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Clinical Presentation of Inherited Metabolic Diseases in Newborns Hospitalised in an Intensive Care Unit

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IMD diagnosed in hospitalised newborns by pathophysiological group.

Pathophysiological group IMD n
Small molecules (accumulation/intoxication) n=15 Organic aciduria 4
  Propionic aciduria 1
  Methylmalonic aciduria 3
Maple syrup urine disease 4
Urea cycle disorders 3
  Citrullinaemia type 1* 2
  Ornithine transcarbamylase deficiency (OTC) 1
Galactosemia 3
  - Classic 2
  - Epimerase deficiency 1
Nonketotic hyperglycinemia 1
Small molecules (deficiency) n=1 Asparagine synthetase deficiency 1
Energy defects n=4 Carnitinepalmitoyltransferase 1 deficiency (CPT1) 1
Carnitine-acylcarnitine translocase deficiency (CACT) 1
Multiple oxidative phosphorylation defect (complexes IV-V-II+IV) 1
Combined oxidative phosphorylation defect type 13 1

Newborns’ demographic and clinical data (n=20).

Variable
Age at PICU admission, median (IQR), days 7.5 (3.25–9)
Female gender n (%) 13 (65)
Gestational age, median (IQR), weeks 38.5 (36–39)
Birth weight, mean (SD), grams 2831.3 (523.1)
Neonatal resuscitation n (%) 1 (5)
Pregnancy complications n (%) 6 (30)
Family history of IMD n (%) 4 (20)
Age at onset of symptoms, median (IQR), days 5 (1–7)
Symptom-free interval n (%) 16 (80)
Length of the symptom-free interval, median (OQR), days 5 (1–7)

Comparison of clinical manifestations between the two IMD groups.

Small molecules n=16 Energy defects n=4 p
Symptom-free interval n (%) 15 (93.8) 1 (25) 0.01*
Length of the symptom-free interval, median (IQR), days 5.5 (0–7.8) 3 (0–6.8) 0.3**
Encephalopathy n (%) 14 (87.5) 3 (75) 0.5*
Hypotonia n (%) 10 (62.5) 2 (50) 0.2*
Seizures n (%) 6 (37.5) 2 (50) 1*
Acute liver failure n (%) 3 (18.8) 0 1*
Heart failure n (%) 2 (12.5) 2 (50) 0.2*
Cardiac structural change n (%) 3 (18.8) 2 (50) 0.4*
Death n (%) 4 (25) 1 (25) 0.7*

Main alterations of diagnostic tests by pathophysiological group of IMD.

Diagnostic tests Small molecules group (n=16) Energy defects group (n=4) p*
Altered plasma aminoacids, n (%) 12 (75) 1 (25) 0.2
CK elevation, n (%) 11 (68.8) 2 (50) 0.6
Hyperlactatemia, n (%) 8 (50) 4 (100) 0.4
Glomerular renal dysfunction, n (%) 8 (50) 3 (75) 0.6
Metabolic acidosis with increased anion gap, n (%) 7 (43.8) 1 (25) 0.5
Organic aciduria, n (%) 7 (43.8) 3 (75) 0.2
Abnormal urine aminoacids, n (%) 7 (43.8) 0 0.08
Hyperammonemia, n (%) 6 (37.5) 1 (25) 1
DNPH urine test - positive, n (%) 6 (37.5) 0 0.2
Hypoglycemia, n (%) 6 (37.5) 2 (50) 0.4
Thrombocytopenia, n (%) 5 0 0.2
Leukopenia, n (%) 0 1 0.2
eISSN:
2719-535X
Lingua:
Inglese
Frequenza di pubblicazione:
Volume Open
Argomenti della rivista:
Medicine, Clinical Medicine, Pediatrics and Juvenile Medicine, Paediatric Haematology and Oncology, Public Health