Phenylketonuria treatment duration before discontinuation

Written by Zeng Hai Jiang
Pediatrics
Updated on February 17, 2025
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Phenylketonuria is the first genetic metabolic disease that can be treated through dietary control. Once diagnosed with phenylketonuria, active treatment must be given, ceasing a natural diet and implementing a low-phenylalanine diet. Generally, a low-phenylalanine milk formula should be administered at least until the age of three. When the concentration of phenylalanine in the blood is adjusted to an ideal range, a small amount of natural diet can gradually be reintroduced. The reintroduced diet should still adhere to low-protein and low-phenylalanine standards.

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Written by Yan Xin Liang
Pediatrics
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How is phenylketonuria tested?

Phenylketonuria is a treatable inherited metabolic disease, and early diagnosis is essential for early treatment. Currently, we have generally implemented a newborn disease screening system that requires collecting peripheral blood by pricking the heel of newborns after three days of breastfeeding, dropping the blood onto specialized filter paper and sending it to a screening laboratory for phenylalanine concentration measurement. If the concentration exceeds the confirmed value, further differential diagnosis and confirmation are needed. If treatment can begin early, especially within two to three weeks after birth, the prognosis is generally good. Normally, the concentration is less than 120 µmol/L; a fetal concentration of 1200 µmol/L would be considered mild phenylketonuria.

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Written by Zeng Hai Jiang
Pediatrics
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"Phenylketonuria weakly positive" means what?

The indication of weakly positive phenylketonuria suggests a re-examination of blood phenylalanine levels. Generally, there are no obvious specialized clinical symptoms of phenylketonuria in the newborn period. Some newborns may experience feeding difficulties, vomiting, or irritability, and the manifestations of phenylketonuria gradually appear after three months of age. Currently, hospitals routinely screen newborns for phenylketonuria. This screening is conducted 72 hours after birth and must be completed by no later than 20 days post-birth. If the result of the blood phenylalanine test is weakly positive or positive, further testing is generally recommended to determine whether the infant has phenylketonuria or if other factors are affecting the phenylalanine levels.

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Written by Yan Xin Liang
Pediatrics
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Can phenylketonuria be treated?

Can phenylketonuria be treated? Yes, it can be treated, and treatment should begin immediately once diagnosed. The younger the age at which treatment begins, the better the prognosis. Infants are generally treated with low-phenylalanine formula milk. Once the blood phenylalanine concentration drops to an ideal level, natural foods can gradually be added in small amounts, with a preference for adding breast milk, since it contains only one-third the phenylalanine content of cow's milk. Older infants and children can add foods like milk, porridge, noodles, and eggs. Added foods should follow the principle of being low in protein and phenylalanine. The amount and frequency of these foods should be determined based on the blood phenylalanine concentration. Concentrations that are too high or too low can affect the growth and development of the child. As each child's tolerance to phenylalanine concentration differs, it is necessary to regularly measure the blood phenylalanine concentration during dietary treatment and adjust the diet according to the specific situation of the child, avoiding increased phenylalanine levels or deficiency.

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Written by Yao Li Qin
Pediatrics
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Is phenylketonuria often misdiagnosed?

Phenylketonuria belongs to congenital hereditary metabolic disorders and is caused by enzyme deficiencies in the phenylalanine metabolic pathway. Misdiagnosis of phenylketonuria is not common; if the disease develops, meaning that the child has typical clinical manifestations, it is relatively easy to diagnose. However, once a child exhibits the typical clinical manifestations of phenylketonuria such as blood phenylalanine levels, by the time of diagnosis the child may already have varying degrees of neurological damage, meaning the child might already have intellectual disabilities. Therefore, in such cases, we cannot rely solely on clinical symptoms for diagnosis but should instead carry out newborn disease screening promptly after birth. By diagnosing and treating before any clinical symptoms appear, we can prevent the occurrence of neurological complications, allowing the child to grow and develop like a normal child.

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Written by Hu Qi Feng
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Mechanism of phenylketonuria

Phenylketonuria is characterized by reduced activity of phenylalanine hydroxylase, which fails to convert phenylalanine to tyrosine, causing extremely elevated levels of phenylalanine in the blood, cerebrospinal fluid, and tissues. This leads to the production of large amounts of phenylpyruvic acid, phenylacetic acid, phenyllactic acid, and p-hydroxyphenylacetic acid via alternative pathways. High concentrations of phenylalanine and its metabolic products can cause brain damage, which manifests as developmental intellectual disabilities, changes in skin and hair pigmentation, and a mousy urine odor, all part of a clinical syndrome.