PEDIATRICS Vol. 85 No. 6 June 1990, pp. 1001-1007
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Newborn Screening for Cystic Fibrosis Is Complicated by Age-Related Decline in Immunoreactive Trypsinogen Levels

Michael J. Rock MD1, Elaine H. Mischler MD1, Philip M. Farrell MD, PhD1, Lee-Jen Wei PhD1, W. Theodore Bruns MD1, David J. Hassemer MS1, and Ronald H. Laessig PhD1

1 From the Departments of Pediatrics and Statistics, University of Wisconsin-Madison; the Medical College of Wisconsin, Milwaukee; and the Wisconsin State Laboratory of Hygiene, Madison

Detection of elevated levels of immunoreactive trypsinogen (IRT) in dried neonatal blood spots has been used as a screening test for cystic fibrosis. In other cystic fibrosis newborn-screening studies, a sweat chloride test is generally performed only if an infant has a persistent IRT level above a selected cutoff value on both the initial and subsequent specimens. Neither the timing of the second specimen nor the value of the cutoff point for the second specimen has been comprehensively evaluated. In this randomized, controlled study, 145 024 infants were screened in the neonatal period for cystic fibrosis using the 99.8 percentile (180 ng/mL) as the neonatal cutoff point. A total of 129 infants had elevated neonatal IRT levels and had negative results on sweat tests (false-positive by IRT screening). A total of 54 children with cystic fibrosis were identified in the screened and comparison groups. Excluding patients with meconium ileus, 4 infants with cystic fibrosis had neonatal IRT values less than 180 ng/mL, and an additional 9 infants with cystic fibrosis had values decline to less than 180 ng/mL within the first 2frac12 months of age. The IRT values of infants with and without cystic fibrosis overlapped considerably beyond 30 days of age. These findings suggest that further refinement of cystic fibrosis screening methodology will be necessary to achieve an acceptable sensitivity and specificity.

Key Words: cystic fibrosis • newborn screening • immunoreactive trypsinogen

Submitted on May 4, 1989
Accepted on July 3, 1989




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