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Document Details : Title: Risk factors for elevated levels of 17-hydroxyprogesterone during neonatal intensive care unit admission Author(s): PAUWELS G, ALLEGAERT K, RÉGAL L, MEULEMANS A Journal: Acta Clinica Belgica Volume: 67 Issue: 2 Date: 2012 Pages: 88-93 DOI: 10.2143/ACB.67.2.1003109 Abstract : 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 ≤ 2000 g), 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 cut-off 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. |
