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Previous Volume 337:963-969 October 2, 1997 Number 14 Next

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ABSTRACT

Background Many patients with cystic fibrosis are malnourished at the time of diagnosis. Whether newborn screening and early treatment may prevent the development of a nutritional deficiency is not known.

Methods We compared the nutritional status of patients with cystic fibrosis identified by neonatal screening or by standard diagnostic methods. A total of 650,341 newborn infants were screened by measuring immunoreactive trypsinogen on dried blood spots (from April 1985 through June 1991) or by combining the trypsinogen test with DNA analysis (from July 1991 through June 1994). Of 325,171 infants assigned to an early-diagnosis group, cystic fibrosis was diagnosed in 74 infants, including 5 with negative screening tests. Excluding infants with meconium ileus, we evaluated nutritional status for up to 10 years by anthropometric and biochemical methods in 56 of the infants who received an early diagnosis and in 40 of the infants in whom the diagnosis was made by standard methods (the control group). Pancreatic insufficiency was managed with nutritional interventions that included high-calorie diets, pancreatic-enzyme therapy, and fat-soluble vitamin supplements.

Results The diagnosis of cystic fibrosis was confirmed by a positive sweat test at a younger age in the early-diagnosis group than in the control group (mean age, 12 vs. 72 weeks). At the time of diagnosis, the early-diagnosis group had significantly higher height and weight percentiles and a higher head-circumference percentile (52nd, vs. 32nd in the control group; P = 0.003). The early-diagnosis group also had significantly higher anthropometric indexes during the follow-up period, especially the children with pancreatic insufficiency and those who were homozygous for the F508 mutation.

Conclusions Neonatal screening provides the opportunity to prevent malnutrition in infants with cystic fibrosis.

Source Information

From the Department of Pediatrics and Biostatistics, University of Wisconsin, Madison (P.M.F., M.R.K., A.L., G.S., R.E.K.), and the Department of Pediatrics, Medical College of Wisconsin, Milwaukee (W.T.B., M.S., E.H.M.).

Address reprint requests to Dr. Farrell at the University of Wisconsin Medical School, 1300 University Ave., Madison, WI 53706.

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