Summary
Background: In the rare autosomal recessive disorder maple syrup urine disease (MSUD) the accumulation of the branched-chain amino acids and their metabolic products results in acute and chronic brain dysfunction. Since 2002, MSUD has been part of the extended newborn screening programme in Germany and Austria. Early diagnosis and intervention during the presymptomatic or early symptomatic period should improve the outcome of the patients, which would make the case for screening for MSUD. Aim: The aim of the study was to evaluate the clinical course and alterations of marker metabolites during the first weeks of life in 10 patients with classical MSUD detected by newborn screening (NBS) in comparison with the 10 youngest German patients diagnosed clinically. Method: Laboratory data as well as information on clinical course and management during the neonatal period were obtained retrospectively. Results: Patients detected in NBS presented with lower plasma leucine concentrations at confirmation of diagnosis and less severe clinical symptoms. Lowering of leucine to below a critical threshold of 1000 μmol/L was achieved earlier than in patients diagnosed on clinical grounds. Conclusion: After diagnosis in screening, treatment can be initiated before the occurrence of severe metabolic decompensation. However, a favourable effect can only be achieved with immediate transfer of the neonate to a metabolic centre for adequate treatment in case of a positive screening result.
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Abbreviations
- BCAA:
-
branched chain amino acid
- BCOA-DH:
-
branched-chain 2-oxo acid dehydrogenase
- DBS:
-
dried blood spot(s)
- MS/MS:
-
tandem mass spectrometry
- MSUD:
-
maple syrup urine disease
- NBS:
-
newborn screening
References
German Joint Committee (2004) Federal Screening guidelines for the newborn screening. Bundesanzeiger 60: 4833.
Heldt K, Schwahn B, Marquardt I, et al (2005) Diagnosis of MSUD by newborn screening allows early intervention without extraneous detoxification. Mol Genet Metab 84: 313–316.
Hilliges C, Awiszus D, Wendel U (1993) Intellectual performance of children with maple syrup urine disease. Eur J Pediatr 152: 144–147.
Hoffmann B, Helbling C, Schadewaldt P, et al (2006) Impact of longitudinal plasma leucine levels on the intellectual outcome in patients with classic MSUD. Pediatr Res 59: 17–20.
Jouvet P, Poggi F, Rabier D, et al (1997) Continuous venovenous haemodiafiltration in the acute phase of neonatal maple syrup urine disease. J Inherit Metab Dis 20: 462–472.
Kaplan P, Mazur A, Field M, et al (1991) Intellectual outcome in children with maple syrup urine disease. J Pediatr 119: 46–50.
Naughten E, Jenkins J, Francis D, et al (1982) Outcome of maple syrup urine disease. Arch Dis Child 57: 918–921.
Ogier de Baulny H, Saudubray J (2000) Branched-chain organic acidurias. In: Fernandes J, Saudubray J, van den Berghe G, eds. Inborn Metabolic Diseases. Diagnosis and Treatment. Berlin: Springer, 197–212.
Schäfer F, Straube E, Oh J, et al (1999) Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 14: 910–918.
Snyderman S (1988) Treatment and outcome of maple syrup urine disease. Acta Paediatr Jpn 30: 417–424.
Wendel U (1990) Maple syrup urine disease. In: Fernandes J, Saudubray J, Tada K, eds. Inborn Metabolic Diseases. Berlin: Springer, pp. 263–270.
Wilson J, Jungner G (1968) Principles and Practice of Screening for Disease. Geneva: World Health Organization.
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Communicating Editor: Rodney Pollitt
Competing interests: None declared
References to Electronic Databases: MSUD, OMIM 248600
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Simon, E., Fingerhut, R., Baumkötter, J. et al. Maple syrup urine disease: Favourable effect of early diagnosis by newborn screening on the neonatal course of the disease. J Inherit Metab Dis 29, 532–537 (2006). https://doi.org/10.1007/s10545-006-0315-y
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DOI: https://doi.org/10.1007/s10545-006-0315-y