A retrospective analysis of metabolic control in children with PKU in the COVID-19 era

Abstract

Background: Patients with phenylketonuria (PKU) must maintain a lifelong natural protein-restricted diet to prevent neuro-cognitive damage. Early diagnosis is established with newborn screening, with diet subsequently controlled by regular phenylalanine (Phe) monitoring. During the COVID-19 pandemic, significant lockdown measures were introduced that may have influenced the above.

Aim of our study: To establish whether the diagnosis was delayed in neonates during the pandemic. In addition, metabolic control was further assessed during the COVID-19 pandemic era (CE) compared to the same period a year prior (non-COVID-19 era, NCE). The lockdown periods (LD) were also compared with unrestricted periods (URP).

Patients methods: Six neonates born during the CE and eight neonates born during NCE were included in the newborn screening analysis. Seventy-two classical PKU patients aged 2-18 years and categorized as children (2-12 years; 51 patients) and adolescents (>13 years; 21 patients) were included in the metabolic control analysis. The frequency of dried blood spot (DBS) sampling and Phe levels were assessed according to the different periods.

Results: There was no diagnostic or therapeutic delay in reaching the recommended Phe range in neonates born during CE compared to those born in NCE (median [interquartile range, IQR]: 23.5 [22.5-24] vs. 22 [18.0-27] days, p = NS). The cumulative DBS sampling frequency in children increased by 9.9% in the CE while no change was noted in the adolescent group. The median Phe level increased significantly in both age groups in the CE, but remained within the recommended target range. During CE, changes in Phe levels differed in the two age groups: children had the highest median Phe in the second lockdown period (LD2), while the adolescents had an increased Phe in URP.There were significant negative correlations between DBS sampling frequencies and Phe levels in both age groups in NCE (children: r - 0.43, p = 0.002; adolescents r = -0.37, p = 0.012), and in adolescents in CE (r = -0.62, p = 0.006).

Conclusion: The pandemic did not impact newborn metabolic screening. The increased frequency of DBS sampling in CE and good target Phe levels suggest a better compliance in a very sensitive period. Since many factors may impact metabolic control in the different age groups, further studies are needed to analyse their respective role.

Keywords: CE, COVID-19 era; CLD1, control to lockdown period 1; CLD2, control to lockdown period 2; COVID, coronavirus disease; COVID-19 pandemic; CURP, control to unrestricted period; DBS, dried blood spot; IQR, interquartile range; LD, lockdown; Lockdown; MS/MS, tandem mass spectrometry; Metabolic control; NCE, non-COVID-19 era; Phenylketonuria; SARS, Severe Acute Respiratory Syndrome,; URP, unrestricted period.

Fig. 1

The enrolled children of the neonatal study.

Fig. 2

Patient enrolment in the metabolic study.

Fig. 3

Phe levels of PKU patients during CE and NCE. CE: COVID-19 era (2020/21), NCE: Non-COVID-19 era (2019/20). CLD1: control to lockdown period 1, CLD2: control to lockdown period 2, CURP: control to unrestricted period, LD1: lockdown period one, UPR: unrestricted period, LD2: lockdown period two. Blue horizontal lines indicate the recommended Phe ranges in PKU. n.s.: not significant. The single dots represent the median Phe levels of each patient.