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Lunke S, Bouffler SE, Downie L, Caruana J, Amor DJ, Archibald A, Bombard Y, Christodoulou J, Clausen M, De Fazio P, Greaves RF, Hollizeck S, Kanga-Parabia A, Lang N, Lynch F, Peters R, Sadedin S, Tutty E, Eggers S, Lee C, Wall M, Yeung A, Gaff C, Gyngell C, Vears DF, Best S, Goranitis I, Stark Z. Prospective cohort study of genomic newborn screening: BabyScreen+ pilot study protocol. BMJ Open 2024; 14:e081426. [PMID: 38569677 PMCID: PMC11146401 DOI: 10.1136/bmjopen-2023-081426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Newborn bloodspot screening (NBS) is a highly successful public health programme that uses biochemical and other assays to screen for severe but treatable childhood-onset conditions. Introducing genomic sequencing into NBS programmes increases the range of detectable conditions but raises practical and ethical issues. Evidence from prospectively ascertained cohorts is required to guide policy and future implementation. This study aims to develop, implement and evaluate a genomic NBS (gNBS) pilot programme. METHODS AND ANALYSIS The BabyScreen+ study will pilot gNBS in three phases. In the preimplementation phase, study materials, including education resources, decision support and data collection tools, will be designed. Focus groups and key informant interviews will also be undertaken to inform delivery of the study and future gNBS programmes. During the implementation phase, we will prospectively recruit birth parents in Victoria, Australia, to screen 1000 newborns for over 600 severe, treatable, childhood-onset conditions. Clinically accredited whole genome sequencing will be performed following standard NBS using the same sample. High chance results will be returned by genetic healthcare professionals, with follow-on genetic and other confirmatory testing and referral to specialist services as required. The postimplementation phase will evaluate the feasibility of gNBS as the primary aim, and assess ethical, implementation, psychosocial and health economic factors to inform future service delivery. ETHICS AND DISSEMINATION This project received ethics approval from the Royal Children's Hospital Melbourne Research Ethics Committee: HREC/91500/RCHM-2023, HREC/90929/RCHM-2022 and HREC/91392/RCHM-2022. Findings will be disseminated to policy-makers, and through peer-reviewed journals and conferences.
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Affiliation(s)
- Sebastian Lunke
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sophie E Bouffler
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lilian Downie
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Jade Caruana
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David J Amor
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alison Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Bombard
- Genomics Health Services Research Program, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - John Christodoulou
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Marc Clausen
- Genomics Health Services Research Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Paul De Fazio
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ronda F Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian Hollizeck
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anaita Kanga-Parabia
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nitzan Lang
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona Lynch
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Simon Sadedin
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erin Tutty
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stefanie Eggers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Crystle Lee
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Meaghan Wall
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Yeung
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Clara Gaff
- University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Christopher Gyngell
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Danya F Vears
- University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- University of Melbourne, Melbourne, Victoria, Australia
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
| | - Zornitza Stark
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
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Notini L, Gaff C, Savulescu J, Vears DF. Offering and Returning Secondary Findings in the Context of Exome Sequencing for Hearing Loss: Clinicians' Views and Experiences. AJOB Empir Bioeth 2023; 14:74-83. [PMID: 36595590 DOI: 10.1080/23294515.2022.2160507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is ongoing debate regarding whether and under which circumstances secondary findings (SF) should be offered in the pediatric context. Although studies have examined patient perspectives on receiving SF, little research has been conducted examining the experiences of clinicians offering SF to parents of newborns receiving genomic sequencing for a recently diagnosed medical condition. METHODS To address this, we conducted qualitative interviews exploring the views and experiences of 12 clinicians who offered SF to parents of infants who had diagnostic exome sequencing (ES) to identify the cause of their hearing loss. Interviews explored clinicians' accounts of parents' choices and decision-making about receiving SF, their views on whether and when to offer SF, their experiences returning SF, and any ethical challenges they encountered. Interviews were audio-recorded, transcribed and analyzed using inductive content analysis. RESULTS Clinicians reported parents who declined all SF often felt finding out about future conditions unrelated to their child's hearing loss may be unhelpful, or even harmful, or were overwhelmed by their child's diagnosis. Clinicians also reported that some parents chose SF because they felt obliged to, even if they did not want to receive them. They explained that while some parents experienced decision-making regarding SF as positive, for others, this process was challenging or distressing. While clinicians generally agreed SF should be offered, mainly to promote parental choice, most felt SF should be offered after disclosing diagnostic results, primarily to avoid overwhelming parents. Clinicians encountered several ethical challenges, including balancing parental autonomy with non-maleficence, wanting to report or not report certain SF, and questioning whether parents can make an autonomous choice regarding SF. CONCLUSIONS Our findings, which are novel as they relate to parents of young infants with a recent diagnosis of hearing loss, add new insights into clinicians' and parents' decision-making regarding SF in pediatrics.
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Affiliation(s)
- Lauren Notini
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Clara Gaff
- Genomics in Society, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Melbourne Genomics Health Alliance, Parkville, Australia
| | - Julian Savulescu
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia.,Chen Su Lan Centennial Professor in Medical Ethics, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Danya F Vears
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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3
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Zhang X, Ma Z, Zheng J, Xu H, Pan J, Lv L. Analysis of Serum Inflammatory Markers in Infants Under 6 Months of Age with Non-Syndromic Moderate and Severe Hearing Loss Associated with GJB2 Gene Mutations. Med Sci Monit 2023; 29:e938165. [PMID: 36593740 PMCID: PMC9825025 DOI: 10.12659/msm.938165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The GJB2 gene is reported to be the main hereditary factor responsible for non-syndromic hearing impairment in infants. Several kinds of hearing loss have been linked to elevated inflammatory markers. This study aimed to evaluate serum levels of IL-2, IL-4, IL-6, IL-10, IL-17, alpha-TNF, and γ-IFN and the severity of hearing loss. MATERIAL AND METHODS Ninety newborns were divided into 3 groups: severe hearing impairment (31 infants), moderate hearing impairment (30 infants), and normal hearing (29 infants). Hearing screening was performed using otoacoustic emissions test. Mutations of the GJB2 gene were detected with Sanger sequencing. The patients had DNFB1 mutation. Seven blood inflammatory markers were tested using Cytometric Bead Array. We performed the t test to examine differences in expression of 7 inflammatory markers between sexes in the groups. The correlation between indicators within groups was studied using the Pearson correlation test. Correlation of different indicators among groups was studied using the Spearman correlation test. RESULTS When compared among the 3 groups (severe, moderate hearing impairment, and normal hearing group), we found that IL-10 had a positive correlation with the severity of GJB2-associated hearing loss, which was statistically significant (P<0.05). CONCLUSIONS This research aimed to assess the relationship of 7 serum inflammatory markers with GJB2-associated hearing loss in infants. Inflammatory marker IL-10 had a positive correlation with the severity of GJB2-associated infant hearing loss, and it might have the potential to become a future therapeutic target.
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Affiliation(s)
- Xingang Zhang
- Department of Otorhinolaryngology – Head and Neck Surgery, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, PR China
| | - Zhaoxin Ma
- Department of Otorhinolaryngology – Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Jishan Zheng
- Department of Pediatrics, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, PR China
| | - Huiqing Xu
- Department of Pediatrics, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, PR China
| | - Jiewen Pan
- Central Laboratory of Birth Defects Prevention and Control, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, PR China
| | - Lanqiu Lv
- Department of Child Healthcare, Ningbo Women and Children’s Hospital, Ningbo, Zhejiang, PR China
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Vears D, Amor DJ. A framework for reporting secondary and incidental findings in prenatal sequencing: When and for whom? Prenat Diagn 2022; 42:697-704. [PMID: 35032068 PMCID: PMC9306573 DOI: 10.1002/pd.6097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 12/27/2022]
Abstract
As the use of genomic sequencing (GS) in the prenatal setting becomes more widespread, laboratories and clinicians will be tasked with making decisions about whether to offer incidental and secondary findings to expectant parents and, if so, which ones. Unfortunately, few guidelines or position statements issued by professional bodies address the return of secondary findings specifically in the context of prenatal GS, nor do they offer clear guidance on whether, and which types of incidental findings should be reported. Laboratories and clinicians will also need to navigate other challenges, such as how to obtain sufficiently informed consent, workload burdens for both laboratories and clinicians, and funding. Here we discuss these, and other challenges associated with offering incidental and secondary findings in the context of prenatal GS. We outline existing guidelines for return of these findings, prenatally and in children. We review the existing literature on stakeholder perspectives on return of incidental and secondary findings and discuss the main practical and ethical challenges that require consideration. We then propose a framework to help guide decision-making, suggesting a baseline routine analysis, with additional layers of analysis that could be offered, according to local laboratory policy, with additional opt-in consent from the parents.
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Affiliation(s)
- Danya Vears
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Melbourne Law School, University of Melbourne, Carlton, Victoria, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
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Notini L, Gaff CL, Savulescu J, Vears DF. Clinicians' Views and Experiences with Offering and Returning Results from Exome Sequencing to Parents of Infants with Hearing Loss. J Clin Med 2021; 11:35. [PMID: 35011775 PMCID: PMC8745321 DOI: 10.3390/jcm11010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Exome sequencing (ES) is an effective method for identifying the genetic cause of hearing loss in infants diagnosed through newborn hearing screening programs. ES has the potential to be integrated into routine clinical care, yet little is known about the experiences of clinicians offering this test to families. To address this gap, clinicians involved in a clinical study using ES to identify the cause of infants' hearing loss were interviewed to explore their experiences with offering and returning results to parents. Interview transcripts were analysed using inductive content analysis. Twelve clinicians participated: seven genetic counsellors, four clinical geneticists, and one paediatrician. Most clinicians were supportive of offering ES to infants with hearing loss, primarily because results may inform the child's clinical management. However, some expressed concerns, questioning the utility of this information, particularly for isolated hearing loss. Clinicians had differing views regarding the optimal time to offer ES to families; while some felt that families can manage everything at once, others recommended delaying testing until parents have come to terms with their child's diagnosis. These findings show the complexity involved in determining how ES should be offered to families following the diagnosis of a child with hearing loss, particularly with regards to when testing is suggested.
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Affiliation(s)
- Lauren Notini
- Melbourne Law School, University of Melbourne, Carlton, Melbourne 3052, Australia;
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, Melbourne 3052, Australia;
| | - Clara L. Gaff
- Genomics in Society, Murdoch Children’s Research Institute, Parkville, Melbourne 3052, Australia;
- Department of Paediatrics, University of Melbourne, Parkville, Melbourne 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, Melbourne 3052, Australia
| | - Julian Savulescu
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, Melbourne 3052, Australia;
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX1 4BH, UK
- University of Melbourne, Parkville, Melbourne 3052, Australia
| | - Danya F. Vears
- Melbourne Law School, University of Melbourne, Carlton, Melbourne 3052, Australia;
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, Melbourne 3052, Australia;
- Centre for Biomedical Ethics and Law, KU Leuven, 3000 Leuven, Belgium
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Prenatal Diagnosis by Array Comparative Genomic Hybridization in Fetuses with Cardiac Abnormalities. Genes (Basel) 2021; 12:genes12122021. [PMID: 34946970 PMCID: PMC8701951 DOI: 10.3390/genes12122021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Congenital heart defects (CHDs) appear in 8–10 out of 1000 live born newborns and are one of the most common causes of deaths. In fetuses, the congenital heart defects are found even 3–5 times more often. Currently, microarray comparative genomic hybridization (array CGH) is recommended by worldwide scientific organizations as a first-line test in the prenatal diagnosis of fetuses with sonographic abnormalities, especially cardiac defects. We present the results of the application of array CGH in 484 cases with prenatally diagnosed congenital heart diseases by fetal ultrasound scanning (256 isolated CHD and 228 CHD coexisting with other malformations). We identified pathogenic aberrations and likely pathogenic genetic loci for CHD in 165 fetuses and 9 copy number variants (CNVs) of unknown clinical significance. Prenatal array-CGH is a useful method allowing the identification of all unbalanced aberrations (number and structure) with a much higher resolution than the currently applied traditional assessment techniques karyotype. Due to this ability, we identified the etiology of heart defects in 37% of cases.
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Abstract
Compelling evidence indicates that some newborns harboring genetic variants associated with hearing loss might not be identified by current physiologic newborn hearing screening (NBHS) rendering current NBHS protocols suboptimal. Incorporating genomic sequencing into NBHS would improve clinical diagnosis and decrease time to early intervention efforts.
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Affiliation(s)
- Calli Ober Mitchell
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, NRB 160, 77 Avenue Louis Pasteur, Boston, MA 02115, USA. https://twitter.com/CalliMitchell3
| | - Cynthia Casson Morton
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, NRB 160, 77 Avenue Louis Pasteur, Boston, MA 02115, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, UK.
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8
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Núñez-Batalla F, Jáudenes-Casaubón C, Sequí-Canet JM, Vivanco-Allende A, Zubicaray-Ugarteche J, Olleta Lascarro I. New-born Hearing Screening Programmes in 2020: CODEPEH Recommendations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:312-323. [PMID: 34535222 DOI: 10.1016/j.otoeng.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 10/20/2022]
Abstract
Programmes for early detection of congenital hearing loss have been successfully implemented mainly in developed countries, after overcoming some conceptual errors argued against their implementation and some criticism of their efficacy. However, some difficulties and weaknesses are still identified in these programmes: the detection of late-onset hearing loss and the percentage of children who did not pass the screening and did not complete the process of diagnosis and treatment, these being cases that are lost in the process. The purpose of this Document is to analyse these problems to determine areas for improvement and to emphasize one of the basic principles for the success of the programmes: continuous training for the interdisciplinary team. The result of the review process carried out by CODEPEH has been drafted as Recommendations for updating the Programmes with the evidence of the last decade, including advances in screening technology, the impact of the present knowledge on congenital infection by cytomegalovirus, genetic hearing loss research and control systems of lost to follow-up cases, treatment and follow up.
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Núñez-Batalla F, Jáudenes-Casaubón C, Sequí-Canet JM, Vivanco-Allende A, Zubicaray-Ugarteche J, Olleta Lascarro I. Programas de cribado de la hipoacusia congénita en 2020: recomendaciones CODEPEH. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tutty E, Amor DJ, Jarmolowicz A, Paton K, Downie L. Personal utility of genomic sequencing for infants with congenital deafness. Am J Med Genet A 2021; 185:3634-3643. [PMID: 34184819 DOI: 10.1002/ajmg.a.62411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 06/12/2021] [Indexed: 11/08/2022]
Abstract
Decisions about genetic testing have traditionally been based on clinical utility and cost, but personal utility is increasingly recognized when assessing the value of testing. Whole exome sequencing (WES) was offered to a population cohort of 106 infants diagnosed with congenital hearing loss. Parents could choose to receive results relating to hearing loss only or also learn additional information about childhood-onset conditions (medically nonactionable and/or actionable). This study aimed to quantify the personal utility of WES for parents after a diagnosis of hearing loss in their child. Parents completed surveys pretest (63/106), after hearing loss results (52/106) and after receiving additional information (47/72). Open-ended responses from all three surveys (N = 67) were analyzed using inductive content analysis. Answers to questions regarding the value of sequencing to parents were analyzed and collated. Parents placed high value on diagnostic WES for hearing loss but had different perspectives on the personal utility of additional information. Diagnostic results provided certainty while the choice to learn additional information about childhood-onset disorders was associated with empowerment. WES also represented an opportunity to promote their child's best interests. Results provide insights into the utility of WES for the indication of congenital deafness and for genomic newborn screening broadly.
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Affiliation(s)
- Erin Tutty
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Victorian Clinical Genetics Service, Melbourne, Victoria, Australia
| | - Anna Jarmolowicz
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Kate Paton
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lilian Downie
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Downie L, Amor DJ, Halliday J, Lewis S, Martyn M, Goranitis I. Exome Sequencing for Isolated Congenital Hearing Loss: A Cost-Effectiveness Analysis. Laryngoscope 2020; 131:E2371-E2377. [PMID: 33382469 DOI: 10.1002/lary.29356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the relative cost-effectiveness of exome sequencing for isolated congenital deafness compared with standard care. STUDY DESIGN Incremental cost-effectiveness and cost-benefit analyses were undertaken from the perspective of the Australian healthcare system using an 18-year time horizon. METHODS A decision tree was used to model the costs and outcomes associated with exome sequencing and standard care for infants presenting with isolated congenital deafness. RESULTS Exome sequencing resulted in an incremental cost of AU$1,000 per child and an additional 30 diagnoses per 100 children tested. The incremental cost-effectiveness ratio was AU$3,333 per additional diagnosis. The mean societal willingness to pay for exome sequencing was estimated at AU$4,600 per child tested relative to standard care, resulting in a positive net benefit of AU$3,600. Deterministic and probabilistic sensitivity analyses confirmed the cost-effectiveness of exome sequencing. CONCLUSIONS Our findings demonstrate the cost-effectiveness of exome sequencing in congenital hearing loss, through increased diagnostic rate and consequent improved process of care by reducing or ceasing diagnostic investigation or facilitating targeted further investigation. We recommend equitable funding for exome sequencing in infants presenting with isolated congenital hearing loss. LEVEL OF EVIDENCE N/A. Laryngoscope, 131:E2371-E2377, 2021.
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Affiliation(s)
- Lilian Downie
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Amor
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia.,Australian Genomics Health Alliance, Melbourne, Victoria, Australia
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12
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Downie L, Halliday J, Lewis S, Lunke S, Lynch E, Martyn M, Gaff C, Jarmolowicz A, Amor DJ. Exome sequencing in newborns with congenital deafness as a model for genomic newborn screening: the Baby Beyond Hearing project. Genet Med 2020; 22:937-944. [PMID: 31974413 DOI: 10.1038/s41436-019-0745-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Genomic newborn screening raises practical and ethical issues. Evidence is required to build a framework to introduce this technology safely and effectively. We investigated the choices made by a diverse group of parents with newborns when offered tiered genomic information from exome sequencing. METHODS This population-derived cohort comprised infants with congenital deafness. Parents were offered exome sequencing and choice regarding the scope of analysis. Options were choice A, diagnostic analysis only; choice B, diagnostic analysis plus childhood-onset diseases with medical actionability; or choice C, diagnostic analysis plus childhood-onset diseases with or without medical actionability. RESULTS Of the 106 participants, 72 (68%) consented to receive additional findings with 29 (27.4%) selecting choice B and 43 (40.6%) opting for choice C. Family size, ethnicity, and age of infant at time of recruitment were the significant predictors of choice. Parents who opted to have additional findings analysis demonstrated less anxiety and decisional conflict. CONCLUSIONS These data provide evidence from a culturally diverse population that choice around additional findings is important and the age of the infant when this choice is offered impacts on their decision. We found no evidence that offering different levels of genomic information to parents of newborns has a negative psychological impact.
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Affiliation(s)
- Lilian Downie
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Elly Lynch
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Anna Jarmolowicz
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - David J Amor
- Victorian Clinical Genetics Services, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia. .,Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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13
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Downie L, Halliday J, Burt R, Lunke S, Lynch E, Martyn M, Poulakis Z, Gaff C, Sung V, Wake M, Hunter MF, Saunders K, Rose E, Lewis S, Jarmolowicz A, Phelan D, Rehm HL, Amor DJ. Exome sequencing in infants with congenital hearing impairment: a population-based cohort study. Eur J Hum Genet 2019; 28:587-596. [PMID: 31827275 DOI: 10.1038/s41431-019-0553-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022] Open
Abstract
Congenital hearing impairment (HI) is the most common sensory impairment and can be isolated or part of a syndrome. Diagnosis through newborn hearing screening and management through early intervention, hearing aids and cochlear implantation is well established in the Australian setting; however understanding the genetic basis of congenital HI has been missing. This population-derived cohort comprised infants with moderate-profound bilateral HI born in the 2016-2017 calendar years, detected through newborn hearing screening. Participants were recruited through an integrated paediatric, otolaryngology and genetics HI clinic and offered whole exome sequencing (WES) on a HiSeq4000 or NextSeq500 (Illumina) platform with a targeted average sequencing depth of 100x and chromosome microarray on the Illumina Infinium core exome-24v1.2 platform. Of those approached, 68% (106/156) consented to participate. The rate of genetic diagnosis was 56% (59/106), significantly higher than standard of care (GJB2/6 sequencing only), 21% (22/106). There were clinical implications for the 106 participants: 36% required no further screening, 9% had tailored screening initiated, 2% were offered treatment and 4% had informed care for a complex neurodevelopmental syndrome. WES in this cohort demonstrates the range of diagnoses associated with congenital HI and confirms the genetic heterogeneity of congenital HI. The high diagnostic yield and clinical implications emphasises the need for genomic sequencing to become standard of care.
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Affiliation(s)
- Lilian Downie
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Burt
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Elly Lynch
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Zeffie Poulakis
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | - Valerie Sung
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew F Hunter
- Monash Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Kerryn Saunders
- Monash Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Elizabeth Rose
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Anna Jarmolowicz
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Dean Phelan
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Heidi L Rehm
- Massachusetts General Hospital and the Broad Institute of MIT and Harvard, Boston, MA, USA
| | | | - David J Amor
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia. .,Murdoch Children's Research Institute, Melbourne, VIC, Australia. .,Royal Children's Hospital, Melbourne, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
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14
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Sung V, Downie L, Paxton GA, Liddle K, Birman CS, Chan WW, Cottier C, Harris A, Hunter M, Peadon E, Peacock K, Roddick L, Rose E, Saunders K, Amor DJ. Childhood Hearing Australasian Medical Professionals network: Consensus guidelines on investigation and clinical management of childhood hearing loss. J Paediatr Child Health 2019; 55:1013-1022. [PMID: 31524978 DOI: 10.1111/jpc.14508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/12/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Valerie Sung
- Prevention Innovation, Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lilian Downie
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Reproductive Epidemiology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Monash University, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Monash University, Melbourne, Victoria, Australia
| | - Georgia A Paxton
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen Liddle
- Child Development Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine S Birman
- ENT Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Cochlear Implant Centre, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Medical School, Macquarie University, Sydney, New South Wales, Australia
| | - Wei Wei Chan
- Department of Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Carolyn Cottier
- The Hearing Support Service, Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Alison Harris
- Child Development Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Hunter
- Monash Genetics, Monash Health, Monash University, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Peadon
- Deafness Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kenneth Peacock
- Deafness Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Laurence Roddick
- Department of General Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Department of Paediatric Respiratory Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Discipline of Paediatrics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth Rose
- Department of Otolaryngology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia.,Neurogenetics, Genetics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Kerryn Saunders
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Paediatric Hearing Services, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Monash University, Melbourne, Victoria, Australia.,Neurodisability and Rehabilitation, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
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15
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Data Resource Profile: The Victorian Childhood Hearing Impairment Longitudinal Databank (VicCHILD). Int J Epidemiol 2019; 48:1409-1410h. [DOI: 10.1093/ije/dyz168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 01/26/2023] Open
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16
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Martyn M, Kanga-Parabia A, Lynch E, James PA, Macciocca I, Trainer AH, Halliday J, Keogh L, Wale J, Winship I, Bogwitz M, Valente G, Walsh M, Downie L, Amor D, Wallis M, Cunningham F, Burgess M, Brown NJ, Jarmolowicz A, Lunke S, Goranitis I, Gaff CL. A novel approach to offering additional genomic findings-A protocol to test a two-step approach in the healthcare system. J Genet Couns 2019; 28:388-397. [DOI: 10.1002/jgc4.1102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Melissa Martyn
- Melbourne Genomics Health Alliance; Melbourne Australia
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | - Anaita Kanga-Parabia
- Melbourne Genomics Health Alliance; Melbourne Australia
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | - Elly Lynch
- Melbourne Genomics Health Alliance; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
| | - Paul A. James
- Peter MacCallum Cancer Institute; Melbourne Australia
- The Royal Melbourne Hospital; Melbourne Australia
| | - Ivan Macciocca
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
| | - Alison H. Trainer
- Peter MacCallum Cancer Institute; Melbourne Australia
- The Royal Melbourne Hospital; Melbourne Australia
| | - Jane Halliday
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | | | - Janney Wale
- Melbourne Genomics Health Alliance; Melbourne Australia
| | | | | | | | - Maie Walsh
- Peter MacCallum Cancer Institute; Melbourne Australia
- The Royal Melbourne Hospital; Melbourne Australia
| | - Lilian Downie
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
| | - David Amor
- University of Melbourne; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | | | - Fiona Cunningham
- Murdoch Children’s Research Institute; Melbourne Australia
- Monash Health; Melbourne Australia
| | | | - Natasha J. Brown
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
- Austin Health; Melbourne Australia
- Royal Children’s Hospital; Melbourne Australia
| | - Anna Jarmolowicz
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
| | - Sebastian Lunke
- Murdoch Children’s Research Institute; Melbourne Australia
- Victorian Clinical Genetics Services; Melbourne Australia
| | - Ilias Goranitis
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
| | - Clara L. Gaff
- Melbourne Genomics Health Alliance; Melbourne Australia
- University of Melbourne; Melbourne Australia
- Murdoch Children’s Research Institute; Melbourne Australia
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