Diagnosis, treatment and outcome of glutaric aciduria type I in Zhejiang Province, China

Background:    Glutaric aciduria type I (GA I; MIM 231670) is a rare autosomal recessive disorder resulting from glutaryl-CoA dehydrogenase deficiency. This article reports our experience in the diagnosis, treatment and outcome of GA I patients in Zhejiang Province, China.
    Material/Methods:    A total of 129,415 newborns (accounting for approximately one-tenth of the annual births in Zhejiang Province) and 9640 high-risk infants were screened for inborn errors of metabolism in the Neonatal Screening Center of Zhejiang Province during a 3-year period. Tandem mass spectrometry and gas chromatography-mass spectrometry were used for diagnosis of the patients. Dietary modification, carnitine supplementation and aggressive treatment of intercurrent illnesses were adapted for GA I patients.
    Results:    Three infants were diagnosed with GA I by high-risk screening (detection rate: 1/3,213) and 2 were diagnosed by newborn screening (incidence: 1/64,708). Four patients (3 by high-risk screening and 1 by neonatal screening) undergoing MRI examination showed remarkable changes on T2-weighted image. Four patients accepted timely treatment, and in the patient diagnosed by neonatal screening, treatment was delayed until hypotonia appeared 3 months later. Neuropsychological assessment showed mental and motor retardation in 3 patients after treatment, including the patient diagnosed by neonatal screening.
    Conclusions:    Individualized timely treatment and close monitoring of GA I patients needs to be optimized in China. Appropriate communication with parents may help to achieve successful management of GA I patients.

Keywords: Infant, Newborn, Incidence, Glutaryl-CoA Dehydrogenase - genetics, Genes, Recessive, Gas Chromatography-Mass Spectrometry, China - epidemiology, Carnitine - therapeutic use, Brain Diseases, Metabolic - genetics, Amino Acid Metabolism, Inborn Errors - genetics, Mass Screening, Neuropsychological Tests, Riboflavin - therapeutic use, tandem mass spectrometry