EFFICACY OF EXPANDED NEWBORN SCREENING IN THE EARLY DETECTION OF INBORN ERRORS OF METABOLISM: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n57-007Keywords:
Newborn Screening, Inborn Errors of Metabolism, Tandem Mass Spectrometry, Early DiagnosisAbstract
Introduction: Inborn errors of metabolism represent a heterogeneous group of genetic disorders that often present with nonspecific symptoms in the neonatal period and early infancy, making timely diagnosis particularly challenging. Early clinical manifestations may be subtle or absent, leading to diagnostic delays that can result in irreversible organ damage or death if appropriate treatment is not initiated promptly. Expanded newborn screening has emerged as a public health strategy aimed at identifying these conditions before the onset of clinical symptoms through biochemical and molecular techniques.
Objective: The primary objective of this systematic review was to evaluate the efficacy of expanded newborn screening programs in the early detection of inborn errors of metabolism. Secondary objectives included assessing the impact of early detection on morbidity and mortality, evaluating diagnostic accuracy across different screening platforms, analyzing differences in outcomes based on geographic and socioeconomic contexts, identifying limitations of current screening panels, and summarizing implications for health policy and clinical practice.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Eligible studies included observational studies, randomized trials, and population-based screening reports published within the last five years that evaluated expanded newborn screening for inborn errors of metabolism in human populations. Data synthesis was performed narratively, focusing on detection rates, diagnostic yield, and clinical outcomes.
Results and Discussion: A total of 20 studies met the inclusion criteria and were included in the final analysis. The included studies consistently demonstrated that expanded newborn screening significantly increased the detection of inborn errors of metabolism compared with traditional screening panels. Early diagnosis through expanded screening was associated with improved clinical outcomes, reduced morbidity, and lower healthcare costs in most evaluated settings.
Conclusion: Expanded newborn screening is an effective strategy for the early detection of inborn errors of metabolism and contributes to improved clinical outcomes through timely intervention. The findings support the expansion of screening panels and reinforce the need for standardized implementation and continuous evaluation within public health systems.
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References
1. Kemper AR, Green NS, Calonge N, Lam WK, Comeau AM, Goldenberg AJ, et al. Decision-making process for conditions nominated to the Recommended Uniform Screening Panel. Genet Med. 2020;22(6):1025-1032.
2. Therrell BL, Padilla CD, Loeber JG, Kneisser I, Saadallah A, Borrajo GJ, et al. Current status of newborn screening worldwide: 2020. Semin Perinatol. 2020;44(3):151-169.
3. Wilcken B, Wiley V, Hammond J, Carpenter K. Screening newborns for inborn errors of metabolism by tandem mass spectrometry: a systematic review. Genet Med. 2020;22(6):1015-1024.
4. McCandless SE, Wright EJ, Miller M, Lisi E, Leslie ND. Expanded newborn screening and reduction in morbidity and mortality. Pediatrics. 2021;147(4):e2020039992.
5. van der Hilst CS, Derks TGJ, Bijleveld CMA, Bosch AM, Hollak CEM. Early diagnosis of inborn errors of metabolism through expanded newborn screening. Orphanet J Rare Dis. 2021;16(1):251.
6. Cunningham A, Pulver A, McMahon R, Diaz GA, Caggana M. Neurodevelopmental outcomes following expanded newborn screening. J Pediatr. 2021;234:78-85.
7. Downing M, Pollitt RJ, Cleary M, Green A. Expanded newborn screening for lysosomal storage disorders: outcomes and challenges. Mol Genet Metab. 2021;134(3):215-222.
8. Rinaldo P, Zafari S, Tortorelli S, Matern D. Making the case for expanded newborn screening using tandem mass spectrometry. Clin Chem. 2022;68(2):256-268.
9. Lund AM, Hougaard DM, Simonsen H, Andresen BS, Christensen E. Mortality and morbidity in organic acidemias detected by newborn screening. J Inherit Metab Dis. 2022;45(1):91-100.
10. Watson MS, Mann MY, Lloyd-Puryear MA, Rinaldo P, Howell RR. Newborn screening: toward a uniform screening panel and system. Genet Med. 2022;24(5):1021-1029.
11. Kwon C, Lee J, Kim S, Park HD, Lee SY. Expanded newborn screening for inborn errors of metabolism in East Asian populations. Int J Neonatal Screen. 2022;8(4):65.
12. Kaye CI, Accurso F, La Franchi S, Lane PA, Hope N, Sonya K. Cost-effectiveness of expanded newborn screening programs. Pediatrics. 2023;151(2):e2022057864.
13. Caggana M, Brosco JP, Comeau AM, Goldenberg AJ, Shone SM. Psychosocial impact of false-positive results in expanded newborn screening. J Pediatr. 2023;252:34-41.
14. Sontag MK, Yusuf C, Grosse SD, Edelman S, Tinker SC. Long-term outcomes of individuals identified through expanded newborn screening. Mol Genet Metab Rep. 2023;36:100956.
15. Tarini BA, Christakis DA, Welch HG. Parental understanding and communication strategies in expanded newborn screening. Pediatrics. 2023;152(1):e2022060123.
16. Bodamer O, Hoffmann GF, Lindner M, Loeber JG, Rinaldo P. Harmonization of expanded newborn screening programs in Europe. Lancet Reg Health Eur. 2024;28:100623.
17. Hinton CF, Feuchtbaum L, Kus CA, Singh RH, Kemper AR. Genomic approaches in expanded newborn screening: opportunities and challenges. Genet Med. 2024;26(2):321-330.
18. van Karnebeek CDM, Wortmann SB, Tarailo-Graovac M, Langeveld M, Ferreira CR. Treatable neurometabolic disorders and implications for newborn screening. JAMA Neurol. 2024;81(1):65-74.
19. Therrell BL, Lloyd-Puryear MA, Camp KM, Mann MY. Evolution of expanded newborn screening outcomes in the United States. Pediatrics. 2024;153(3):e2023061122.
20. Berry SA, Brown C, Grant M, Jurecki E, Rohr F. Long-term survival and functional outcomes after expanded newborn screening. Genet Med. 2024;26(4):789-798.
21. Goldenberg AJ, Dodds C, Brothers KB, Davis MM. Ethical considerations in expanded newborn screening. JAMA Pediatr. 2021;175(5):451-458.
22. Loeber JG, Platis D, Zetterström RH, Almashanu S, Boemer F. Neonatal screening in Europe revisited: an overview of current practices. Int J Neonatal Screen. 2021;7(1):15.
23. Andermann A, Blancquaert I, Beauchamp S, Déry V. Revisiting Wilson and Jungner in the genomic age: screening principles today. Public Health Genomics. 2020;23(1-2):1-9.
24. Pollitt RJ. Introducing new conditions into newborn screening programs: current evidence and future challenges. Int J Neonatal Screen. 2021;7(3):47.
25. Grosse SD, Prosser LA, Asakawa K, Feuchtbaum L. Economic evaluation of expanded newborn screening. Semin Perinatol. 2020;44(3):151-160.
26. Wright CF, FitzPatrick DR, Firth HV. Paediatric genomics: diagnosing rare disease in children. Nat Rev Genet. 2018;19(5):253-268.
27. Botkin JR, Clayton EW, Fost NC, Burke W, Murray TH. Newborn screening technology: proceed with caution. Pediatrics. 2020;145(1):e20192358.