RISK FACTORS FOR ELEVATED LEVELS OF 17-HYDROXYPROGESTERONE DURING NEONATAL INTENSIVE CARE UNIT ADMISSION

被引:6
作者
Pauwels, G. [1 ]
Allegaert, K.
Regal, L. [1 ]
Meulemans, A. [2 ]
机构
[1] Univ Ziekenhuis Leuven, Metabool Ctr, Dienst Kindergeneeskunde, Louvain, Belgium
[2] Univ Libre Bruxelles, Pediat Lab, Brussels, Belgium
关键词
Congenital adrenal hyperplasia; 17-hydroxyprogesterone; neonatal screening; neonatal intensive care unit; false positive rate; CONGENITAL ADRENAL-HYPERPLASIA; STEROIDOGENESIS;
D O I
10.2143/ACB.67.2.2062637
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction - Screening for congenital adrenal hyperplasia (CAH) by measurement of 17-hydroxyprogesterone (17-OHP) in dried blood spots results in a high false positive rate among preterm newborns admitted in a neonatal intensive care unit (NICU). We searched for risk factors of this population for raised 17-OHP levels. Methods - We retrospectively collected clinical characteristics (prenatal, at birth, postnatal) in newborns with an increased 17-OHP level at initial screening 30 nmol/L for a birth weight > 2000 g and >= 60 nmol/L for a birth weight <= 2000g), that turned out to be false positive (no CAH). The correlation of these characteristics with individual 17-OHP levels was evaluated. We also performed a case-control study matched for gestational age (GA). Results - In 94 screened newborns 17-OHP levels were raised at initial screening. Negative correlations were found between 17-OHP levels and GA and birth weight, positive correlations with prenatal betamethasone administration and several parameters of respiratory disease. In a multiple regression model GA was the dominant variable. In the case control study with 91 index patients admitted to the NICU (91/1275 newborns admitted to the NICU, 7.1%) a positive correlation with respiratory disease was confirmed and cases had a significant higher birth weight and a significant lower incidence of prenatal betamethasone administration. Application of new cutoff tables adjusted by GA and/or day of sampling would have resulted in a reduction in false positive rate. Conclusion - The dominant risk factor for a false positive screening during NICU admission is GA. Prenatal administration of betamethasone and birth weight are more complex risk factors. These observations support the use of new cut-off values based on GA to reduce the problem of false positive screening.
引用
收藏
页码:88 / 93
页数:6
相关论文
共 23 条
  • [1] [Anonymous], 2009, DRAAIB NEON OPSP AAN
  • [2] Fetal growth and the function of the adrenal cortex in preterm infants
    Bolt, RJ
    van Weissenbruch, MM
    Popp-Snijders, C
    Sweep, CGJ
    Lafeber, HN
    Delemarre-van de Waal, HA
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2002, 87 (03) : 1194 - 1199
  • [3] Centrum voor bevolkingsonderzoek, 2007, DRAAIB NEON HIELPR, V6
  • [4] Doom E, 2009, SPE
  • [5] False positive rate in newborn screening for congenital adrenal hyperplasia (CAH)-ether extraction reveals two distinct reasons for elevated 17α-hydroxyprogesterone (17-OHP) values
    Fingerhut, Ralph
    [J]. STEROIDS, 2009, 74 (08) : 662 - 665
  • [6] Effect of single and multiple courses of prenatal corticosteroids on 17-hydroxyprogesterone levels: Implication for neonatal screening of congenital adrenal hyperplasia
    Gatelais, F
    Berthelot, J
    Beringue, F
    Descamps, P
    Bonneau, D
    Limal, JM
    Coutant, R
    [J]. PEDIATRIC RESEARCH, 2004, 56 (05) : 701 - 705
  • [7] ADRENAL STEROIDOGENESIS IN VERY-LOW-BIRTH-WEIGHT PRETERM INFANTS
    HINGRE, RV
    GROSS, SJ
    HINGRE, KS
    MAYES, DM
    RICHMAN, RA
    [J]. JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1994, 78 (02) : 266 - 270
  • [8] Adrenocortical function in the very low birth weight infant: Improved testing sensitivity and association with neonatal outcome
    Korte, C
    Styne, D
    Merritt, TA
    Mayes, D
    Wertz, A
    Helbock, HJ
    [J]. JOURNAL OF PEDIATRICS, 1996, 128 (02) : 257 - 263
  • [9] Longitudinal measurements of 17α-hydroxyprogesterone in premature infants during the first three months of life
    Linder, N
    Davidovitch, N
    Kogan, A
    Barzilai, A
    Kuint, J
    Mazkeret, R
    Sack, J
    [J]. ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 1999, 81 (03): : F175 - F178
  • [10] Martens E, 2009, SPE