米国神経学会と米国小児科学会の世界的発達遅延と知的障害の診断に関する臨床ガイドラインは、2006年のガイドラインでは、診断率が1~5%だったため、世界的発達遅延のある小児に対する代謝研究の体系的な実施を推奨していなかった。しかし、2014年のレビューでは、この推奨事項が変更され、van Karnebeeckが提案した2つのステップに基づくプロトコールに従い、原因が特定できない小児にも代謝研究が含まれるようになりました。

第 1 ステップ: 非標的代謝スクリーニング。
  • 血:
    • 乳酸塩。
    • アンモニウム。
    • アミノ酸。
    • 葉酸。
    • シアロトランスフェリン。
    • 銅とセルロプラスミン。
    • 総ホモシステイン。
    • アシルカルニチン。
    • VLCFA。
  • 尿:
    • 有機酸。
    • クレアチンとGAA。
    • グルコサミングリカン。
    • オリゴ糖。
第 2 ステップ: ターゲットを絞った代謝スクリーニング。
  • CSF:
    • 神経伝達物質。
    • アミノ酸。
  • 血:
  • 尿:
    • プリンとピリミジン。

No obstante, también puede orientarse a qué pacientes realizar un estudio metabólico a partir de la presencia de determinados datos de la historia clínica o características exploratorias que incrementan la probabilidad de una metabolopatía (¿cuando sospechar una metabolopatía?).

ウェブ上で Treatable ID puede buscarse información para orientar de forma más adecuada el estudio apropiado.

ウェブ上で Vademecum Metabólicum, existe un compendio de acceso libre sobre todos los errores congénitos del metabolismo.

19955111 {19955111:5WUGPWQ8} 1 バンクーバー 50 デフォルト 944 https://neuropediatoolkit.org/wp-content/plugins/zotpress/
%7B%22status%22%3A%22success%22%2C%22updateneeded%22%3Afalse%2C%22instance%22%3Afalse%2C%22meta%22%3A%7B%22request_last%22%3A0%2C%22request_next%22%3A0%2C%22used_cache%22%3Atrue%7D%2C%22data%22%3A%5B%7B%22key%22%3A%225WUGPWQ8%22%2C%22library%22%3A%7B%22id%22%3A19955111%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Moeschler%20et%20al.%22%2C%22parsedDate%22%3A%222014-09-01%22%2C%22numChildren%22%3A1%7D%2C%22bib%22%3A%22%26lt%3Bdiv%20class%3D%26quot%3Bcsl-bib-body%26quot%3B%20style%3D%26quot%3Bline-height%3A%201.35%3B%20%26quot%3B%26gt%3B%5Cn%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-entry%26quot%3B%20style%3D%26quot%3Bclear%3A%20left%3B%20%26quot%3B%26gt%3B%5Cn%20%20%20%20%26lt%3Bdiv%20class%3D%26quot%3Bcsl-left-margin%26quot%3B%20style%3D%26quot%3Bfloat%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%26quot%3B%26gt%3B1.%26lt%3B%5C%2Fdiv%26gt%3B%26lt%3Bdiv%20class%3D%26quot%3Bcsl-right-inline%26quot%3B%20style%3D%26quot%3Bmargin%3A%200%20.4em%200%201.5em%3B%26quot%3B%26gt%3BMoeschler%20JB%2C%20Shevell%20M%2C%20Moeschler%20JB%2C%20Shevell%20M%2C%20Saul%20RA%2C%20Chen%20E%2C%20et%20al.%20Comprehensive%20Evaluation%20of%20the%20Child%20With%20Intellectual%20Disability%20or%20Global%20Developmental%20Delays.%20Pediatrics%20%5BInternet%5D.%202014%20Sept%201%20%5Bcited%202015%20June%2029%5D%3B134%283%29%3Ae903%26%23x2013%3B18.%20Available%20from%3A%20%26lt%3Ba%20class%3D%26%23039%3Bzp-ItemURL%26%23039%3B%20href%3D%26%23039%3Bhttp%3A%5C%2F%5C%2Fpediatrics.aappublications.org%5C%2Fcontent%5C%2F134%5C%2F3%5C%2Fe903%26%23039%3B%26gt%3Bhttp%3A%5C%2F%5C%2Fpediatrics.aappublications.org%5C%2Fcontent%5C%2F134%5C%2F3%5C%2Fe903%26lt%3B%5C%2Fa%26gt%3B%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%20%20%26lt%3B%5C%2Fdiv%26gt%3B%5Cn%26lt%3B%5C%2Fdiv%26gt%3B%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Comprehensive%20Evaluation%20of%20the%20Child%20With%20Intellectual%20Disability%20or%20Global%20Developmental%20Delays%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22John%20B.%22%2C%22lastName%22%3A%22Moeschler%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Michael%22%2C%22lastName%22%3A%22Shevell%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22John%20B.%22%2C%22lastName%22%3A%22Moeschler%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Michael%22%2C%22lastName%22%3A%22Shevell%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Robert%20A.%22%2C%22lastName%22%3A%22Saul%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Emily%22%2C%22lastName%22%3A%22Chen%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Debra%20L.%22%2C%22lastName%22%3A%22Freedenberg%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Rizwan%22%2C%22lastName%22%3A%22Hamid%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Marilyn%20C.%22%2C%22lastName%22%3A%22Jones%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Joan%20M.%22%2C%22lastName%22%3A%22Stoler%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Beth%20Anne%22%2C%22lastName%22%3A%22Tarini%22%7D%5D%2C%22abstractNote%22%3A%22Global%20developmental%20delay%20and%20intellectual%20disability%20are%20relatively%20common%20pediatric%20conditions.%20This%20report%20describes%20the%20recommended%20clinical%20genetics%20diagnostic%20approach.%20The%20report%20is%20based%20on%20a%20review%20of%20published%20reports%2C%20most%20consisting%20of%20medium%20to%20large%20case%20series%20of%20diagnostic%20tests%20used%2C%20and%20the%20proportion%20of%20those%20that%20led%20to%20a%20diagnosis%20in%20such%20patients.%20Chromosome%20microarray%20is%20designated%20as%20a%20first-line%20test%20and%20replaces%20the%20standard%20karyotype%20and%20fluorescent%20in%20situ%20hybridization%20subtelomere%20tests%20for%20the%20child%20with%20intellectual%20disability%20of%20unknown%20etiology.%20Fragile%20X%20testing%20remains%20an%20important%20first-line%20test.%20The%20importance%20of%20considering%20testing%20for%20inborn%20errors%20of%20metabolism%20in%20this%20population%20is%20supported%20by%20a%20recent%20systematic%20review%20of%20the%20literature%20and%20several%20case%20series%20recently%20published.%20The%20role%20of%20brain%20MRI%20remains%20important%20in%20certain%20patients.%20There%20is%20also%20a%20discussion%20of%20the%20emerging%20literature%20on%20the%20use%20of%20whole-exome%20sequencing%20as%20a%20diagnostic%20test%20in%20this%20population.%20Finally%2C%20the%20importance%20of%20intentional%20comanagement%20among%20families%2C%20the%20medical%20home%2C%20and%20the%20clinical%20genetics%20specialty%20clinic%20is%20discussed.%22%2C%22date%22%3A%2209%5C%2F01%5C%2F2014%22%2C%22section%22%3A%22%22%2C%22partNumber%22%3A%22%22%2C%22partTitle%22%3A%22%22%2C%22DOI%22%3A%2210.1542%5C%2Fpeds.2014-1839%22%2C%22citationKey%22%3A%22%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fpediatrics.aappublications.org%5C%2Fcontent%5C%2F134%5C%2F3%5C%2Fe903%22%2C%22PMID%22%3A%2225157020%22%2C%22PMCID%22%3A%22%22%2C%22ISSN%22%3A%220031-4005%2C%201098-4275%22%2C%22language%22%3A%22en%22%2C%22collections%22%3A%5B%22TSGGWJ4V%22%2C%22WP7IK3VM%22%5D%2C%22dateModified%22%3A%222026-07-15T22%3A40%3A32Z%22%7D%7D%5D%7D
1.
Moeschler JB, Shevell M, Moeschler JB, Shevell M, Saul RA, Chen E, et al. Comprehensive Evaluation of the Child With Intellectual Disability or Global Developmental Delays. Pediatrics [Internet]. 2014 Sept 1 [cited 2015 June 29];134(3):e903–18. Available from: http://pediatrics.aappublications.org/content/134/3/e903