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Background: Fabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. This study aims to explore how it can be done effectively from a multidisciplinary perspective for children with FD at a tertiary children's hospital in China., Methods: A multidisciplinary team (MDT) of pediatric FD experts was launched at Children's Hospital of Fudan University. Children with high-risk characteristics were referred by the MDT screening team using the dried blood spot (DBS) triple-test (α-galactosidase A, globotriaosylsphingosine, GLA gene). For newborns who were undergoing genetic testing in the hospital, the GLA gene was listed as a routine analysis gene. Evaluation, family screening, and genetic counselling were implemented after screening by the MDT management team., Results: Before the establishment of the MDT, no case was diagnosed with FD in the hospital. However, twelve months following the MDT program's implementation, thirty-five children with high-risk profiles were referred for screening by DBS triple-test, with a yield of diagnosis of 14.3% (5/35). These 5 diagnosed children were referred due to a high-risk profile of pain accompanied by dermatological angiokeratoma and hypohidrosis (n = 2), pain accompanied by abnormal liver function (n = 1), pain only (n = 1), and unexplained renal tubular dysfunction (n = 1). Two neonates were detected early with GLA mutations in the hospital, with a yield of detection of 0.14% (2/1420). Furthermore, another 3 children diagnosed with FD were referred from other hospitals. Family screening of these 10 diagnosed children indicated that 9 boys inherited it from their mothers and 1 girl inherited it from her father. Four of them started to receive enzyme replacement therapy., Conclusion: Screening and management of children with FD is effective based on a defined screening protocol and a multidisciplinary approach. We should pay more attention to the high-risk profiles of pain, angiokeratoma, decreased sweating, and unexplained chronic kidney disease in children., (© 2021. The Author(s).)

Fabry disease is a rare X-linked genetic lysosomal storage disorder caused by mutations in the GLA gene, which results of reduced or absent activity of α-galactosidase A, accumulation of metabolic substrates globotriaosylceramide (GL-3) and derivatives deacylated derivative globotriaosylsphingosine (Lyso-GL-3) in multiple tissues, and multi-organ diseases and even life-threatening complications. Due to the lack of specific symptoms, there is a need to combine the clinical features and the results of enzymatic, biochemical, and genetic tests to realize the early definite diagnosis of Fabry disease. Furthermore, the approval of agalsidase beta/alpha in China will benefit the vast Chinese patients for Fabry disease specific therapies. Based on the evidence-based medicine, this consensus summarizes several main aspects related to Fabry disease, including clinical manifestations, diagnosis and its flow chart, therapies, screening, genetic counseling and prenatal diagnosis, so as to further promote the standardized diagnosis and treatment of Fabry disease.