PA, Fernhoff PM, Hinton CF, Panny SR, parks JS,
Pelias MZ, Rhead WJ, Ross SI, Wethers DL, Elsas LJ for CORN.
US newborn screening system guidelines II: Follow-up of children,
diagnosis, management and evaluation. Statement of the councilof
regional networks for genetic services (CORN). Pediatrics 2000;
137(4):s1-s46.
The Genetics Education Project
The Genetics Education Project
Download