Phenylketonuria (PKU) is an inherited genetic disorder that interferes with the metabolism of a specific amino acid. Those born with it are unable to process part of a protein called phenylalanine (Phe). Phe is in almost all foods. If the Phe level gets too high, it can damage the brain and cause severe intellectual disability. All babies born in U.S. hospitals must have a screening test for PKU. This makes it easier to diagnose and treat the problem early.
The best treatment for PKU is a diet of low-protein foods. There are special formulas for newborns. For older children and adults, the diet includes many fruits and vegetables. It also includes some low-protein breads, pastas and cereals. Nutritional formulas provide the vitamins and minerals you can’t get from their food.
Phenylketonuria affects about one in 10,000 to 25,000 babies. Males and females are affected equally. The disease was discovered in 1934 by Ivar Asbjørn Følling with the importance of diet determined in 1953.
Because the mother’s body is able to break down phenylalanine during pregnancy, infants with PKU are normal at birth. The disease is not detectable by physical examination at that time, because no damage has yet been done. However, a blood test can reveal elevated phenylalanine levels after one or two days of normal infant feeding. This is the purpose of newborn screening, to detect the disease with a blood test before any damage is done, so that treatment can prevent the damage from happening.
If a child is not diagnosed during the routine newborn screening test (typically performed 2–7 days after birth, using samples drawn by neonatal heel prick), and a phenylalanine restricted diet is not introduced, then phenylalanine levels in the blood will increase over time. Toxic levels of phenylalanine (and insufficient levels of tyrosine) can interfere with infant development in ways which have permanent effects. The disease may present clinically with seizures, hypopigmentation (excessively fair hair and skin), and a “musty odor” to the baby’s sweat and urine (due to phenylacetate, a carboxylic acid produced by the oxidation of phenylketone). In most cases, a repeat test should be done at approximately two weeks of age to verify the initial test and uncover any phenylketonuria that was initially missed.
Untreated children often fail to attain early developmental milestones, develop microcephaly, and demonstrate progressive impairment of cerebral function. Hyperactivity, EEG abnormalities, and seizures, and severe learning disabilities are major clinical problems later in life. A characteristic “musty or mousy” odor on the skin, as well as a predisposition for eczema, persist throughout life in the absence of treatment.
The damage done to the brain if PKU is untreated during the first months of life is not reversible. It is critical to control the diet of infants with PKU very carefully so that the brain has an opportunity to develop normally. Affected children who are detected at birth and treated are much less likely to develop neurological problems or have seizures and intellectual disability (though such clinical disorders are still possible.)
In general, however, outcomes for people treated for PKU are good. Treated people may have no detectable physical, neurological, or developmental problems at all. Many adults with PKU who were diagnosed through newborn screening and have been treated since birth have high educational achievement, successful careers, and fulfilling family lives.
Phenylketonuria. (2016, October 14). In Wikipedia, The Free Encyclopedia. Retrieved 16:38, October 14, 2016, from https://en.wikipedia.org/w/index.php?title=Phenylketonuria&oldid=744344416