Infants suspected to have very-long chain acyl-CoA dehydrogenase deficiency from newborn screening

J. Lawrence Merritt, Sverre Vedal, Jose E. Abdenur, Sylvia M. Au, Bruce A. Barshop, Lisa Feuchtbaum, Cary Harding, Cheryl Hermerath, Fred Lorey, David E. Sesser, John D. Thompson, Arthur Yu

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a fatty acid oxidation disorder with widely varying presentations that has presented a significant challenge to newborn screening (NBS). The Western States Regional Genetics Services Collaborative developed a workgroup to study infants with NBS positive for VLCADD. We performed retrospective analysis of newborns with elevated C14:1-acylcarnitine on NBS in California, Oregon, Washington, and Hawai'i including available confirmatory testing and clinical information.Overall, from 2,802,504 children screened, there were 242 cases screen-positive for VLCADD. There were 34 symptomatic true positive cases, 18 asymptomatic true positives, 112 false positives, 55 heterozygotes, 11 lost to follow-up, and 12 other disorders. One in 11,581 newborns had an abnormal NBS for suspected VLCADD. Comparison of analytes and analyte ratios from the NBS demonstrated statistically significant differences between true positive and false positive groups for C14:1, C14, C14:1/C2, and C14:1/C16. The positive predictive value for all true positive cases was 94%, 54%, and 23% when C14:1 was ≥. 2.0. μM, ≥. 1.0. μM, and ≥. 0.7. μM, respectively. Sequential post-analytical analysis could reduce the referral rate in 25.8% of cases.This study is the largest reported follow-up of infants with NBS screen-positive results for suspected VLCADD and demonstrates the necessity of developing comprehensive and consistent long-term follow-up NBS systems. Application of clinical information revealed differences between symptomatic and asymptomatic children with VLCADD. Comparison of NBS analytes and analyte ratios may be valuable in developing more effective diagnostic algorithms.

Original languageEnglish (US)
Pages (from-to)484-492
Number of pages9
JournalMolecular Genetics and Metabolism
Volume111
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Long-Chain Acyl-CoA Dehydrogenase
Screening
Newborn Infant
Neonatal Screening
Genetic Services
VLCAD deficiency
Lost to Follow-Up
Heterozygote
Fatty Acids
Referral and Consultation

Keywords

  • Clinical outcome research
  • False positive
  • Newborn screening
  • Very-long chain acyl-CoA dehydrogenase deficiency
  • VLCADD

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology
  • Genetics
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Merritt, J. L., Vedal, S., Abdenur, J. E., Au, S. M., Barshop, B. A., Feuchtbaum, L., ... Yu, A. (2014). Infants suspected to have very-long chain acyl-CoA dehydrogenase deficiency from newborn screening. Molecular Genetics and Metabolism, 111(4), 484-492. https://doi.org/10.1016/j.ymgme.2014.01.009

Infants suspected to have very-long chain acyl-CoA dehydrogenase deficiency from newborn screening. / Merritt, J. Lawrence; Vedal, Sverre; Abdenur, Jose E.; Au, Sylvia M.; Barshop, Bruce A.; Feuchtbaum, Lisa; Harding, Cary; Hermerath, Cheryl; Lorey, Fred; Sesser, David E.; Thompson, John D.; Yu, Arthur.

In: Molecular Genetics and Metabolism, Vol. 111, No. 4, 2014, p. 484-492.

Research output: Contribution to journalArticle

Merritt, JL, Vedal, S, Abdenur, JE, Au, SM, Barshop, BA, Feuchtbaum, L, Harding, C, Hermerath, C, Lorey, F, Sesser, DE, Thompson, JD & Yu, A 2014, 'Infants suspected to have very-long chain acyl-CoA dehydrogenase deficiency from newborn screening', Molecular Genetics and Metabolism, vol. 111, no. 4, pp. 484-492. https://doi.org/10.1016/j.ymgme.2014.01.009
Merritt, J. Lawrence ; Vedal, Sverre ; Abdenur, Jose E. ; Au, Sylvia M. ; Barshop, Bruce A. ; Feuchtbaum, Lisa ; Harding, Cary ; Hermerath, Cheryl ; Lorey, Fred ; Sesser, David E. ; Thompson, John D. ; Yu, Arthur. / Infants suspected to have very-long chain acyl-CoA dehydrogenase deficiency from newborn screening. In: Molecular Genetics and Metabolism. 2014 ; Vol. 111, No. 4. pp. 484-492.
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abstract = "Very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a fatty acid oxidation disorder with widely varying presentations that has presented a significant challenge to newborn screening (NBS). The Western States Regional Genetics Services Collaborative developed a workgroup to study infants with NBS positive for VLCADD. We performed retrospective analysis of newborns with elevated C14:1-acylcarnitine on NBS in California, Oregon, Washington, and Hawai'i including available confirmatory testing and clinical information.Overall, from 2,802,504 children screened, there were 242 cases screen-positive for VLCADD. There were 34 symptomatic true positive cases, 18 asymptomatic true positives, 112 false positives, 55 heterozygotes, 11 lost to follow-up, and 12 other disorders. One in 11,581 newborns had an abnormal NBS for suspected VLCADD. Comparison of analytes and analyte ratios from the NBS demonstrated statistically significant differences between true positive and false positive groups for C14:1, C14, C14:1/C2, and C14:1/C16. The positive predictive value for all true positive cases was 94{\%}, 54{\%}, and 23{\%} when C14:1 was ≥. 2.0. μM, ≥. 1.0. μM, and ≥. 0.7. μM, respectively. Sequential post-analytical analysis could reduce the referral rate in 25.8{\%} of cases.This study is the largest reported follow-up of infants with NBS screen-positive results for suspected VLCADD and demonstrates the necessity of developing comprehensive and consistent long-term follow-up NBS systems. Application of clinical information revealed differences between symptomatic and asymptomatic children with VLCADD. Comparison of NBS analytes and analyte ratios may be valuable in developing more effective diagnostic algorithms.",
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