Assessment for treatment
Serial monitoring of blood phenylalanine levels (weekly for the first 2 or 3 y of life declining to monthly by the age of 7–8 y) is an essential element of treatment. The choice of therapeutic ranges for blood levels and the duration of diet are still a matter of debate. However, in children <10 y of age, it is universally admitted that the blood phenylalanine levels should be kept between 2 and 5 mg/dL (120–300 μmol/L). Life-long dietary treatment is quite universally recommended but because of the practical difficulties involved in sustaining a strict diet, many clinics allow a relaxation at some point between adolescence and adulthood. In France, it is recommended to keep the blood phenylalanine levels between 2 and 15 mg/dL (120–600 μmol/L) until the age of 15–18 y and below 20 mg/dL (1200 μmol/L) thereafter.
Such a restrictive diet poses nutritional risks and psychological burden that must be monitored by experienced teams that would regularly evaluate the clinical and biological status of patients and offer educational and psychological support. Whatever the decision regarding the diet discontinuation, sustained follow-up is essential for the affected females who are at risk for maternal PKU.
Maternal PKU
This term defines the embryopathy that affects the infants born to untreated PKU mothers despite the fact that usually the children do not themselves have PKU. The syndrome is characterized by low birthweight, microcephaly, dysmorphism, congenital defects, and developmental retardation. There is evidence that an increased risk is directly correlated to maternal phenylalanine levels during pregnancy. There is now good evidence that a strict low-phenylalanine diet along with provision of adequate energy and nutrients can prevent these devastating effects (8).
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