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CF newborn screening and growth

In the UK, newborn screening (NBS) for cystic fibrosis (CF) became universal in 2007, so our first cohort of screened children will soon head into puberty. Older cohorts have been shown to have poorer growth compared to non-CF children: can we expect screened children to grow better? In Wisconsin, USA, they embarked on a randomised controlled trial of NBS back in 1985. They now report detailed puberty and growth data on their screened group compared to controls diagnosed with CF through symptoms (Zhang Z, et al. Pediatrics 2016. doi: 10.1542/peds.2015-2907). They found significant differences in final height at age 18 (NBS group mean 50th centile vs control 29th centile; p=0.02). However this couldn't be explained by differences in pubertal growth spurt: in boys, the ages at peak height velocity (PHV) did not differ, while in girls the screened group actually had a slightly later menarche (13.6 vs 12.2 years) and lower PHV.

The authors attribute the final height differences not to pubertal variation but rather to less favourable nutrition and general health in early childhood; they observed height differences of a similar order longitudinally from diagnosis. Even though both groups received optimal nutritional management after diagnosis, the critical …

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