NC NEXUS, North Carolina Newborn Exome Sequencing for Universal Screening

描述（由申请人提供）：自20世纪60年代新生儿筛查（NBS）开始以来，技术进步导致其在越来越多的疾病中使用。全基因组测序的最新发展及其更简单的推论，全外显子组测序（WES），现在提供了以快速和负担得起的方式全面定义个体基因组变异的机会。基因组规模测序的临床应用以及对婴儿和儿童的实际益处面临许多挑战。它在NBS中的效用尚未得到证实，它在儿科人群中的应用需要特殊的检查，不仅是为了潜在的临床效益，而且还为了它所带来的独特的伦理挑战。在本提案中，我们概述了一种高度跨学科的方法

DESCRIPTION (provided by applicant): Since newborn screening (NBS) began in the 1960's, technological advances have resulted in its use in an increasing number of disorders. Recent developments in whole genome sequencing and its simpler corollary, whole exome sequencing (WES), now afford the opportunity to comprehensively define the variation within an individual's genome in a rapid and affordable manner. Many challenges arise with the clinical application of genome-scale sequencing and in deriving practical benefit to infants and children. Its utility in NBS has yet to be demonstrated and its application in the pediatric population requires special examination, not only for potential clinical benefits, but also for the unique ethical challenges it presents. In this proposal, we outline a highly interdisciplinary approach to identifying, confronting and overcoming the major challenges that must be met in order to implement deep sequencing technology to enhance current newborn screening in a diverse pediatric population. Overarching Aim 1 will evaluate the utility of WES as a diagnostic tool to extend the utility of current NBS. Using diverse cohorts of infants and young children with known conditions identified through NBS, we will examine the sensitivity and specificity of WES. We will also utilize WES in cohorts of children with known conditions not currently screened for as potential candidates for NBS in the future. Overarching Aim 2 will develop and assess a framework for analyzing WES in a clinically oriented framework based on principles of ethics and evidence-based medicine. We will develop strategies to guide clinicians, clinical laboratories and patients/families in their decisions regarding the inevitable incidental findings that will be detected in ways that respect the child and protect his/her future autonomy, while also respecting parental interests and rights. Overarching Aim 3 will explore ethical, legal and social issues (ELSl) involved in informed decision-making and develop best practices regarding return of results after testing. We will develop novel decision support tools and evaluate their usefulness in parental decision making, and examine the burdens placed on clinicians as this new technology is deployed in the vulnerable and special population that are newborns and their families.