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Follow-up of fatty acid β-oxidation disorders in expanded newborn screening era

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Abstract

Fatty acid β-oxidation (FAO) disorders have a wide variety of symptoms, not usually evident between episodes of acute decompensations. Cardiac involvement is frequent, and severe ventricular arrhythmias are suspected of causing sudden death. Expanded newborn screening (ENS) for these disorders, hopefully, contribute to prevent potentially acute life-threatening events. In order to characterize acute decompensations observed in FAO-deficient cases identified by ENS, a retrospective analysis was performed, covering a period of 9 years. Demographic data, number/type of acute decompensations, treatment, and follow-up were considered. Eighty-three clinical charts, including 66 medium-chain acyl-CoA dehydrogenase deficiency (MCADD), 5 carnitine-uptake deficiency (CUD), 3 carnitine palmitoyltransferase I and II (CPT I/II) deficiency, 5 very long-chain acyl-CoA dehydrogenase deficiency (VLCADD), and 4 multiple acyl-CoA dehydrogenase deficiency (MADD) cases were reviewed. Nineteen patients had acute decompensations (1 CPT I, 1 CPT II, 3 MADD, 14 MCADD). Six patients developed symptoms previously to ENS diagnosis. Severe clinical manifestations included multiple organ failure, liver failure, heart failure, and sudden death. Long-chain FAO disorders had the highest number of decompensations per patient.

Conclusion: Despite earlier diagnosis by ENS, sudden deaths were not avoided and acute decompensations with severe clinical manifestations still occur as well.

What is Known:

• Severe ventricular arrhythmias are suspected to cause unexpected death in FAO disorders.

• Neonatal screening intends to reduce the incidence of severe metabolic crisis and death.

What is New:

• Acute severe decompensations occurred in FAO disorders diagnosed through neonatal screening.

• Sudden deaths were not avoided by starting treatment precociously.

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Abbreviations

CK:

Creatine kinase

CK-MB:

Creatine kinase muscle and brain subunits

CPT I:

Carnitine palmitoyltransferase I

CPT II:

Carnitine palmitoyltransferase II

CUD:

Carnitine-uptake deficiency

DBS:

Dry blood spot

DMD:

Duchenne muscular dystrophy

ENS:

Expanded newborn screening

FAO:

Fatty acid β-oxidation

LC-FAO:

Long-chain fatty acid oxidation disorders

MADD:

Multiple acyl-CoA dehydrogenase deficiency

MCADD:

Medium-chain acyl-CoA dehydrogenase deficiency

R.V.:

Refference values

VLCADD:

Very long-chain acyl-CoA dehydrogenase deficiency

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Authors and Affiliations

  1. Centro de Referência de Doenças Hereditárias do Metabolismo, Departamento de Pediatria Médica, Hospital de Santa Maria – CHULN, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal

    Patrícia Janeiro & Ana Gaspar

  2. Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – CHULN, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal

    Rita Jotta

  3. Laboratório de Metabolismos e Genética, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto Edificio F, 1649-099, Lisbon, Portugal

    Ruben Ramos, Cristina Florindo, Fátima V. Ventura & Isabel Tavares de Almeida

  4. Unidade de Rastreio Neonatal Metabolismo e Genética, Departamento de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal

    Laura Vilarinho

Authors
  1. Patrícia Janeiro
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  2. Rita Jotta
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  3. Ruben Ramos
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  4. Cristina Florindo
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  5. Fátima V. Ventura
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  6. Laura Vilarinho
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  7. Isabel Tavares de Almeida
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  8. Ana Gaspar
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Contributions

The planning, carrying out, and reporting of the work was done by Patrícia Janeiro with guidance from Isabel Tavares de Almeida. Rita Jotta had a major contribution in data collection. Ruben Ramos and Fátima Ventura contributed with biochemical and molecular studies. Laura Vilarinho provided neonatal screening data. Ana Gaspar provided clinical outcome data and contributed in the article review process.

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Correspondence to Patrícia Janeiro.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required.

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Communicated by Peter de Winter

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Janeiro, P., Jotta, R., Ramos, R. et al. Follow-up of fatty acid β-oxidation disorders in expanded newborn screening era. Eur J Pediatr 178, 387–394 (2019). https://doi.org/10.1007/s00431-018-03315-2

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  • DOI: https://doi.org/10.1007/s00431-018-03315-2

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