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Predictors of Survival in Children with Methymalonic Acidemia with Homocystinuria.

We read with interest the recent report by Qiliang, et al. [1] on the outcome of 45 children diagnosed with combined methymalonic academia (MMA) and homocystinemia. The authors report a 40% mortality in their cohort. Apart from mortality, it would be important to know the degree and pattern of neuromorbidity in the survivors. Combined MMA and homocystinemia is a potentially treatable inborn error of metabolism, and high mortality and possibly high morbidity in the reported cohort need a careful evaluation. The high mortality in the reported cohort can partly be explained by the inadequate parenteral B12 replacement given to the patients. Highlighting the importance of meticulous long-term treatment, we wish to point out certain important aspects of management of children with combined MMA and homocystinemia.