title: Causes of delay in referral of patients with phenylketonuria to a specialized reference centre in Mexico.
abstract: OBJECTIVE
  To expose causes leading to the delayed arrival of phenylketonuria (PKU) patients at a governmental reference centre (RC), and to describe their clinical characteristics.  Material and methods PKU files registered during the past 18 years at the National Institute of Pediatrics in Mexico City were evaluated. Patients were classified into two groups according to their age at arrival: Group I (early reference), patients arriving during the first month of life; and Group II (late reference), those who arrived after thirty days of age. Time and causes of delay were documented.
  
  
  RESULTS
  Of 57 recorded files, 10 were classified in Group I and 47 in Group II. Causes leading to the late arrival of Group II patients were absence of routine newborn screening (NBS), PKU not included in the routine NBS, sampling after the recommended age, false negative result, results without interpretation and/or instructions to follow, delayed notification of results, poor medical criteria of attending physician, difficulties in obtaining confirmatory tests, and administrative failures.
  
  
  CONCLUSIONS
  The main cause of late referral of PKU patients was the absence of PKU testing. As a developing country, Mexico still faces challenges in the proper functioning and expansion of the NBS programme. Most PKU patients arrived at the RC late, presenting with varying degrees of the clinical spectrum. Incorporating PKU testing into the already established Mexican NBS system and adding quality indicators to guarantee proper operation in all NBS phases is necessary to achieve the goal of identifying, referring, diagnosing, and treating patients promptly.
authors: Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatria, Secretaria de Salud, Mexico. dravelaamieva@yahoo.com
authors: M
authors: M
authors: Vela-Amieva
authors: I
authors: I
authors: Ibarra-González
authors: C
authors: C
authors: Fernández-Lainez
authors: S
authors: S
authors: Monroy-Santoyo
authors: S
authors: S
authors: Guillén-López
authors: L
authors: L
authors: Belmont-Martínez
authors: A
authors: A
authors: Hernández-Montiel
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D015984:Causality; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D004704:Endocrinology; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D010661:Phenylketonurias / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013038:Specialization; D013997:Time Factors