Newborn Screening and Genetic Testing

Universal Newborn Hearing Screening in Midwifery Education: A Survey

INTRODUCTION

Universal newborn hearing screening has been adopted by all 50 states in the United States. However, there is currently a lack of knowledge about how health care providers learn about universal newborn hearing screening during their education programs. The purpose of this study was to identify whether midwifery education programs in the United States currently include information regarding universal newborn hearing screening in the standard curricula and, if so, what specific information is covered.

METHODS

A survey that assessed whether specific topics related to universal newborn hearing screening are presented during midwifery education was sent to directors of midwifery education programs.

RESULTS

Seventy-one midwifery education program directors were contacted, and the response rate was 38% (27 surveys). Most respondents reported that universal newborn hearing screening is discussed in the program, with the amount of time spent covering these topics varying considerably. Programs provide information about the midwife's role in universal newborn hearing screening, legal obligation to provide hearing screening information, and tests used to complete universal newborn hearing screening. How to complete the hearing screening, counseling for parents about results, and follow-up after a newborn does not pass the screening are topics that were not often discussed. There was no influence of program type or program length on the universal newborn hearing screening content discussed.

DISCUSSION

The majority of midwifery education program directors that responded indicated that their programs include information about universal newborn hearing screening to midwifery students. There is a need for further information and resources specific to universal newborn hearing screening. Providing additional information to midwifery students about newborn hearing screening may result in increased awareness and education for families.

Assessment of Hearing Loss by OAE in Asphyxiated Newborns

BACKGROUND

Severe birth asphyxia (apgar < 7 at the 5th minute of birth) is recognized as a hearing loss risk factor by the joint committee on infant hearing (JCIH). About half of the newborns with hearing loss do not indicate any sign and risk factor at birth. Accordingly, the joint committee recommended performance of hearing screening test in 2000, especially for babies born with risk factors.

OBJECTIVES

The aim of this study was to evaluate hearing loss in asphyxiated neonates. Early diagnosis would result in early treatment of these newborns.

PATIENTS AND METHODS

We assessed the relationship between asphyxia and hearing impairment in newborns admitted to a referral hospital, Tehran, Iran within 3 years (2003 - 2006). Hearing problems were diagnosed and followed by otoacoustic emission (OAE) in the third and fifth days of birth. Asphyxiated neonates with abnormal OAE were referred to an ENT specialist; second OAE and tympanometry were carried out after 2 weeks. Based on the results, newborns underwent treatment or were discharged.

RESULTS

Of 149 asphyxiated neonates, 80 had mean first minute apgar score of 4.01, and mean 5th minute score was 7.24. Two percent (3/149) of asphyxiated neonates had abnormal OAEs. No statistical correlation was found between the 5th minute apgar score and abnormal OAE (P value = 0.391). However, a significant relationship between the mean birth weight and abnormal OAE (P value = 0.0406) was found.

CONCLUSIONS

It seems that birth asphyxia is not correlated with hearing loss.

Newborn screening for treatable genetic conditions: past, present and future

Newborn screening is a complex public health program that has been very successful at significantly reducing infant morbidity and mortality from specific genetic conditions. As this program continues to expand, the role of the obstetrician as patient educator has become increasingly important. The need and desire for prenatal education about newborn screening has been demonstrated, and obstetricians are in the prime position to satisfy this vital role.

Neonatal genetic testing is more than screening

Newborn screening practices have changed since breakthroughs have occurred in genetics and mapping of the human genome. Although newborn screening has been in existence since the 1960s, today's newborn screening practices are subsumed primarily under the umbrella of genetic testing. Inclusion of the family history tool is another dimension of neonatal assessment. Technology allows many noninvasive tests to be run at a low cost but with this advance comes ethical and legal dilemmas. This article discusses neonatal genetic testing and some of the ethical dilemmas that arise.

Clinical Care at the Genomic Interface: Current Genetic Issues in Neonatal Nursing

Although only one in 33 infants is born with a genetic condition, neonatal nurses have a growing responsibility to integrate genetic competency into their clinical practice. This review article outlines the specific aspects of assessment, genetic screening and testing, and communication of genetic information between provider and patient in both the newborn and pregnancy period. Essential nursing competencies are introduced as a framework for building a skill and knowledge set in clinical genetics as it applies to neonatal care. The potential development of inquiry and research oriented practice problems are also highlighted. The exponential growth of human genetic and genomic information drives the need for neonatal nursing to embrace the interface of clinical care and genetic issues.

Attitudes of genetic counselors towards expanding newborn screening and offering predictive genetic testing to children

There is movement to expand newborn screening (NBS) to include conditions that challenge the traditional public health screening criteria. Little is known about the attitudes of genetic counselors towards expanding NBS and offering predictive genetic tests to children. For our study genetic counselors completed an internet survey posted on the National Society of Genetic Counselors Listserv regarding five conditions: cystic fibrosis (CF), Duchenne muscular dystrophy (DMD), glucose-6-phosphate dehydrogenase deficiency (G6PD), fragile X (FraX), and type 1 diabetes (T1D). The survey addressed attitudes towards: (1) testing high-risk infants; (2) mandatory NBS; (3) population screening beyond the newborn period; and (4) testing one's own child. Two hundred sixty-seven usable surveys were received. Over two-thirds of respondents supported testing high-risk infants for all conditions except T1D (22%). CF was the only condition for which there was majority support for both mandatory NBS (56%) and later population screening (60%). For all other conditions, later population screening was preferred over NBS (P <or= 0.01). Genetic counselors were most likely to test their own child for CF (46%) and least likely to test their own child for T1D (6%). For each condition, genetic counselors were more likely to support NBS if they chose to screen their own newborn (P < 0.001). Attitudes towards NBS were not influenced by year of graduation or professional experience. We can conclude that genetic counselors are supportive of targeted testing of high-risk infants. They prefer voluntary population screening with consent to mandatory NBS for conditions that challenge Wilson and Jungner criteria. Their support for NBS correlates with their interest in testing their own children and not with professional experience.

Genetic competencies essential for health care professionals in primary care

The completion of the sequencing of the human genome in 2003 signaled the onset of the genomic era in health care. The knowledge gleaned from the Human Genome Project has led to the understanding that every health problem has a genetic component and that clinicians should include the application of genetic information in all aspects of health care. This article describes the genetic competencies essential for all health care professionals in primary care. Health care professionals should augment their current practice by obtaining a multigenerational genetic family history for each patient, assessing all patients for potentially heritable conditions, providing referrals to genetic health professionals as needed, offering genetic testing when indicated, and considering an individual's genetic makeup in the selection of medications and treatments for that person. Finally, all health care professionals ought to be prepared to address the complex personal, cultural, theological, ethical, legal, and social issues associated with genetic testing and other genetic issues commonly encountered in clinical practice.

New phosphate langbeinites, K2MTi(PO4)3 (M = Er, Yb or Y), and an alternative description of the langbeinite framework

Three new potassium rare-earth/titanium phosphate structures, K(2)ErTi(PO(4))(3) (KErTP), K(2)YbTi(PO(4))(3) (KYbTP) and K(2)YTi(PO(4))(3) (KYTP), are presented, all of which are characterized by single-crystal X-ray diffraction studies. In addition, a fourth structure, K(2)CrTi(PO(4))(3) (KCrTP), has been reinvestigated. All structures are isostructural to the langbeinite-type structure and result from changes made to the growth constituents in high-temperature flux-growth experiments intended to give structurally modified potassium titanyl phosphate (KTP). The two crystallographically independent octahedra sites (site symmetry 3) have a mixed Ti/M (M = Er, Yb, Y or Cr) population, although the rare-earth metals favour one site while chromium favours the other. An alternative approach for the description of the channels and cation cages in langbeinite and related structures is given using [M(5)X(6)O(39)] units. The framework of langbeinite is compared with that of nasicon using these alternative building units. All of the investigated structures crystallize in space group P2(1)3 with Z = 4; a = 10.1053 (2) A, R = 0.023 (KErTP); a = 10.0939 (8) A, R = 0.022 (KYbTP); a = 10.1318 (6) A, R = 0.047 (KYTP); a = 9.8001 (2) A, R = 0.016 (KCrTP).