High incidence of maternal vitamin B12 deficiency detected by newborn screening: first results from a study for the evaluation of 26 additional target disorders for the German newborn screening panel
Newborn screening (NBS) in Germany currently includes 15 target disorders. Recent diagnostic improvements suggest an extension of the screening panel.
Since August 2016, a prospective study evaluating 26 additional target disorders (25 metabolic disorders and vitamin B12-deficiency) in addition to the German screening panel is performed at the Newborn Screening Center Heidelberg. First-tier results from tandem-MS screening are complemented by second-tier strategies for 15 of the additional target disorders. NBS results of seven patients diagnosed symptomatically with one of the additional target disorders by selective screening since August 2016 are retrospectively evaluated.
Over a 13-month period, 68,418 children participated in the study. Second-tier analyses were performed in 5.4% of samples. Only 59 (0.1%) of study participants had abnormal screening results for one of the additional target disorders. Target disorders from the study panel were confirmed in 12 children: 1 3-hydroxy-3-methylglutaryl coenzyme A (CoA)-lyase deficiency, 1 citrullinemia type I, 1 multiple acyl-CoA dehydrogenase-deficiency, 1 methylenetetrahydrofolate reductase-deficiency, and 8 children with maternal vitamin B12-deficiency. In addition, six of seven patients diagnosed symptomatically outside the study with one of the target disorders would have been identified by the study strategy in their NBS sample.
Within 13 months, the study “Newborn Screening 2020” identified additional 12 children with treatable conditions while only marginally increasing the recall rate by 0.1%. Maternal vitamin B12-deficiency was the most frequent finding. Even more children could benefit from screening for the additional target disorders by extending the NBS panel for Germany and/or other countries.
KeywordsMetabolic disorders Newborn screening Second-tier Vitamin B12 deficiency
GG contributed to study design, collection, evaluation and interpretation of data, drafting and writing of the manuscript. JFH contributed to contribution and interpretation of data, and revision of the manuscript. PF contributed to study design, data acquisition and management, and revision of the manuscript. PM and GK contributed to development of the laboratory methods, contribution and interpretation of data, and revision of the manuscript. JGO contributed to study design, development of the laboratory methods, and revision of the manuscript. GFH contributed to study design, interpretation of data, and revision of the manuscript. All authors approved the final version of the manuscript.
This study is generously supported by the Dietmar Hopp Foundation, St. Leon-Rot, Germany. The authors confirm independence from the sponsor; the content of the article has not been influenced by the sponsor.
Compliance with ethical standards
The study “Newborn Screening 2020” as well as retrospective evaluation of NBS results of patients diagnosed by selective screening has been approved by the Ethics Committee of the University Hospital Heidelberg (no. S-533/2015). Written informed consent was obtained from parents before participation of children in the study “Newborn Screening 2020”.
Conflict of interest
GG received a lecture fee from MetaX, Friedberg; JFH, PF, GK, PM, JGO, and GFH report no disclosures.
- 8.Advisory Committee on Heritable Disorders in Newborns and Children. Health Resources and Services Administration. Recommended Uniform Screening Panel. https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html. Accessed 13 Mar 2018.
- 12.la Marca G, Malvagia S, Pasquini E, Innocenti M, Donati MA, Zammarchi E. Rapid 2nd-tier test for measurement of 3-OH-propionic and methylmalonic acids on dried blood spots: reducing the false-positive rate for propionylcarnitine during expanded newborn screening by liquid chromatography-tandem mass spectrometry. Clin Chem. 2007;53:1364–9.CrossRefPubMedCentralGoogle Scholar
- 18.Gramer G, Okun JG, Hoffmann GF. Pilot study for evaluation of 21 additional metabolic disorders for the German newborn screening panel. J Inherit Metab Dis. 2016;39(Suppl 1):75.Google Scholar
- 19.German Society for Newborn Screening. Screening reports. http://www.screening-dgns.de/reports.php. Accessed 6 Mar 2017.
- 23.Monostori P, Klinke G, Richter S, Baráth Á, Fingerhut R, Baumgartner MR, et al. Simultaneous determination of 3-hydroxypropionic acid, methylmalonic acid and methylcitric acid in dried blood spots: second-tier LC-MS/MS assay for newborn screening of propionic acidemia, methylmalonic acidemias and combined remethylation disorders. PLoS One. 2017;12:e0184897.CrossRefPubMedCentralGoogle Scholar
- 28.Richter M, Beoing H, Grünewald-Funk D, Heseker H, Kroke A, Leschik-Bonnet E, et al. Vegan Diet–Position of the German Nutrition Society (DGE). Ernährungs Umschau. 2016;63:92–102.Google Scholar
- 29.Reinson K, Künnapas K, Kriisa A, Vals M, Muru K, Õunap K. Very high incidence of low vitamin B12 in estonian newborns. Meeting Report ISNS 9th International Symposium, 11–14 Sep 2016, The Hague, The Netherlands.Google Scholar
- 43.Weisfeld-Adams JD, Bender HA, Miley-Akerstedt A, Frempong T, Schrager NL, Patel K, et al. Neurologic and neurodevelopmental phenotypes in young children with early-treated combined methylmalonic acidemia and homocystinuria, cobalamin C type. Mol Genet Metab. 2013;110:241–7.CrossRefPubMedCentralGoogle Scholar
- 45.Weisfeld-Adams JD, Morrissey MA, Kirmse BM, Salveson BR, Wasserstein MP, McGuire PJ, et al. Newborn screening and early biochemical follow-up in combined methylmalonic aciduria and homocystinuria, cblC type, and utility of methionine as a secondary screening analyte. Mol Genet Metab. 2010;99:116–23.CrossRefPubMedCentralGoogle Scholar