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pdfAttachment I--Newborn Screening PROGRAM data collection instrument
Form Approved
OMB No. 09200879
Expiration Date: 03/31/2014
Thank you for providing input as part of our effort to demonstrate the capacity and impact of state newborn screening
programs. For each condition listed in the tables that follow please provide for your state: the first year of statewide
screening and the number of confirmed cases in 2009, 2010, and 2011.
Where the number of cases for a condition exceeds the largest value in the drop down menu, note the year and actual
number of cases in the corresponding comments section.
*1. State
*2. Organic Acid Conditions
Year Started
Statewide
Screening
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
PROPPropionic acidemia
6
6
6
6
MUTMethylmalonic acidemia
6
6
6
6
6
6
6
6
IVAIsovaleric acidemia
6
6
6
6
3MCC3MethylcrotonylCoA
6
6
6
6
6
6
6
6
6
6
6
6
ßKTßKetothiolase deficiency
6
6
6
6
GA1Glutaric acidemia type I
6
6
6
6
(methylmalonylCoA mutase)
Cbl A,BMethylmalonic acidemia
(cobalamin disorders)
carboxylase deficiency
HMG3Hydroxy3methyglutaric
aciduria
MCDHolocarboxylase synthase
deficiency
Comments about Organic Acid Conditions. Be sure to note here the year and # of cases for any condition where
the # confirmed cases exceeds the drop down maximum.
5
6
Public reporting burden of this collection of information is estimated to average 38 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D74, Atlanta, Georgia
30333; ATTN: PRA (09200879).
Attachment I--Newborn Screening PROGRAM data collection instrument
*3. Fatty Acid Oxidation Conditions
Year Started
Statewide
Screening
CUDCarnitine uptake defect/carnitine
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
transport defect
MCADMediumchain acylCoA
dehydrogenase deficiency
VLCADVery longchain acylCoA
dehydrogenase deficiency
LCHADLongchain L3 hydroxyacylCoA
dehydrogenase deficiency
TFPTrifunctional protein deficiency
Comments about Fatty Acid Oxidation Conditions. Be sure to note here the year and # of cases for any condition
where the # confirmed cases exceeds the drop down maximum.
5
6
*4. Amino Acid Conditions
Year Started
Statewide
Screening
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
ASAArgininosuccinic aciduria
6
6
6
6
CITCitrullinemia, type I
6
6
6
6
MSUDMaple syrup urine disease
6
6
6
6
HCYHomocystinuria
6
6
6
6
PKUClassic phenylketonuria
6
6
6
6
TYR ITyrosinemia, type I
6
6
6
6
Comments about Amino Acid Conditions. Be sure to note here the year and # of cases for any condition where the
# confirmed cases exceeds the drop down maximum.
5
6
Attachment I--Newborn Screening PROGRAM data collection instrument
*5. Endocrine Disorders
Year Started
Statewide
Screening
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
CHPrimary congenital hypothyroidism
6
6
6
6
CAHCongenital adrenal hyperplasia
6
6
6
6
Comments about Endocrine Disorders. Be sure to note here the year and # of cases for any condition where the #
confirmed cases exceeds the drop down maximum.
5
6
*6. Hemoglobin Disorders
Year Started
Statewide
Screening
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
Hb SSS,S disease (Sickle cell anemia)
6
6
6
6
Hb S/ßThS, βetathalassemia
6
6
6
6
Hb S/CS,C disease
6
6
6
6
Comments about Hemoglobin Disorders. Be sure to note here the year and # of cases for any condition where the
# confirmed cases exceeds the drop down maximum.
5
6
*7. Other Disorders
Year Started
Statewide
Screening
# Confirmed
# Confirmed
# Confirmed
Cases, 2009
Cases, 2010
Cases, 2011
BIOTBiotinidase deficiency
6
6
6
6
CCHDCritical congenital heart disease
6
6
6
6
CFCystic fibrosis
6
6
6
6
GALTClassic galactosemia
6
6
6
6
HEARHearing loss
6
6
6
6
SCIDSevere combined
6
6
6
6
immunodeficiences
Comments about Other Disorders. Be sure to note here the year and # of cases for any condition where the #
confirmed cases exceeds the drop down maximum.
5
6
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |