Diagnosis of Cystic Fibrosis in Screened Populations

Philip M. Farrell, Terry B. White, Michelle Howenstine, Anne Munck, Richard B. Parad, Margaret Rosenfeld, Olaf Sommerburg, Frank J. Accurso, Jane C. Davies, Michael J. Rock, Don B. Sanders, Michael Wilschanski, Isabelle Sermet-Gaudelus, Hannah Blau, Silvia Gartner, Susanna A. McColley

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective Cystic fibrosis (CF) can be difficult to diagnose, even when newborn screening (NBS) tests yield positive results. This challenge is exacerbated by the multitude of NBS protocols, misunderstandings about screening vs diagnostic tests, and the lack of guidelines for presumptive diagnoses. There is also confusion regarding the designation of age at diagnosis. Study design To improve diagnosis and achieve standardization in definitions worldwide, the CF Foundation convened a committee of 32 experts with a mission to develop clear and actionable consensus guidelines on diagnosis of CF with an emphasis on screened populations, especially the newborn population. A comprehensive literature review was performed with emphasis on relevant articles published during the past decade. Results After reviewing the common screening protocols and outcome scenarios, 14 of 27 consensus statements were drafted that apply to screened populations. These were approved by 80% or more of the participants. Conclusions It is recommended that all diagnoses be established by demonstrating dysfunction of the CF transmembrane conductance regulator (CFTR) channel, initially with a sweat chloride test and, when needed, potentially with newer methods assessing membrane transport directly, such as intestinal current measurements. Even in babies with 2 CF-causing mutations detected via NBS, diagnosis must be confirmed by demonstrating CFTR dysfunction. The committee also recommends that the latest classifications identified in the Clinical and Functional Translation of CFTR project [http://www.cftr2.org/index.php] should be used to aid with CF diagnosis. Finally, to avoid delays in treatment, we provide guidelines for presumptive diagnoses and recommend how to determine the age of diagnosis.

Original languageEnglish (US)
Pages (from-to)S33-S44
JournalJournal of Pediatrics
Volume181
DOIs
StatePublished - Feb 1 2017

Fingerprint

Cystic Fibrosis
Population
Guidelines
Cystic Fibrosis Transmembrane Conductance Regulator
Sweat
Routine Diagnostic Tests
Chlorides
Mutation
Membranes

Keywords

  • CF screen positive, inconclusive diagnosis
  • CFTR-related metabolic syndrome
  • immunoreactive trypsinogen
  • intestinal current measurement
  • nasal potential difference
  • newborn screening
  • pancreatitis associated protein
  • sweat test

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Farrell, P. M., White, T. B., Howenstine, M., Munck, A., Parad, R. B., Rosenfeld, M., ... McColley, S. A. (2017). Diagnosis of Cystic Fibrosis in Screened Populations. Journal of Pediatrics, 181, S33-S44. https://doi.org/10.1016/j.jpeds.2016.09.065

Diagnosis of Cystic Fibrosis in Screened Populations. / Farrell, Philip M.; White, Terry B.; Howenstine, Michelle; Munck, Anne; Parad, Richard B.; Rosenfeld, Margaret; Sommerburg, Olaf; Accurso, Frank J.; Davies, Jane C.; Rock, Michael J.; Sanders, Don B.; Wilschanski, Michael; Sermet-Gaudelus, Isabelle; Blau, Hannah; Gartner, Silvia; McColley, Susanna A.

In: Journal of Pediatrics, Vol. 181, 01.02.2017, p. S33-S44.

Research output: Contribution to journalArticle

Farrell, PM, White, TB, Howenstine, M, Munck, A, Parad, RB, Rosenfeld, M, Sommerburg, O, Accurso, FJ, Davies, JC, Rock, MJ, Sanders, DB, Wilschanski, M, Sermet-Gaudelus, I, Blau, H, Gartner, S & McColley, SA 2017, 'Diagnosis of Cystic Fibrosis in Screened Populations', Journal of Pediatrics, vol. 181, pp. S33-S44. https://doi.org/10.1016/j.jpeds.2016.09.065
Farrell PM, White TB, Howenstine M, Munck A, Parad RB, Rosenfeld M et al. Diagnosis of Cystic Fibrosis in Screened Populations. Journal of Pediatrics. 2017 Feb 1;181:S33-S44. https://doi.org/10.1016/j.jpeds.2016.09.065
Farrell, Philip M. ; White, Terry B. ; Howenstine, Michelle ; Munck, Anne ; Parad, Richard B. ; Rosenfeld, Margaret ; Sommerburg, Olaf ; Accurso, Frank J. ; Davies, Jane C. ; Rock, Michael J. ; Sanders, Don B. ; Wilschanski, Michael ; Sermet-Gaudelus, Isabelle ; Blau, Hannah ; Gartner, Silvia ; McColley, Susanna A. / Diagnosis of Cystic Fibrosis in Screened Populations. In: Journal of Pediatrics. 2017 ; Vol. 181. pp. S33-S44.
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abstract = "Objective Cystic fibrosis (CF) can be difficult to diagnose, even when newborn screening (NBS) tests yield positive results. This challenge is exacerbated by the multitude of NBS protocols, misunderstandings about screening vs diagnostic tests, and the lack of guidelines for presumptive diagnoses. There is also confusion regarding the designation of age at diagnosis. Study design To improve diagnosis and achieve standardization in definitions worldwide, the CF Foundation convened a committee of 32 experts with a mission to develop clear and actionable consensus guidelines on diagnosis of CF with an emphasis on screened populations, especially the newborn population. A comprehensive literature review was performed with emphasis on relevant articles published during the past decade. Results After reviewing the common screening protocols and outcome scenarios, 14 of 27 consensus statements were drafted that apply to screened populations. These were approved by 80{\%} or more of the participants. Conclusions It is recommended that all diagnoses be established by demonstrating dysfunction of the CF transmembrane conductance regulator (CFTR) channel, initially with a sweat chloride test and, when needed, potentially with newer methods assessing membrane transport directly, such as intestinal current measurements. Even in babies with 2 CF-causing mutations detected via NBS, diagnosis must be confirmed by demonstrating CFTR dysfunction. The committee also recommends that the latest classifications identified in the Clinical and Functional Translation of CFTR project [http://www.cftr2.org/index.php] should be used to aid with CF diagnosis. Finally, to avoid delays in treatment, we provide guidelines for presumptive diagnoses and recommend how to determine the age of diagnosis.",
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