The first 4 years - Outcome of children identified by newborn screening
for CF in Germany
Abstract
Background: Newborn screening (NBS) has been shown to improve CF disease
course and has been widely implemented worldwide. This monocentric study
compared children diagnosed by NBS vs. a cohort preceding the
implementation of NBS in Germany in 2016 to evaluate ascribed benefits
of NBS. Methods: We compared all children with confirmed CF diagnosis
(n=19, “NBS group”) out of all children presenting with positive NBS
at our center after implementation of NBS (n=100) to children diagnosed
with CF at our center within 4 years before NBS implementation (n=29,
“pre-NBS group”) for outcomes of anthropometry, gastrointestinal and
pulmonary disease manifestations and respiratory microbiology. Results:
Children diagnosed by NBS had a lower incidence of initial feeding
problems (15% vs. 41%), had a higher BMI z-score at diagnosis and
higher mean z-scores for BMI, weight and length during the study period.
Children in the pre-NBS group displayed higher proportions of
oxygen-dependent pulmonary exacerbations (10% vs. 0%), a significantly
lower amount of normal bacterial flora (p=0.005) along with a
significantly higher number of throat swab cultures positive for
Pseudomonas aeruginosa (p=0.0154) in the first year of life. Yet,
pulmonary imaging did not reveal less pulmonary morbidity in the NBS
compared to the pre-NBS group. Conclusions: Our results confirm that NBS
for CF leads to earlier diagnosis and improves nutritional outcomes in
early childhood. Although trajectories of structural lung damage at
early age were unaffected by NBS, NBS positive CF patients at preschool
age displayed less severe pulmonary exacerbations and pathological
bacteria in throat swabs.