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KMID : 0918520160160010018
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Journal of the Korean Society of Inherited Metabolic Disease
2016 Volume.16 No. 1 p.18 ~ p.23
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Investigation of False Positive Rates Newborn Screening using Tandem Mass Spectrometry (TMS) Technology in Single Center
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Kim Hyun-Soo
Shin Son-Moon
Ko Sun-Young
Lee Yeon-Kyung
Park Sung-Won
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Abstract
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Objective: Newborn screening leads to improved treatment and disease outcomes, but false-positive newborn screening results may impact include parental stress and anxiety, perception of child as unhealthy, parent-child relationship dysfunction, and increased infant hospitalizations. The purpose of this study was to investigate of the false positive rates and the causative factors of false positive results in Tandem Mass Spectrometry (TMS) in single center.
Methods: Records were reviewed for all 18,872 subjects who were born in Cheill General Hospital, during January 1st, 2012 to December 31st, 2014. 17,292 neonates (91.62%) were tested for tandem mass screening almost in 2-5th day of life. Newborn babies whose first results were abnormal had been tested repeatedly by same methods in 7-14 day. If the results were abnormal again, further evaluation was performed. TMS analysis included data for the 43 disorders screened for using TMS broken down into three categories: fatty acid oxidation disorders, organic acidurias, and aminoacidopathies. The impact of several factors on increased false positive rates was analyzed using a multivariate analysis: time from birth to sample collection, birth weight, birth height, BMI, gender, gestational age, delivery type.
Results: Males of the subjects were 8942 (51.7%), female 8350 (48.3%), the mean gestational age was 38.6±1.7 weeks, the average birth weight 3,155.6±502.4 g, the average birth height 49.1±2.9 cm, and the average BMI 13.0±3.8 (kg/m2). Vaginal delivery cases were 9713 (56.2%), caesarean section 7,579 (43.8%). The average date of the inspection was 2.8±1.1 days. 224 cases were identified as TMS positive. All the subjects were false positive (222/17,292, 1.30%) except 2 cases (1 male; benign phenylketonuria and 1 female; Short chain acyl-CoA dehydrogenase deficiency). The false positive rates
were 0.61% in fatty acid oxidation disorders, 0.25% in organic acidurias, and 0.45% in aminoacidopathies. In our study, the date of inspection got late, the false positive rates got higher. Because almost the cases of late test date were in treatment in neonatal intensive care unit so their test date was affected by their medical conditions. False positive rate was higher in extreme immaturity≤27 weeks than newborns of gestational age >27 weeks [OR=6.957 (CI=1.273-38.008), p<0.025] and extremely low birth weight<1,000 g than newborns of birthweight ≥1,000 g [OR=5.616 (CI=1.134-27.820), p<0.035].
Conclusion: False positive rate of TMS was 1.30% in Cheil General Hospital. Lower gestational age the reporting of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting. of screening tests, and the ability to modify these important factors, may improve the screening process and reduce the need for retesting.
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KEYWORD
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Neonatal screening test, Tandem mass spectrometry, False positive
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