1. Neonatal factors related to survival and intellectual and developmental outcome of patients with early-onset urea cycle disorders.
- Author
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Pontoizeau C, Roda C, Arnoux JB, Vignolo-Diard P, Brassier A, Habarou F, Barbier V, Grisel C, Abi-Warde MT, Boddaert N, Kuster A, Servais A, Kaminska A, Hennequin C, Dupic L, Lesage F, Touati G, Valayannopoulos V, Chadefaux-Vekemans B, Oualha M, Eisermann M, Ottolenghi C, and de Lonlay P
- Subjects
- Age of Onset, Ammonia blood, Developmental Disabilities enzymology, Developmental Disabilities pathology, Female, France epidemiology, Humans, Infant, Infant, Newborn, Intellectual Disability enzymology, Intellectual Disability pathology, Male, Retrospective Studies, Urea Cycle Disorders, Inborn enzymology, Urea Cycle Disorders, Inborn pathology, Argininosuccinate Synthase metabolism, Carbamoyl-Phosphate Synthase (Ammonia) metabolism, Developmental Disabilities epidemiology, Infant Mortality trends, Intellectual Disability epidemiology, Ornithine Carbamoyltransferase metabolism, Urea Cycle Disorders, Inborn mortality
- Abstract
Purpose: We aimed to identify prognostic factors for survival and long-term intellectual and developmental outcome in neonatal patients with early-onset urea cycle disorders (UCD) experiencing hyperammonaemic coma., Methods: We retrospectively analysed ammonia (NH3) and glutamine levels, electroencephalogram and brain images obtained during neonatal coma of UCD patients born between 1995 and 2011 and managed at a single centre and correlated them to survival and intellectual and developmental outcome., Results: We included 38 neonates suffering from deficiencies of argininosuccinate synthetase (ASSD, N = 12), ornithine transcarbamylase (OTCD, N = 10), carbamoylphosphate synthetase 1 (CPSD, N = 7), argininosuccinate lyase (ASLD, N = 7), N-acetylglutamate synthase (NAGS, N = 1) or arginase (ARGD, N = 1). Symptoms occurred earlier in mitochondrial than in cytosolic UCD. Sixty-eight percent of patients survived, with a mean (standard deviation-SD) follow-up of 10.4 (5.3) years. Mortality was mostly observed in OTCD (N = 7/10) and CPSD (N = 4/7) patients. Plasma NH3 level during the neonatal period, expressed as area under the curve, but not glutamine level was associated with mortality (p = .044 and p = .610). 62.1% of the patients had normal intellectual and developmental outcome. Intellectual and developmental outcome tended to correlate with UCD subtype (p = .052). No difference in plasma NH3 or glutamine level during the neonatal period among developmental outcomes was identified. EEG severity was linked to UCD subtypes (p = .004), ammonia levels (p = .037), duration of coma (p = .043), and mortality during the neonatal period (p = .020). Status epilepticus was recorded in 6 patients, 3 of whom died neonatally, 1 developed a severe intellectual disability while the 2 last patients had a normal development., Conclusion: UCD subtypes differed by survival rate, intellectual and developmental outcome and EEG features in the neonatal period. Hyperammonaemia expressed as area under the curve was associated with survival but not with intellectual and developmental outcome whereas glutamine was not associated with one of these outcomes. Prognostic value of video-EEG monitoring and the association between status epilepticus and mortality should be assessed in neonatal hyperammonaemic coma in further studies., Competing Interests: Declaration of Competing Interest Clément Pontoizeau, Célina Roda, Jean-Baptiste Arnoux, Patricia Vignolo-Diard, Anais Brassier, Florence Habarou, Valérie Barbier, Coraline Grisel, Marie-Thérèse Abi-Warde, Nathalie Boddaert, Alice Kuster, Aude Servais, Anna Kaminska, Carole Hennequin, Laurent Dupic, Fabrice Lesage, Guy Touati, Vassili Valayannopoulos, Bernadette Chadefaux-Vekemans, Mehdi Oualha, Monika Eisermann, Chris Ottolenghi and Pascale de Lonlay declare that they have no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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