Five years of experience with biochemical cystic fibrosis newborn screening based on IRT/PAP in Germany

Pediatr Pulmonol. 2015 Jul;50(7):655-64. doi: 10.1002/ppul.23190. Epub 2015 Apr 23.


Background: Evidence from recent studies suggests that IRT/PAP protocols may be successfully used as a purely biochemical newborn screening (NBS) for cystic fibrosis (CF) that does not require genetic screening. However, the experience with the performance of different IRT/PAP protocols remains limited. In this study, we evaluated the performance of IRT/PAP-based CF-NBS used in two German regions between 2008 and 2013 in a large cohort.

Methods: In both regions slightly different IRT/PAP protocols were used to screen newborns for CF. In contrast to the original IRT/PAP protocol published by Sarles et al., both German protocols contained an IRT-dependent safety net strategy (CF-NBS positive, if IRT≥99.9th percentile). Positive rating of the screening result led to confirmatory diagnostics using sweat chloride testing and clinical assessment.

Findings: A total of 328,181 newborns were tested with IRT/PAP in Germany within 5 years. 639 of these newborns (0.19%) were tested positive, and 60 infants were diagnosed with CF leading to a sensitivity of 0.968 and a PPV (positive predictive value) of 0.097. Compared to IRT/DNA protocols, the PPV of IRT/PAP is lower, but PAP used as second tier test has the advantage of a lower detection rate of healthy carriers and CF patients with equivocal results.

Conclusions: Our results obtained in a large cohort of ∼330,000 newborns support the use of a purely biochemical IRT/PAP protocol as an acceptable alternative when genetic CF-NBS has to be avoided.

Keywords: Cystic fibrosis; biochemical screening; immunoreactive trypsinogen; newborn screening; pancreatitis associated protein.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, Neoplasm / blood*
  • Biomarkers / blood
  • Biomarkers, Tumor / blood*
  • Cohort Studies
  • Cystic Fibrosis / blood*
  • Cystic Fibrosis / diagnosis
  • Female
  • Germany
  • Humans
  • Infant
  • Infant, Newborn
  • Lectins, C-Type / blood*
  • Male
  • Neonatal Screening / methods*
  • Pancreatitis-Associated Proteins
  • Sensitivity and Specificity
  • Trypsinogen / blood*


  • Antigens, Neoplasm
  • Biomarkers
  • Biomarkers, Tumor
  • Lectins, C-Type
  • Pancreatitis-Associated Proteins
  • REG3A protein, human
  • Trypsinogen