Objective: To compare the incidence of diagnosis and morbidity in newborns
who were screened with newborns who were not screened for congenital adrena
l hyperplasia(CAH).
Design: A retrospective cohort study.
Setting: Arkansas, Oklahoma, and Texas. Patients: An unscreened population
in Arkansas and Oklahoma (n = 400 118) was compared with a screened populat
ion in Texas (n = 1 613 378) during a 5-year period. Simultaneous data were
collected on the incidence of diagnosis and associated morbidity in patien
ts with CAH.
Main Outcome Measures: Diagnosis of CAH, age (in days) at diagnosis, and fr
equency and length of initial hospitalization.
Results: The incidence of diagnosis of classic CAH per 100 000 newborns in
the unscreened cohort (5.75) and in the screened cohort (6.26) was similar
(relative risk, 0.92; 95% confidence interval, 0.58-1.44). The unscreened g
roup had 0.73 fewer male newborns with salt-wasting CAH diagnosed per 100 0
00 newborns (relative risk, 0.73; 95% confidence interval, 0.35-1.56). The
median age at diagnosis was 26 days for male newborns with salt-wasting CAI
-I in the unscreened cohort vs 12 days in the screened cohort (z = 2.49; P
= .01). Male newborns with simple-virilizing CAH and newborns with nonclass
ic CAH were detected only in the screened cohort.
Conclusions: There was not a statistically significant (P = .73) increase i
n the diagnosis of salt-wasting CAH in the screened cohort. Male newborns b
enefited as a result of significantly (P = .01) earlier diagnosis, reduced
morbidity, and shorter lengths of hospitalization. Large collaborative stud
ies or meta-analyses are needed to determine the life-saving benefits of sc
reening.