How is Silver-Russell syndrome (SRS) diagnosed?

Updated: Feb 11, 2019
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Luis O Rohena, MD, MS, FAAP, FACMG  more...
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Even with recent advancements in molecular diagnosis, Silver-Russell syndrome remains a clinical diagnosis based on a combination of characteristic features and a scoring system. To date, about 40% of cases of suspected Silver-Russell syndrome remain unexplained by currently offered molecular investigations.

Several scoring systems exist in the literature, but a published international consensus statement on the clinical diagnosis, investigation, and management of Silver-Russell syndrome endorsed the Netchine-Harbison clinical scoring system (NH-CSS), based on favorable sensitivity (98%) and negative predictive (89%) values. [14]  The NH-CSS scoring system is based on six clinical criteria, including the following:

  • Degree of SGA
  • Postnatal growth failure
  • Relative macrocephaly at birth
  • Protruding forehead
  • Body asymmetry
  • Feeding difficulty and/or low body mass index (BMI)

The presence of at least four of these six factors was classified as "likely" Silver-Russell syndrome by Azzi et al, while a determination of "unlikely" Silver-Russell syndrome was reached if three or fewer factors were found during study. [15]

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