TY - JOUR T1 - Neonatal-onset mitochondrial disease: clinical features, molecular diagnosis and prognosis JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed DO - 10.1136/archdischild-2021-321633 SP - fetalneonatal-2021-321633 AU - Tomohiro Ebihara AU - Taro Nagatomo AU - Yohei Sugiyama AU - Tomoko Tsuruoka AU - Yoshiteru Osone AU - Masaru Shimura AU - Makiko Tajika AU - Tetsuro Matsuhashi AU - Keiko Ichimoto AU - Ayako Matsunaga AU - Nana Akiyama AU - Minako Ogawa-Tominaga AU - Yukiko Yatsuka AU - Kazuhiro R Nitta AU - Yoshihito Kishita AU - Takuya Fushimi AU - Atsuko Imai-Okazaki AU - Akira Ohtake AU - Yasushi Okazaki AU - Kei Murayama Y1 - 2021/09/28 UR - http://fn.bmj.com/content/early/2021/09/28/archdischild-2021-321633.abstract N2 - Objective Neonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis.Design Retrospective observational study from January 2004 to March 2020.Setting Population based.Patients Patients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches.Interventions None.Main outcome measures Disease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis.Results Of the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival.Conclusions Neonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.Data are available on reasonable request. Deidentified participant data are available from corresponding author, Kei Murayama. kmuraya@mri.biglobe.ne.jp. ORCID iD 0000-0002-3923-8636. Data are available on reasonable request. ER -