Genetic counseling considerations with rapid genome-wide sequencing in a neonatal intensive care unit

Abstract

As genome-wide sequencing (GWS; exome sequencing [ES] and whole genome sequencing [WGS]) is implemented more frequently in the neonatal intensive care unit (NICU), it is important to understand parents' opinions regarding GWS, and views toward incidental findings (IFs) (also known as secondary findings). RAPIDOMICS was a pilot study of rapid trio-based (biological parents and neonate) ES for 25 neonates with a suspected genetic condition at the BC Women's Hospital NICU. As part of RAPIDOMICS, we explored parents' motivations and concerns regarding ES of their child, uptake of IFs for themselves, and rates of anxiety and depression at the time of pre-test genetic counseling via administration of the Generalized Anxiety Disorder Assessment 7 and Patient Health Questionnaire 8. These findings were compared to those from the Clinical Assessment of the Utility of Sequencing and Evaluation as a Service (CAUSES) study (outpatient trio-based GWS) that includes pediatric patients with suspected genetic disease (with an average age of 10 years). Parents in RAPIDOMICS were more likely to identify "diagnosis" as their primary motivation to pursue GWS (p = 0.011), less likely to identify "no concerns" (p = 0.003), and less likely to opt in to receive IFs (p = 0.003) than parents in CAUSES. Rates of depression and anxiety in both groups were higher relative to the general population. We present novel findings regarding the similarities and differences in parental opinions and decisions of these cohorts.

Keywords: exome sequencing; genetic counseling; genome-wide sequencing; incidental (secondary) findings; neonatal intensive care unit (NICU).