What is newborn screening?¹
Newborn screening is the practice of testing all babies in their first days of life for certain disorders and conditions that can hinder their normal development, affecting a child’s long-term health or survival. Each year, millions of babies in the U.S. are routinely screened for certain genetic, endocrine, and metabolic disorders. All newborn babies are required by the State to get tested typically before they leave the hospital. They are also tested for hearing loss and critical congenital heart defects (CCHDs) prior to discharge. To do the test, a nurse will take a few drops of blood from the newborn’s heel.
Why is newborn screening important?²
Each year, 4.1 million newborns are screened for congenital disorders in the United States. Of these, 4,000 infants are diagnosed as having a condition. It is estimated another 1,000 infants that have conditions go undetected. The conditions included in newborn screening can cause serious health problems starting in infancy or childhood. Early detection, diagnosis, and intervention can help prevent intellectual and physical disabilities, and life-threatening illnesses, enabling children to reach their full potential.
Why is newborn screening important to the rare disease community?³
Of the 7000 rare diseases, only 35 are included in the Recommended Universal Screening Panel (RUSP). Unfortunately, screening programs vary widely by state. While some states screen for fewer than 30 diseases, others screen for over 60. Although states ultimately determine what disorders their public health departments program will screen for, the RUSP establishes a recommended standardized list of disorders that every baby should be screened for. Serious problems can be prevented if disorders are detected right away. By knowing more about these very rare disorders and the advantages of early detection, the primary care physician can work with the child and family to develop a comprehensive plan of care.
How to locate a genetics professional?
To find a genetics professional in your community, check with your doctor for a referral. You can also contact your insurance company to find a medical geneticist or genetic counselor in your area who participates in your plan. For further information visit the NIH webpage on finding a genetics professional.
Firefly Fund’s NPC Newborn Screening Initiative had the opportunity to deliver a presentation at this year’s NNPDF Family conference, updating participants on the latest activities with this important community activity. We focused on two research initiatives: 1) the ScreenPlus pilot newborn screening study is making final preparations to launch in the state of New York, amidst the covid-19 pandemic; and 2) the NPC Sibling Study, being conducted in collaboration with a research entity called RDMD, to compare health outcomes of NPC-affected siblings based on timing of initiation of treatment. You can check out the presentation here. The Initiative also hosted its third quarter Working Group call in July. We welcomed researchers from RDMD to discuss the sibling study in greater detail. They outlined the development of recruitment materials that are in the final stages of preparation. As soon as these are ready to go, Firefly and other Working Group participants like NNPDF will be sharing these with the NPC community so we can encourage families to participate. The research – with a study protocol being developed by leading NPC clinicians Drs. Elizabeth Berry-Kravis, Marc Patterson, and Denny Porter – will go a long way to helping the NPC community to demonstrate the impact and importance of intervening earlier in disease progression to improve health outcomes for people affected with NPC.
Extra Extra: Read All About Parallels Between Testing for COVID-19 and Newborn Screening Testing for NPC
Test, Test, Test. It’s the mantra we’ve been hearing for months to help the United States get a handle on the spread of COVID-19. Leaders of the NPC community’s newborn screening initiative heard the messages, too and wondered, “how are the calls for testing for the coronavirus different from testing for NPC?” Turns out, there are a lot of parallels. 1. Like the power testing affords us as we confront COVID-19, knowledge can also empower families in the newborn screening environment; 2. As with COVID-19 testing, we need nationwide and consistent newborn screening; 3. Just like with COVID-19, rare diseases often go undetected at first. Early testing is the only way to know sooner and take action; 4. Just as we’re learning with COVID-19, we need to build the testing capacity of our nation’s laboratories so we can better manage diseases earlier; and 5. Like COVID-19 where knowing sooner means a person can take immediate steps to “stop the spread,” knowing sooner with rare diseases means parents can make informed decisions regarding interventions.
The insights, authored by Firefly Fund’s NPC Newborn Screening Initiative leaders, Pam Andrews and Allison May Rosen were published by Rare Daily. Please read the article and help spread the word. Thank you!
Pam Andrews and Allison Rosen’s well written article draws parallels in testing for rare diseases such as NPC and testing for COVID19. Read it here.
The NPC Community is engaged with a multi-disciplinary stakeholder group focused on adding NPC to newborn screening lists across the country (See Firefly Fund’s newborn screening initiative.) Since adding NPC to these lists would mean that all newborns would routinely be screened for this rare disease, it’s essential to demonstrate that intervening earlier in a patient’s disease progression is better and critical to improved health outcomes.
Within our small patient community, one way that leading NPC experts believe will help us tell this story is to look at families with multiple affected children.
Why is that? Often these families will have a child who, following significant symptom onset, is ultimately diagnosed with NPC. This diagnosis will trigger specific NPC testing of another child of the same family who may be diagnosed before the onset of visible signs and symptoms. NPC expert clinicians believe that if we are able to describe the different diagnostic and clinical journeys of these children – based on timing of intervention – we could have powerful evidence demonstrating the benefit of screening for NPC at birth, and the criticalness of earlier intervention.
What will we need for this research? 1) We will need to identify families with multiple children affected with NPC, both those who are currently living as well as those who may have passed. 2) An independent third party, RDMD, is providing a secure virtual filing cabinet for de-identified medical records from NPC families so that NPC experts can analyze the data in a effort to determine: a) how closely the course of disease is similar and b) what affect the timing of an intervention has on progression of disease.
Would you like to participate or like additional information? Please contact firstname.lastname@example.org and we can provide some more detail and discuss how you might partner with us on this important project. Thank you!
The NPC community is engaged in a multi-stakeholder effort to add NPC to newborn screening lists across the country (See Firefly Fund’s newborn screening initiative.) Since adding NPC to these lists would mean that all newborns would routinely be screened for this rare disease, it’s essential to demonstrate that intervening earlier in a patient’s disease progression is better and critical to improved health outcomes.
Within our small patient community, one way that leading NPC experts believe will help us tell this story is to look at families with multiple affected children.
Why is that? Often these families will have a child who, following significant symptom onset, is ultimately diagnosed with NPC. This diagnosis will trigger specific NPC testing of another child of the same family who – if affected – may be diagnosed before the onset of visible signs and symptoms. If we are able to describe the different diagnostic and clinical journeys of these children – based on timing of intervention – we could have powerful evidence demonstrating the benefit of screening for NPC at birth, and the criticalness of earlier intervention.
Please stay tuned to the NNPDF Newsletter and other NPC community information channels for an opportunity to participate in this important research project. Thank you!
The NPC community is engaged in a multi-stakeholder effort to add NPC to newborn screening lists across the country. Since adding any new condition to these lists would mean that any newborn would routinely be screened for a certain disease, it’s essential to demonstrate that the benefit to public health is greater than any burden to a family or to the larger public health system.
The federal government maintains a list of diseases and conditions that they have determined meet the standards for being included. That list, known as the Recommended Uniform Screening Panel or the RUSP, serves as the “Gold Standard” for states across the country that look to the federal government for advice when considering what to add to their own screening lists. In order to be included on the RUSP, a sponsoring organization must complete a nomination form that answers very specific questions regarding a condition’s “readiness” to be added. One of the questions asks for evidence that demonstrates the urgency of treatment. The application reviewers need to know how essential it is to identify a particular condition at birth so that an intervention can take place. Specifically, the RUSP nomination form asks, “How soon after birth must treatment be initiated to be effective?”
For NPC, this is an important and challenging question to answer. While there are several clinical trials ongoing to investigate the efficacy and safety of possible medications to treat NPC, we are still awaiting a first approval in the United States. Related to the gap that exists in an FDA-approved therapy, is the answer to the question of “when to treat.” To help gather the necessary evidence and expert opinion on this matter, the Firefly Newborn Screening Working Group has initiated the help of a Clinical Roundtable. This Roundtable is comprised of experts who are working to gain consensus regarding the timing for initiating treatment for patients positively identified with NPC following newborn screening. It’s important work that the Working Group not only believes will be essential for the quest for newborn screening, but also in the quest to improve clinical care for patients.
The calendar has turned to 2020 and Firefly’s NPC Newborn Screening Working Group is full of anticipation and excitement about the year ahead.
As we begin the year, Firefly notes the Working Group is set for a full year of activities designed to advance the research supporting adding NPC to newborn screening lists. This includes the launch of the first-ever newborn screening pilot study that will include NPC. This will be the first time anywhere newborns will be screened for NPC. Additionally, the group is poised to raise awareness among even more stakeholders about the importance of including NPC on newborn screening lists. This includes our first presentation at the World Orphan Drug Congress taking place in April. Of course none of this would be possible without the incredible and growing support from our partners in industry, academia, and the nonprofit world. Three years ago it was hard to imagine where our nascent efforts would be today. But, with continued commitments from all, we look forward to making even more progress on our common vision where all newborns are screened for NPC, enabling a diagnosis at birth.
Firefly Fund’s Newborn Screening Working Group completed its final meeting of the year in December – the Annual Stakeholder Meeting. While in Washington, DC, the Working Group reviewed the year’s activities and set sights on key research and advocacy activities for 2020. Key activities for the past year included a series of Working Group calls, the first annual NPC Clinical Roundtable, the first NPC community webinar delivered in partnership with the NNPDF, and major community presentations.
Significantly, we were also proud to announce the inclusion of NPC in the ScreenPlus pilot newborn screening study in New York, the largest consented multi-disorder newborn screening pilot study ever conducted in the United States.
Key external speakers at the stakeholder meeting included representatives from the Association of Public Health Laboratories and the American College of Medical Genetics and Genomics. Leaders from both groups discussed key barriers and opportunities we can expect to face on the path to adding NPC to newborn screening lists nationwide. Experts outlined what the NPC community will need to demonstrate in terms of “readiness” for routine newborn screening – such as having an accurate screen and effective treatment options. They also described challenges in the public health system that could delay adoption – such as having a provider group that can manage patients and enough capacity in state labs to add an additional test.
Looking ahead, Firefly is excited to welcome additional supporters to the NPC NBS Initiative, broadening stakeholder support for the effort from industry, the NPC Community and NPC/NBS experts. Learn more here.
It’s official! The ScreenPlus program in New York state that will include NPC received a major award from the National Institutes of Health that will allow the program to move forward. ScreenPlus is the most expansive consented pilot newborn screening study in the country, where families of newborns born at 8 New York hospitals will be offered the option to have their babies screened for an additional 13 disorders – including Niemann-Pick C. This is the first time any newborn, anywhere in the world, will be given the option of being screened for NPC at birth.
The Firefly Fund’s NPC Newborn Screening Working Group member Dr. Melissa Wasserstein of Montefiore Hospital in NY is leading the study. And Firefly is one of the funders supporting the program through a unique cost-sharing collaboration that also includes academic centers and several pharmaceutical companies.
NNPDF joins Firefly, all its Working Group members and supporting NPC stakeholders in congratulating Dr. Wasserstein on this major accomplishment. This study is history-in-the-making as the NPC community will begin to gather evidence regarding the importance of early diagnosis and intervention in the treatment of NPC. Learn more by clicking on this official announcement – and share the news with your networks!
September is Newborn Screening Awareness month – a great time to raise awareness about the efforts the Niemann Pick community is undertaking to add NPC to newborn screening lists nationwide. Led by the Firefly Fund’s Newborn Screening Working Group, all month long, you can follow updates on Twitter and LinkedIn about the importance of newborn screening, what it entails and what it would mean for the NPC community. For example, one Tweet noted, “Newborn screening can help families of children with rare diseases avoid a long diagnostic odyssey. Knowing sooner is better!” And another informed people that “Newborn screening is not just a test.” The NPC Working Group is working with a wide range of stakeholders to demonstrate how screening for NPC will fit into the US public health care system. That means demonstrating we can effectively screen, diagnose, refer and care for any family who receives an NPC diagnosis through newborn screening. Follow #Fireflyfund this month and beyond for newborn screening updates. Thank you!
Have you ever heard of baby’s first test? In every state across the nation, hours after birth, infants are tested for a limited number of harmful or potentially fatal disorders that aren’t otherwise apparent at birth. A simple blood test can inform families whether their newborn has a certain condition or not. And when a screening comes back positive, clinicians inform families about the possibility of their newborn having a rare disease. While certainly unexpected, knowledge can bring power. Early diagnosis and treatment can sometimes make the difference between lifelong impairment and healthy development.
Today, however, even though technology exists to detect the disease at birth, NPC is absent from our nation’s newborn screening programs. NNPDF is proud to be joining the Firefly Fund’s NPC Newborn Screening Working Group, focused on advancing the cause of newborn screening for NPC. This multi-disciplinary stakeholder Working Group includes NPC researchers and clinicians from academic centers of excellence and the NIH, representatives from several NPC family foundations, key industry partners, and NPC advocates. While diverse in expertise, the Working Group has a common goal: to advance the cause of newborn screening for NPC and solidify its inclusion on the federal government’s Recommended Uniform Screening Panel (RUSP). The RUSP is the gold standard states look to when selecting conditions to include in their public health screening program.
NNPDF looks forward to working on this critical endeavor, helping to accumulate scientific evidence that demonstrates the positive public health benefit of routinely screening all newborns for NPC. While there is still much unknown about this ultra-rare disease, there is general consensus regarding the value and importance of early diagnosis. Such a change in the disease paradigm would enable clinicians and families to determine much earlier how and when to intervene. And, hopefully, to improve patient outcomes.