[Congenital central hypoventilation syndrome, report of three cases].
OBJECTIVE
To evaluate clinical characteristics and PHOX2B gene mutations in congenital central hypoventilation syndrome (CCHS) and to facilitate the early diagnosis and management of CCHS and reduce the misdiagnosis.


METHODS
Clinical data of 3 infants with CCHS who had recurrent respiratory failure episodes and dependent on mechanical ventilation support in 3 from March 2008 to April 2012 were analyzed, and blood gas analysis was performed respectively in the awaken and sleeping status. Gene sequencing was used for detection of PHOX2B gene mutation.


RESULTS
All the three patients had adequate ventilation during awaken time, but they presented with abnormal frequency and shallow breathing associated with alveolar hypoventilation after falling asleep. Blood gas analysis showed hypercapnia and CO2 partial pressure was consistently over 60 mm Hg (1 mm Hg = 0.133 kPa) after falling asleep, which is in accordance with the clinical features of CCHS. The PHOX2B gene sequencing showed that 6 GCN repeats were inserted at exon3 of PHOX2B in case 1, at same position, 5 GCN repeats were inserted in case 2 and 3.


CONCLUSIONS
Normal ventilation in awaken status while shallow slow breathing accompanied with hypercapnia in sleep are the main clinical characteristics of CCHS, which requires mechanical ventilation. Acquired mutation in exon 3 of PHOX2B gene encoding repeated GCN sequence seems to be the molecular etiology of these three patients.
Department of Neurodevelopment and Genetics, The Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, Anhui Medical University, Beijing 100700, China.
Ying
Y
Wang
Department of Neurodevelopment and Genetics, The Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, Anhui Medical University, Beijing 100700, China. Email: hxyjs2001@yahoo.com.cn.
Xi-yu
XY
He
Department of Neurodevelopment and Genetics, The Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, Anhui Medical University, Beijing 100700, China.
Yao
Y
Yang
Department of Neurodevelopment and Genetics, The Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, Anhui Medical University, Beijing 100700, China.
Xiao-chun
XC
Chen
D000409:Alanine / Q000235:genetics; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood; D004252:DNA Mutational Analysis; D005091:Exons; D005260:Female; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000209:etiology; D007040:Hypoventilation / Q000151:congenital* / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009154:Mutation; D010102:Oxygen Inhalation Therapy; D016133:Polymerase Chain Reaction; D017286:Polysomnography; D012121:Respiration, Artificial; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D014157:Transcription Factors / Q000235:genetics*
D018398:Homeodomain Proteins; C109220:NBPhox protein; D014157:Transcription Factors; D002245:Carbon Dioxide; D000409:Alanine