Aspectos clínicos da fenilcetonúria em serviço de referência em triagem neonatal da Bahia

Evaluation of effectiveness and outcome of PKU screening and management in the State of Sergipe, Brazil

OBJECTIVES

Phenylketonuria (PKU) was the first inherited metabolic disease known to cause mental retardation for which a newborn screening program (NBS) was developed. The objective of this study was to evaluate the effectiveness of PKU NBS and the management of cases in the northeastern Brazilian state of Sergipe (SE).

MATERIALS AND METHODS

We reviewed the phenylalanine concentrations in filter-paper collected from the heel (PKUneo) of 43,449 newborns; blood concentrations obtained by venipuncture in the subjects with abnormal PKUneo; the children's age at several phases of the program, the incidence of the disease from January 2007 to June 2008; and metabolic control of the patients.

RESULTS

The coverage of NBS/SE was 78.93%. The children's age was 10 ± 7 days at PKUneo collection. Twelve children were recalled based on the PKUneo cutoff value at 28 ± 13 days. From these, the concentrations of phenylalanine collected by venipuncture were normal in five children. The incidence of hyperphenylalaninemia was 1/43,449, and of PKU was 1/8,690 (5 cases). One suspected subject died. Another death occurred in the cohort, in a confirmed PKU case. PKU treatment began within 51 ± 12 days of life. In the four patients under dietary phenylalanine restriction, metabolic control was often difficult.

CONCLUSIONS

PKU NBS/SE has satisfactory coverage and adequate cutoff for recalling patients and diagnosis, but the onset of treatment is delayed, and follow-up metabolic control is frequently inadequate.

[Evolution of the neonatal screening program in the state of Tocantins]

OBJECTIVE

To evaluate the Neonatal Screening Program in the State of Tocantins from 1995 to 2011.

MATERIALS AND METHODS

Data collection was conducted by means of interviews with those responsible for the service, by the analysis of medical records of patients diagnosed with phenylketonuria (PKU) and congenital hypothyroidism (CH) that were enrolled in the program, and by interviews with parents and/or guardians of the patients monitored.

RESULTS

Program coverage increased from 32.3% to 76.6% after the implementation of the National Newborn Screening Program (PNTN). The prevalence of PKU and CH was 1:28,309 and 1:4,632 live births, respectively. The mean ages at the collection of the first blood sample (PKU: 9.6 ± 6.3 days; CH: 13.3 ± 10.3 days) and at the beginning of the treatment (PKU: 57.0 ± 17.6 days; CH: 95,6 ± 57.6 days) were greater than recommended by the Ministry of Health. The quality of monitoring was considered satisfactory by 100% of the parents.

CONCLUSION

Although there have been great developments in neonatal screening program in this state, there is need for greater government incentives to optimize the program and to make the PNTN advance to its next phases.