Infant mortality in Brazil attributable to inborn errors of metabolism associated with sudden death: a time-series study (2002\u20132014)

F H De Bitencourt,I V D Schwartz,F S L Vianna

doi:10.1186/s12887-019-1421-y

Abstract

BackgroundThe literature suggests that 0.9 to 6% of infants who die unexpectedly may have had a metabolic disorder. At least 43 different inborn errors of metabolism (IEMs) have been associated with sudden death (SUDI). To date, the frequency of IEM-associated SUDI has not been studied in Brazil. The present study sought to characterize infant mortality related to IEMs known to cause SUDI disaggregated by each of the regions of Brazil.MethodsThis was a descriptive, cross-sectional, population-based study of data obtained from the Brazilian Ministry of Health Mortality Information System (SIM). Death records were obtained for all infants (age < 1 year) who died in Brazil in 2002–2014 in whom the underlying cause of death was listed as ICD-10 codes E70 (Disorders of aromatic amino-acid metabolism), E71 (Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism), E72 (Other disorders of amino-acid metabolism), or E74 (Other disorders of carbohydrate metabolism), which are known to be associated with SUDI.ResultsFrom 2002 to 2014, 199 deaths of infants aged < 1 year were recorded in the SIM with an underlying cause corresponding to one of the IEMs of interest. The prevalence of IEM-related deaths was 0.67 per 10,000 live births (0.58–0.77). Of these 199 deaths, 18 (9.0%) occurred in the North of Brazil, 43 (21.6%) in the Northeast, 80 (40.2%) in the Southeast, 46 (23.1%) in the South, and 12 (6.0%) in the Center-West region. Across all regions of the country, ICD10-E74 was predominant.ConclusionsThis 13-year time-series study provides the first analysis of the number of infant deaths in Brazil attributable to IEMs known to be associated with sudden death.

Highlights

The literature suggests that 0.9 to 6% of infants who die unexpectedly may have had a metabolic disorder
This 13-year time-series study provides the first analysis of the number of infant deaths in Brazil attributable to Inborn errors of metabolism (IEM) known to be associated with sudden death
Death records were obtained for all infants who died in Brazil in 2002–2014 in whom the underlying cause of death was listed as ICD-10 codes E70 (Disorders of aromatic amino-acid metabolism), E71 (Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism), E72 (Other disorders of amino-acid metabolism), or E74 (Other disorders of carbohydrate metabolism), which are known to be associated with sudden death

Summary

Introduction

The literature suggests that 0.9 to 6% of infants who die unexpectedly may have had a metabolic disorder. At least 43 different inborn errors of metabolism (IEMs) have been associated with sudden death (SUDI). The frequency of IEM-associated SUDI has not been studied in Brazil. The present study sought to characterize infant mortality related to IEMs known to cause SUDI disaggregated by each of the regions of Brazil. The symptoms of IEMs vary widely, and the clinical severity of each patient depends on the Sudden unexpected death in infancy (SUDI) is one of the most common causes of postneonatal death in the first year of life. A recent systematic review showed that at least 43 different IEMs are associated with sudden death and/or Reye’s syndrome [7]. Infant mortality remains a major public health concern in Brazil. The frequency of IEM-associated sudden death has not been studied in Brazil

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Conclusion