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Kadıoğlu Yılmaz B, Bağcı Z. Delays in Newborn Screening for Phenylketonuria from Birth to Diagnosis and Factors Affecting This. CHILDREN (BASEL, SWITZERLAND) 2024; 11:571. [PMID: 38790566 PMCID: PMC11120001 DOI: 10.3390/children11050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/12/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
This study aims to evaluate the process of neonatal phenylketonuria (PKU) screening from birth to admission to the pediatric metabolism polyclinic, determining delays in the screening program and the factors influencing them. This study was conducted during 2021-2023. Blood collection dates, results, and probable parameters causing delays in the screening program were recorded. This study included 118 infants. Admission time to the polyclinic was (mean ± SD) 25.2 ± 12.6 days (min-max: 3.4-78.9 days). Admission time was significantly high for refugees, those whose parents were consanguineous, and those who had more heel-prick blood samples taken (p < 0.001, p = 0.005, and p < 0.001, respectively). The first heel-prick blood phenylalanine (phe) level was significantly negatively correlated with the admission time (p < 0.001). Patients' admission time whose first blood phe level < 240 μmol/L was statistically significantly higher than in those with ≥240 μmol/L (p < 0.001). We determined that there were delays in PKU screening from birth to admission to the polyclinic. Being a refugee, the presence of consanguineous marriages, the increase in the number of heel-prick tests, and blood phe levels at a range of 120-240 μmol/L were the factors that played a role in this delay. Taking steps to reduce the impact of these parameters can prevent delays in newborn PKU screening and increase the success of the screening program.
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Affiliation(s)
- Banu Kadıoğlu Yılmaz
- Department of Pediatric Metabolism, Konya City Hospital, University of Health Sciences, Konya 42020, Türkiye
- Department of Pediatric Nutrition and Metabolism, Faculty of Medicine, Selçuk University, Konya 42250, Türkiye
| | - Zafer Bağcı
- Department of Pediatrics, Konya City Hospital, University of Health Sciences, Konya 42020, Türkiye;
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Paermentier L, Cano A, Chabrol B, Roy A. Executive functions in preschool children with moderate hyperphenylalaninemia and phenylketonuria: a prospective study. Orphanet J Rare Dis 2023; 18:175. [PMID: 37400895 DOI: 10.1186/s13023-023-02764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The risk of neuropsychological disorders appears to be high in hyperphenylalaninemia (HPA). The hypothesis of executive function impairment is prominent in accounting for the neuropsychological phenotype in phenylketonuria (PKU) and is suspected in moderate hyperphenylalaninemia (MHP). However, the issue of early onset of executive disorders remains. The aim of this study was to explore the hypothesis of early executive dysfunction in HPA patients and the possible links with certain metabolic variables according to the new international classifications for patients with PKU and MHP. A group of 23 HPA children (12 PKU, 11 MHP) aged 3 to 5 years was included and compared to 50 control children. The two groups were comparable in terms of socio-demographics (age, sex, parental education level). Executive functions were assessed using performance-based tests and daily life questionnaires (parents and teachers). RESULTS Preschool HPA patients have comparable executive scores to control subjects. In contrast, PKU patients score significantly worse than MHP patients on 3 executive tests (verbal working memory, visual working memory and cognitive inhibition. There is no executive complaints in daily life (parents and teachers) for the 2 groups of patients. In addition, 3 correlations were identified between executive scores and Phe levels at inclusion, mean Phe level and variability of Phe levels throughout life. CONCLUSIONS Thus, there appears to be evidence of early executive dysfunction in PKU preschool-children, but not in MHP children. Occasionally, certain metabolic indicators can predict executive difficulties in young children with PKU.
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Affiliation(s)
- Laetitia Paermentier
- Reference Center of Hereditary Metabolic Diseases, AP-HM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France.
- Department of Paediatric Neurometabolism, AP-HM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France.
- Pays de la Loire Psychology Laboratory, EA4638, Faculty of Arts, Languages and Humanities, University of Angers, 49000, Angers, France.
| | - Aline Cano
- Reference Center of Hereditary Metabolic Diseases, AP-HM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Brigitte Chabrol
- Reference Center of Hereditary Metabolic Diseases, AP-HM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
- Department of Paediatric Neurometabolism, AP-HM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Arnaud Roy
- Pays de la Loire Psychology Laboratory, EA4638, Faculty of Arts, Languages and Humanities, University of Angers, 49000, Angers, France
- Learning Disabilities Referral Center and Nantes Neurofibromatosis Competence Center, for Women, Children and Adolescents, Nantes University Hospital, 44000, Nantes, France
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Chien YH, Hwu WL. The modern face of newborn screening. Pediatr Neonatol 2023; 64 Suppl 1:S22-S29. [PMID: 36481189 DOI: 10.1016/j.pedneo.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Newborn screening (NBS) has been developed for years to identify newborns with severe but treatable conditions. Taiwan's NBS system, after the initial setup for a total coverage of newborns in 1990s, was later optimized to ensure the timely return of results in infants with abnormal results. Advancements in techniques such as Tandem mass spectrometry enable the screening into a multiplex format and increase the conditions to be screened. Furthermore, advances in therapies, such as enzyme replacement therapy, stem cell transplantation, and gene therapy, significantly expand the needs for newborn screening. Advances in genomics and biomarkers discovery improve the test accuracy with the assistance of second-tier tests, and have the potential to be the first-tier test in the future. Therefore, challenge of NBS now is the knowledge gap, including the evidence of the long-term clinical benefits in large cohorts especially in conditions with new therapies, phenotypic variations and the corresponding management of some screened diseases, and cost-effectiveness of extended NBS programs. A short-term and a long-term follow-up program should be implemented to gather those outcomes better especially in the genomic era. Ethical and psychosocial issues are also potentially encountered frequently. Essential education and better informed consent should be considered fundamental to parallel those new tests into future NBS.
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Affiliation(s)
- Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan
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Paermentier L, Cano A, Chabrol B, Roy A. Neuropsychological Disorders in Moderate Hyperphenylalaninemia: Literature Review. Dev Neuropsychol 2023; 48:31-45. [PMID: 36594744 DOI: 10.1080/87565641.2022.2162902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Moderate hyperphenylalaninemia (mHPA) is a hydroxylase deficiency corresponding to phenylalanine levels, at newborn screening, below 360 μmol/l. The neurological impact of mHPA is usually considered to be very low, but few studies have investigated the neuropsychological profile of mHPA patients.A systematic review of the neuropsychological aspects of mHPA was therefore conducted.The results showed a preservation of cognitive functions (intelligence, memory, visuoperception…). However, several indicators point to executive difficulties in this population. In regard to the important impact of executive functions in daily life, it is essential to conduct other studies in mHPA patients by proposing an integrative approach.
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Affiliation(s)
- L Paermentier
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France.,Psychology Laboratory, University of Angers, Angers, France
| | - A Cano
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France
| | - B Chabrol
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France
| | - A Roy
- Psychology Laboratory, University of Angers, Angers, France.,Neurofibromatosis Clinic and Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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Cognitive function in untreated subjects with mild hyperphenylalaninemia: a systematic review. Neurol Sci 2022; 43:5593-5603. [DOI: 10.1007/s10072-022-06194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
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Vela-Amieva M, Alcántara-Ortigoza MA, Ibarra-González I, González-del Angel A, Fernández-Hernández L, Guillén-López S, López-Mejía L, Carrillo-Nieto RI, Belmont-Martínez L, Fernández-Lainez C. An Updated PAH Mutational Spectrum of Phenylketonuria in Mexican Patients Attending a Single Center: Biochemical, Clinical-Genotyping Correlations. Genes (Basel) 2021; 12:genes12111676. [PMID: 34828281 PMCID: PMC8620669 DOI: 10.3390/genes12111676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Establishing the genotypes of patients with hyperphenylalaninemia (HPA)/phenylketonuria (PKU, MIM#261600) has been considered a cornerstone for rational medical management. However, knowledge of the phenylalanine hydroxylase gene (PAH) mutational spectrum in Latin American populations is still limited. Herein, we aim to update the mutational PAH spectrum in the largest cohort of HPA/PKU Mexican patients (N = 124) reported to date. The biallelic PAH genotype was investigated by Sanger automated sequencing, and genotypes were correlated with documented biochemical phenotypes and theoretical tetrahydrobiopterin (BH4) responsiveness. Patients were biochemically classified as having classic PKU (50%, 62/124), mild PKU (20.2%, 25/124) and mild HPA (29.8%, 37/124). Furthermore, 78.2% of the included patients (97/124) were identified by newborn screening. A total of 60 different pathogenic variants were identified, including three novel ones (c. 23del, c. 625_626insC and c. 1315 + 5_1315 + 6insGTGTAACAG), the main categories being missense changes (58%, 35/60) and those affecting the catalytic domain (56.6%, 34/60), and c. 60 + 5G > T was the most frequent variant (14.5%, 36/248) mainly restricted (69.2%) to patients from the central and western parts of Mexico. These 60 types of variants constituted 100 different biallelic PAH genotypes, with the predominance of compound-heterozygous ones (96/124, 77%). The expected BH4 responsiveness based on the PAH genotype was estimated in 52% of patients (65/124), mainly due to the p. (Val388Met) (rs62516101) allele. Instead, our study identified 27 null variants with an allelic phenotype value of zero, with a predominance of c. 60 + 5G > T, which predicts the absence of BH4 responsiveness. An identical genotype reported in BIOPKUdb was found in 92/124 (74%) of our patients, leading to a genotype–phenotype concordance in 80/92 (86.9%) of them. The high number of variants found confirms the heterogeneous and complex mutational landscape of HPA/PKU in Mexico.
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Affiliation(s)
- Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
| | - Miguel Angel Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.A.A.-O.); (A.G.-d.A.); (L.F.-H.)
| | - Isabel Ibarra-González
- Unidad de Genética de la Nutrición, Instituto de Investigaciones Biomédicas, UNAM/Instituto Nacional de Pediatría, Ciudad de Mexico 04530, Mexico;
| | - Ariadna González-del Angel
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.A.A.-O.); (A.G.-d.A.); (L.F.-H.)
| | - Liliana Fernández-Hernández
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.A.A.-O.); (A.G.-d.A.); (L.F.-H.)
| | - Sara Guillén-López
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
| | - Lizbeth López-Mejía
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
| | - Rosa Itzel Carrillo-Nieto
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
| | - Leticia Belmont-Martínez
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
| | - Cynthia Fernández-Lainez
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de Mexico 04530, Mexico; (M.V.-A.); (S.G.-L.); (L.L.-M.); (R.I.C.-N.); (L.B.-M.)
- Correspondence: ; Tel.: +52-1-55-10840900 (ext. 1332)
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The financial and time burden associated with phenylketonuria treatment in the United States. Mol Genet Metab Rep 2019; 21:100523. [PMID: 31660292 PMCID: PMC6807265 DOI: 10.1016/j.ymgmr.2019.100523] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Phenylketonuria (PKU) imposes a substantial burden on people living with the condition and their families. However, little is known about the time cost and financial burden of having PKU or caring for a child with the condition. Methods and findings Primary data were collected with a detailed cost and utilization survey. Primary outcomes included utilization and out-of-pocket costs of medical services, medical formula, and prescribed low-protein food consumption, as well as the time and perceived effort involved in following the PKU diet. Respondents were people living with PKU or parents of children with PKU identified through a state newborn screening program database. Secondary administrative claims data were also used to calculate mean total, insurer, and out-of-pocket payments in inpatient, outpatient (office visits, emergency room, and laboratory tests), and pharmacy settings for privately insured persons with PKU. Payments were calculated for sapropterin and for PKU formula.In primary data analysis (children n = 32, adults n = 52), annual out-of-pocket costs were highest for low-protein foods (child = $1651; adult = $967) compared with other categories of care. The time burden of PKU care was high; families reported spending more than 300 h per year shopping for and preparing special diet foods.In secondary data analysis, children 12-17 years old had the highest average medical expenditures ($54,147; n = 140) compared to children 0-11 years old ($19,057; n = 396) and adults 18 years and older ($40,705; n = 454). Medication costs were the largest contributor to medical costs, accounting for 61-81% of total costs across age groups. Sapropterin was the largest driver of medication costs, accounting for 85% of child medication costs and 92% of adult medication costs. Conclusion Treatment for PKU incurs a substantial time and cost burden on persons with PKU and their families. Estimated medical expenditures using claims data varied by age group, but sapropterin represented the largest cost for PKU treatment from a payer perspective across age groups.
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Transient phenylketonuria in premature infants. Nutrition 2018; 59:180-181. [PMID: 30504004 DOI: 10.1016/j.nut.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/11/2018] [Indexed: 12/22/2022]
Abstract
Phenylketonuria (PKU) is an autosomal recessive inborn error of phenylalanine (phe) metabolism caused by a deficiency in the enzyme phenylalanine hydroxylase that converts phe into tyrosine. If left untreated, PKU results in increased phe concentrations in the blood and in the brain, which cause severe intellectual disability, epilepsy, and behavioral problems. These disorders can be prevented if a diet low in phe is introduced. This report focuses on a preterm newborn (gestational age 29 wk) with adequate weight (1290 g) and no family history of PKU. His parents had not received metabolic neonatal screening. A blood sample at 16 d of age and a weight of 1430 g showed phe 420 μmol/L, compatible with mild PKU. Mixed feeding was initiated with a formula free of phe (X-Phe), and breastfeeding was fortified with a contribution of 3.5 g/kg daily (2.5 g X-Phe and 1 g of high-value biological proteins). The next measurements of amino acid levels in the blood and urine were normal, and the progenitors study for PKU was negative. Normal feeding was reintroduced with normal neurologic and metabolic later evolution. The disorders of the metabolism of phe, in most cases, are due to a genetic condition. However, there are infrequent cases of transient hyperphenylalaninemia secondary to delayed maturation of the hydroxylation enzyme system. They are especially significant in premature infants. Although these forms have not been shown to cause sequelae, in view of high levels of phe in the blood, phe consumption must be restricted.
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