To the Editor.—

We read with great interest the review by Dr Burton on inborn errors of metabolism.1 These myriad disorders frequently present with clinical manifestations that are associated with a variety of more common neonatal diseases. Dr Burton is to be commended for presenting a lucid, rational approach for the diagnosis of these oft-confusing afflictions.

However, there is another manifestation of these disorders, not previously recognized in the pediatric literature, that we wish to address.

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