Dear Gg,
I would double-check the units of measure. A value of "71 ng/dl" is completely normal. However, if the number is given in units "ng/ml," then "71" is high and I think you would still need to worry about CAH. (The two are off by a factor or 100, so 71 ng/ml=7100 ng/dl.)
Unfortunately, if they told you that values between 55-89 are possibly indicative of CAH, and anything over 90 is a definite, then---more than likely---they are measuring in "ng/ml." I also believe tthat most newborn screening programs in the US report results in "ng/ml."
Like Lisa, I want to commend you for making the extra effort to make sure that this child is taken care of and doesn’t fall through the cracks in the social justice system. Hopefully, he really is fine, but it’s probably good to be sure you are comparing apples to apples before making that conclusion.
Here is an article that may help to shed some light on the situation.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9003862&dopt=Abstract
| 1: J Pediatr. 1997 Jan;130(1):128-33. | Related Articles,[unauthorised script deleted] language=JavaScript1.2> Links |
re is
Improved precision of newborn screening for congenital adrenal hyperplasia using weight-adjusted criteria for 17-hydroxyprogesterone levels.
Allen DB, Hoffman GL, Fitzpatrick P, Laessig R, Maby S, Slyper A.
Department of Pediatrics, University of Wisconsin School of Medicine, Wisconsin State Laboratory of Hygiene, Marshfield Medical Center, and Children’s Hospital of Wisconsin, Milwaukee, USA.
OBJECTIVE: To evaluate the efficacy and efficiency of weight-adjusted threshold levels for 17-hydroxyprogesterone (17-OHP) in screening newborn infants for 21 hydroxylase deficiency-congenital adrenal hyperplasia (21-OH-D-CAH). DESIGN: Analysis of the number of false-positive reports and diagnoses in infants, of 21-OH-D-CAH with the use of two strategies. Before October 1993, separate criteria for definite abnormal 17-OHP levels were established and implemented for 41,846 infants on the basis of birth weight: either less than 2200 gm (17-OHP level, 90 ng/ml) or 2200 gm or more (40 ng/ml). To reduce the burden of follow-up testing in low birth weight infants, criteria for definite abnormal 17-OHP results were statistically determined for four, rather than two, birth weight divisions: 1299 gm or less (17-OHP level > or = 165 ng/ml), 1300 to 1600 gm (> or = 135 ng/ml), 1700 to 2200 gm (> or = 90 ng/ml), and more than 2200 gm (> or = 40 ng/ml). These criteria were applied to the next 149,684 infants screened, and rates of false-positive test results and of false-positive diagnoses of 21-OH-D-CAH were compared. RESULTS: Before implementation of four-tiered weight-adjusted 17-OHP criteria, 205 definite abnormal reports yielded four confirmed cases of 21-OH-D-CAH (positive predictive value = 2%; incidence of 21-OH-D-CAH = 1 in 10,461). With the revised criteria, 61 of 149,684 infants had definite abnormal results and 14 cases of 21-OH-D-CAH were confirmed (positive predictive value, 20%; incidence of 21-OH-D-CAH, 1 in 10,692). No undetected severe cases of 21-OH-D-CAH have been subsequently reported. CONCLUSIONS: Weight-adjusted criteria for 17-OHP levels in screening for 21 -OH-D-CAH markedly reduced the number of false-positive results requiring immediate follow-up testing, particularly among low birth weight infants. Increased specificity afforded by these criteria was not accompanied by diminished sensitivity in detecting severe cases. Long-term follow-up of this screened cohort will determine whether the goals of newborn screening for 21-OH-D-CAH are adequately and efficiently fulfilled by this approach.
PMID: 9003862 [PubMed - indexed for MEDLINE]