Frequencies of inherited organic acidurias and disorders of mitochondrial fatty acid transport and oxidation in Germany.
The lack of epidemiological data on the frequency and/or burden of organic acidurias (OA) and mitochondrial fatty acid transport and oxidation disorders (mtFATOD) is one reason for hesitation to expand newborn screening (NBS) by tandem mass spectrometry (MS-MS). From 1999 to 2000, the frequency of ten potentially treatable OA and mtFATOD was assessed by active nation-wide surveillance on cases presenting with clinical symptoms using the German Paediatric Surveillance Unit (ESPED) system. Case ascertainment was complemented by a second independent source: 3-monthly inquiries in the metabolic laboratories performing secondary selected screening for OA and mtFATOD. Frequency estimates for clinically symptomatic cases older than 7 days in a birth cohort of 844,575 conventionally screened children was compared to the frequency found in a cohort of 382,247 screened by MS-MS in Bavaria and Baden-Württemberg. The overall frequency of the ten conditions considered was 1:8,000 (95% CI 1:11,000-1:6,000) by MS-MS as compared to 1:23,000 (95% CI 1:36,000-1:17,000) in symptomatic cases presenting mainly with metabolic crisis. The contributions of medium-chain acyl-CoA dehydrogenase deficiency (MCADD), other mtFATOD and OA were 29, 4 and 13 among the 46 cases identified by MS-MS, and 19, 1 and 13 among the 33 clinically symptomatic cases, respectively. Acute metabolic crisis, with a lethal outcome in four patients, was reported for 22/33 clinically symptomatic cases. No clinically symptomatic cases were reported from cohorts with screened by MS-MS.


CONCLUSIONS
ten potentially treatable organic acidurias and mitochondrial fatty acid transport and oxidations disorders were more common than phenylketonuria with organic acidurias accounting for 28% of the cases detected by newborn screening and 39% of the cases identified on high risk screening. These conditions were related to considerable morbidity and mortality. Considerations for their inclusion in expanded newborn screening programmes might be warranted.
Hoffmann
Georg F
GF
Department of Paediatrics, University of Heidelberg, Germany.
von Kries
Rüdiger
R
Klose
Daniela
D
Lindner
Martin
M
Schulze
Andreas
A
Muntau
Ania C
AC
Röschinger
Wulf
W
Liebl
Bernhard
B
Mayatepek
Ertan
E
Roscher
Adelbert A
AA
D042964:Acyl-CoA Dehydrogenase / Q000172:deficiency*; D000592:Amino Acid Metabolism, Inborn Errors / Q000175:diagnosis / Q000453:epidemiology*; D020739:Brain Diseases, Metabolic, Inborn / Q000175:diagnosis / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008375:Maple Syrup Urine Disease / Q000175:diagnosis / Q000453:epidemiology; D015997:Neonatal Screening / Q000379:methods*
D042964:Acyl-CoA Dehydrogenase