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No evidence of an increase in early infant mortality from congenital adrenal hyperplasia in the absence of screening
  1. Beverly E Hird1,
  2. Lesley Tetlow1,
  3. Simon Tobi2,
  4. Leena Patel3,
  5. Peter E Clayton4
  1. 1Department of Biochemistry, Central Manchester University Hospitals NHS Foundation Trust, UK
  2. 2DNA Laboratory, Genetic Medicine, Central Manchester University Hospitals NHS Foundation Trust, UK
  3. 3Department of Endocrinology, Royal Manchester Children's Hospital, UK
  4. 4Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
  1. Correspondence to Beverly E Hird, Department of Biochemistry, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK; beverly.hird{at}cmft.nhs.uk

Abstract

Objective Congenital adrenal hyperplasia (CAH) is not currently included in the UK newborn screening programme. We investigated the hypothesis that, owing to non-specificity of symptoms, a proportion of males affected by salt-wasting (SW) CAH have died in infancy without being diagnosed.

Design Stored newborn screening blood spot samples were analysed for 17α-hydroxyprogesterone (17-OHP) in the following groups: Infants born in the North West of England, 1994 to 2006, who had died by 6 months age; (n=1198), a neonatal reference group (full-term n=100; preterm n=100) and a CAH positive control group. A newborn blood spot sample collected before diagnosis was available in 29/61 CAH patients recruited. SW CAH was present in 18/29 patients (16 males and 2 females). Samples from the deceased group with elevated 17-OHP were analysed for 8 common mutations in the 21-hydroxylase gene (CYP21A2).

Setting North West of England.

Results Grouped by gestational age, mean (maximum) blood spot 17-OHP in nmol/L was as follows. Deceased full-term n=279, 6 (107); deceased premature n=365, 28 (251); deceased unknown gestational age n=553, 13 (>394). In the SW positive control group, the lowest level of 17-OHP was 179 nmol/L and 14 had levels greater than the highest standard (>268 to >420 nmol/L). All samples from the deceased group with 17-OHP results >179 nmol/L (n=6) and a further 13 samples underwent mutation analysis. No mutations were identified.

Conclusions Our findings do not support the hypothesis that, in our unscreened population, males affected by SW CAH are dying prior to diagnosis.

  • Congenital adrenal hyperplasia
  • newborn screening
  • neonatal screening
  • 21-hydroxylase deficiency
  • infant mortality

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