Diagnostic Transitions of Cystic Fibrosis and CRMS Compared After 12 Years of Newborn Screening in California

Abstract

Objective: To compare the long-term diagnostic transitions for cystic fibrosis (CF) and cystic fibrosis transmembrane conductance regulator (CFTR)- related metabolic syndrome (CRMS) side-by-side since the onset of newborn screening in California.

Study design: Using real-world data, we conducted a retrospective cohort study to compare long-term observations of CRMS and CF in California and the diagnostic transitions from one to the other using clinical and diagnostic metrics. The California Genetic Disease Screening Program newborn screening for CF employs an immunoreactive trypsinogen tier-1 laboratory test, followed by molecular testing. This approach captures CF and CRMS, a diagnosis of "watchful waiting" among infants at risk for CF but with signs and symptoms that may emerge outside the screening window. Waiting entails periodic diagnostic reviews that can continue for many years; the California Genetic Disease Screening Program routinely conducts 5 years of follow-up for each child identified with a disorder. We used categorial logistic regression to compare the transitions with CRMS.

Results: After screening 5 944 700 newborns between July 2007 and July 2019, 694 CF cases and 1257 CRMS cases were identified. Of the 1257 CRMS cases, 66 (5.2%, 95% CI 3.9%-6.4%) transitioned from CRMS to CF (CRMS2CF) at a mean age of 3.3 years (median = 2.9 years). CRMS2CF cases had longer follow-up periods and were more likely later to develop positive sweat chloride and fecal elastase test results after 6 months of life than other CRMS cases.

Conclusions: These results suggest that children who have a CRMS2CF transition are more likely to develop positive biochemical markers than other patients who are diagnosed as CRMS and have few clinical indications during the first 5 years of follow-up.

Keywords: CFSPID; CRMS; cystic fibrosis; newborn screening.