Rapid Phenotype-Driven Gene Sequencing with the NeoSeq Panel: A Diagnostic Tool for Critically Ill Newborns with Suspected Genetic Disease

Abstract

New genomic sequencing techniques have shown considerable promise in the field of neonatology, increasing the diagnostic rate and reducing time to diagnosis. However, several obstacles have hindered the incorporation of this technology into routine clinical practice. We prospectively evaluated the diagnostic rate and diagnostic turnaround time achieved in newborns with suspected genetic diseases using a rapid phenotype-driven gene panel (NeoSeq) containing 1870 genes implicated in congenital malformations and neurological and metabolic disorders of early onset (<2 months of age). Of the 33 newborns recruited, a genomic diagnosis was established for 13 (39.4%) patients (median diagnostic turnaround time, 7.5 days), resulting in clinical management changes in 10 (76.9%) patients. An analysis of 12 previous prospective massive sequencing studies (whole genome (WGS), whole exome (WES), and clinical exome (CES) sequencing) in newborns admitted to neonatal intensive care units (NICUs) with suspected genetic disorders revealed a comparable median diagnostic rate (37.2%), but a higher median diagnostic turnaround time (22.3 days) than that obtained with NeoSeq. Our phenotype-driven gene panel, which is specific for genetic diseases in critically ill newborns is an affordable alternative to WGS and WES that offers comparable diagnostic efficacy, supporting its implementation as a first-tier genetic test in NICUs.

Keywords: critically ill newborn; genetic diagnosis; genomic sequencing; trio sequencing.

Figure 1

Schematic comparing NeoSeq and other diagnostic genome sequencing strategies (WGS^14,15,20,22, WES^16,18,19,23, and CES^12,13,17) showing the size of the genomic portion interrogated, the amount of data generated, and the median diagnostic rates achieved for each approach. To facilitate visual comparison, data are represented as the relative area of each circle. For WGS and WES, information on the genomic portion interrogated and data generated data were extracted from www.illumina.com/wes-wgs. For CES, information on the genomic portion interrogated and data generated was estimated for 6000 genes. Diagnostic rates were calculated as the mean of the results of the cited studies. Total number of patients for each genome sequencing strategy: CES, n = 306; WES, n = 242; WGS, n = 395.