Molecular Genetic Screening of Neonatal Intensive Care Units: Hyperbilirubinemia as an Example

Causal association between pregnancy disorders and neonatal jaundice: a two-sample Mendelian randomization study

Background

Some studies have suggested that complications during pregnancy, such as preeclampsia, leiomyoma during pregnancy, oxytocin induction, and mode of delivery, may be risk factors for neonatal jaundice. Herein, we applied Mendelian randomization (MR) analysis to investigate a causal association between pregnancy disorders and neonatal jaundice.

Methods

Data related to neonatal jaundice and pregnancy disorders (including pre-eclampsia or eclampsia, gestational diabetes, and gestational edema) were sourced from the FinnGen Consortium and Integrated Epidemiology Unit (IEU) databases. Inverse-variance weighted (IVW) was used as a main approach for data analysis, while MR-Egger, weighted median (WM), and weighted mode methods were used to validate the robustness of the results. MR-Egger regression method was applied to explore the presence of horizontal pleiotropy. MR pleiotropy residual sum and outlier (MR-PRESSO) method was used to detect potential outliers. Cochran's Q test was used to assess heterogeneity among instrumental variables (IVs); leave-one-out (LOO) analyses were used to evaluate the presence of predominant IVs.

Results

The IVW approach showed that pre-eclampsia or eclampsia {odds ratio (OR) [95% confidence interval (CI)]: 0.86 (0.36-2.07), P=0.73}, gestational edema and proteinuria [OR (95% CI): 1.04 (0.62-1.74), P=0.87], and gestational diabetes mellitus [OR (95% CI): 0.95 (0.60-1.49), P=0.81] were not associated with neonatal jaundice. The MR-Egger regression results showed that horizontal pleiotropy did not affect the relationship between exposure factors and outcomes. Also, no heterogeneity was observed. The MR-PRESSO analysis showed no outliers, confirming that these data were robust.

Conclusions

Our data suggested no genetic causal association between pre-eclampsia or eclampsia, gestational edema, proteinuria, gestational diabetes mellitus, and neonatal jaundice. However, further research is needed to determine if these results apply to other races.

Newborn screening for G6PD deficiency in HeFei, FuYang and AnQing, China: Prevalence, cut-off value, variant spectrum

Background

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive Mendelian genetic disorder characterized by neonatal jaundice and hemolytic anemia, affecting more than 400 million people worldwide. The purpose of this research was to investigate prevalence rates of G6PD deficiency and to evaluate and establish specific cut-off values in early prediction of G6PD deficiency by regions (HeFei, FuYang, AnQing) on different seasons, as well as to investigate the frequencies of G6PD gene mutations among three regions mentioned above.

Methods

A total of 31,482 neonates (21,402, 7680, and 2340 for HeFei, FuYang, and AnQing cities, respectively) were recruited. Positive subjects were recalled to attend genetic tests for diagnosis. G6PD activity on the Genetic screening processor (GSP analyzer, 2021-0010) was measured following the manufactureržs protocol. The cut-off value was first set to 35 U/dL. The receiver operating characteristics (ROC) curve was employed to assess and compare the efficiency in predicting G6PD deficiency among HeFei, FuYang, and AnQing cities in different seasons.

"Light" on Phototherapy-Complications and Strategies for Shortening Its Duration, A Review of the Literature

Neonatal hyperbilirubinemia is an extremely common metabolic complication of the neonatal period which may be associated with bilirubin encephalopathy and even death. Adverse neurological consequences are preventable if a timely diagnosis and treatment are provided. Phototherapy is usually the preferred option to decrease hyperbilirubinemia. Although considered to be safe, evidence in recent years has shown that this treatment may not be free of side effects and short- and long-term unfavorable outcomes. These are usually mild or rare, but should be decreased or avoided if possible. Many useful complementary measures and treatments have been described that could shorten the duration of exposure to phototherapy. However, there is no current unequivocal recommendation to use any of the methods presented in this review. Our review aims to depict the wide range of possible complementary treatments to phototherapy, and to provide the scientific and clinical evidence available regarding their usefulness. It is essential that, while utilizing the full potential of phototherapy to treat hyperbilirubinemia, caregivers are aware of its side effects and possible inherent dangers, and seek ways to minimize the exposure to phototherapy to what is really needed for the newborn. Further studies are needed to clarify the preferred complementary treatments that could reduce the duration of exposure to phototherapy without impairing its effectiveness.

Molecular genetic screening of full-term small for gestational age

OBJECTIVE

To examine the clinical application of genomic screening in newborns small for gestational age (SGA), hoping to provide an efficient technique for early discovery of neonatal diseases, which is necessary to elevate survival rates and the quality of life in infants.

METHODS

Totally 93 full-term SGA newborns were assessed. Dried blood spot (DBS) samples were obtained at 72 h after birth, and tandem mass spectrometry (TMS) and Angel Care genomic screening (GS, using Targeted next generation sequencing) were carried out.

RESULTS

All 93 subjects were examined by Angel Care GS and TMS. No children showing inborn errors of metabolism (IEM) were detected by TMS, while 2 pediatric cases (2.15%, 2/93) were confirmed as thyroid dyshormonogenesis 6 (TDH6) by Angel Care GS. Additionally, 45 pediatric cases (48.4%) had one or more variants conferring a carrier status for recessive childhood-onset disorders, with 31 genes and 42 variants associated with 26 diseases. The top three gene-related diseases with carrier status were autosomal recessive deafness (DFNB), abnormal thyroid hormone and Krabbe disease.

CONCLUSIONS

SGA is tightly associated with genetic variation. Molecular Genetic Screening allows early detection of congenital hypothyroidism and may be a potent genomic sequencing technique for screening newborns.