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  • Newborn screening for homocystinurias: recent recommendations versus current practice
    Publication . Keller, Rebecca; Chrastina, Petr; Pavlíková, Markéta; Gouveia, Sofía; Ribes, Antonia; Kölker, Stefan; Blom, Henk J.; Baumgartner, Matthias R.; Bártl, Josef; Dionisi-Vici, Carlo; Gleich, Florian; Morris, Andrew A.; Kožich, Viktor; Huemer, Martina; Barić, Ivo; Ben-Omran, Tawfeq; Blasco-Alonso, Javier; Bueno Delgado, Maria A.; Carducci, Claudia; Cassanello, Michela; Cerone, Roberto; Couce, Maria Luz; Crushell, Ellen; Delgado Pecellin, Carmen; Dulin, Elena; Espada, Mercedes; Ferino, Giulio; Fingerhut, Ralph; Garcia Jimenez, Immaculada; Gonzalez Gallego, Immaculada; González-Irazabal, Yolanda; Gramer, Gwendolyn; Juan Fita, Maria Jesus; Karg, Eszter; Klein, Jeanette; Konstantopoulou, Vassiliki; la Marca, Giancarlo; Leão Teles, Elisa; Leuzzi, Vincenzo; Lilliu, Franco; Lopez, Rosa Maria; Lund, Allan M.; Mayne, Philip; Meavilla, Silvia; Moat, Stuart J.; Okun, Jürgen G.; Pasquini, Elisabeta; Pedron-Giner, Consuélo Carmen; Racz, Gabor Zoltan; Ruiz Gomez, Maria Angeles; Vilarinho, Laura; Yahyaoui, Raquel; Zerjav Tansek, Moja; Zetterström, Rolf H.; Zeyda, Maximilian
    Purpose: To assess how the current practice of newborn screening (NBS) for homocystinurias compares with published recommendations. Methods: Twenty-two of 32 NBS programmes from 18 countries screened for at least one form of homocystinuria. Centres provided pseudonymised NBS data from patients with cystathionine beta-synthase deficiency (CBSD, n = 19), methionine adenosyltransferase I/III deficiency (MATI/IIID, n = 28), combined remethylation disorder (cRMD, n = 56) and isolated remethylation disorder (iRMD), including methylenetetrahydrofolate reductase deficiency (MTHFRD) (n = 8). Markers and decision limits were converted to multiples of the median (MoM) to allow comparison between centres. Results: NBS programmes, algorithms and decision limits varied considerably. Only nine centres used the recommended second-tier marker total homocysteine (tHcy). The median decision limits of all centres were ≥ 2.35 for high and ≤ 0.44 MoM for low methionine, ≥ 1.95 for high and ≤ 0.47 MoM for low methionine/phenylalanine, ≥ 2.54 for high propionylcarnitine and ≥ 2.78 MoM for propionylcarnitine/acetylcarnitine. These decision limits alone had a 100%, 100%, 86% and 84% sensitivity for the detection of CBSD, MATI/IIID, iRMD and cRMD, respectively, but failed to detect six individuals with cRMD. To enhance sensitivity and decrease second-tier testing costs, we further adapted these decision limits using the data of 15 000 healthy newborns. Conclusions: Due to the favorable outcome of early treated patients, NBS for homocystinurias is recommended. To improve NBS, decision limits should be revised considering the population median. Relevant markers should be combined; use of the postanalytical tools offered by the CLIR project (Collaborative Laboratory Integrated Reports, which considers, for example, birth weight and gestational age) is recommended. tHcy and methylmalonic acid should be implemented as second-tier markers.
    2018-06-15Journal article Restricted access Show more
  • Congenital anomalies: parents' concerns and opinions towards public health policies and improved effectiveness of health services
    Publication . Santos, Ana João; Braz, Paula; Machado, Ausenda; Dias, Carlos Matias
    BACKGROUND: The changes deriving from the birth of a child with a Congenital anomaly (CA) or Cerebral Palsy (CP) implies not only new emotional demands resulting from the child's condition, but in many cases an increase of interactions with health services and professionals. Health services and health policies must acknowledge and offer the opportunity for the family to define its own problems. METHODS: The cross-sectional descriptive qualitative study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies; spina bifida; orofacial clefts and Down syndrome) and/or CP. A semi-structured online questionnaire to be answered by parents was sent by web link to focal points of five parents associations and professional institutions in Portugal. Data was analysed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). RESULTS: Families feel professionals should recognise the importance of obtaining more complete and accurate information about the child's diagnosis. Health services were perceived as displaced and unordered, since parents indicate a lack of multidisciplinary interventions and lack of coordination or communication between professionals. Nonetheless, parents felt overall confident on the health care provided and on the “training” they get to care for their children deriving from the interactions with health professionals. CONCLUSION: Health policies should ensure that families and children with CA and/or CP have access to reliable information. Health services and professionals should take into account the unique needs of each family and child and develop integrated interventions.
    2018-06-15Conference object Open access Show more