Newborn screening (NBS) in the United States has been used for more than 50 years and is often touted as the world’s most successful public health program. Some 99% of the nation’s children are screened at birth for treatable genetic conditions caused in whole or in part by variations in their DNA sequence. Screening has saved infants, and their families, from enormous suffering.
Recently the NBS program has garnered even more attention and interest thanks to the groundbreaking work by Rady Children’s Hospital to leverage genomics more broadly in the screening and treatment of infants. Recently, clinicians have pushed to expand the NBS list of treatable genetic conditions.
The price of genomic testing has continued to come down and innovations in understanding genetic disorders have also been demonstrated to relieve financial pressures on the healthcare sector. In fact, rapid and effective treatment early in life has been shown to be less costly than chronic conditions that would otherwise require ongoing intervention by the health system.
What is newborn screening?
In the United States, small blood samples are collected from every infant shortly after birth and analyzed for treatable genetic disorders. Newborn screening was pioneered in 1963 by Robert Guthrie, MD, for diagnosing phenylketonuria, a genetic disorder that affects metabolism leading to toxicity that damages the brain.
Today, it has become a public health practice in all States to screen newborns for a minimum of 29 treatable disorders to detect inherited genetic disorders. The Advisory Committee for Heritable Disorders in Newborns and Children recommends screening for 61 conditions, 35 of which are conditions that are screened in all 50 states. Over the past decade, the use of low-cost DNA sequencing to diagnose and treat sick children suggests that expanding the Recommended Uniform Screening Panel from 35 treatable conditions to a much more comprehensive set is both possible and affordable for the U.S. healthcare system.
The path to genomic screening in infants
Funding of the sequencing of 100,000 patients in England by the U.K. Department of Health in 2013, Genomics England piloted the use of whole genome sequencing (WGS) in 4,660 children suspected of having rare genetic conditions.1 In parallel, Stephen Kingsmore, MD, and Rady Children’s Institute of Genomics Medicine championed ultra-rapid WGS to diagnose affected newborns within 13 hours.2 These efforts, in conjunction with other programs around the world, established the use case of WGS delivering precision care to pediatric practice and set the stage for use of WGS to screen newborns earlier in life and before symptoms appear.
It is believed there are currently roughly 600 conditions for which early-life intervention will improve the longer-term health of the child. This motivated the National Health Service in the U.K. to begin piloting newborn screening using WGS in 2021. In the U.S., New York is funding the GUARDIAN initiative to offer WGS NBS for 100,000 newborns in the state to screen for 250 conditions and to characterize the diagnostic benefits to the child and the health economic impact on the health system.
Long-term follow-up is key to ensuring the information learned through DNA sequencing of newborns is appropriately communicated and integrated into clinical care with the family’s pediatrician.
Luna, in collaboration with the American College of Medical Genetics, Genetic Alliance, and various medical systems, is engaged in a study to understand the follow-up needs of families and children affected by spinal muscular atrophy and other conditions who receive their diagnosis through NBS. This study uses Luna’s Community Driven Innovation™. This participant-led methodology addresses long-standing problems with traditional research approaches while providing an unbiased, clear understanding of the priorities, values, and challenges of individuals, families, and communities. One of the objectives of this study is to understand the impact of both NBS and long-term follow-up for children impacted by one of the conditions covered with current screening programs and potentially recommend changes in patient care. The NBS study may prove the feasibility of one path to improved care moving forward.
Consider privacy issues with newborn screening research
As new medical approaches are implemented, parents have important decisions to make prior to enrolling their newborn into WGS studies. Consider the risk and benefits involved regarding further use of DNA data after screening for genetic conditions. They should ask how their child’s data will be used in research, by whom, over what period, and for what types of research. Who makes these decisions is a function of the data privacy and protection regulations in various states and countries.
One’s genome uniquely identifies them—and their family—for their entire life, so understanding the impact of early decisions such as these is critical.
Luna’s suite of tools and services connects communities with researchers to accelerate health discoveries. With participation from more than 180 countries and communities advancing causes including disease-specific, public health, environmental, and emerging interests, Luna empowers these collectives to gather a wide range of data—health records, lived experience, disease history, genomics, and more—for research.
Luna gives academia and industry everything they need from engagement with study participants to data analysis across multiple modalities using a common data model. The platform is compliant with clinical regulatory requirements and international consumer data privacy laws.
By providing privacy-protected individuals a way to continually engage, Luna transforms the traditional patient-disconnected database into a dynamic, longitudinal discovery environment where researchers, industry, and community leaders can leverage a range of tools to surface insights and trends, study disease natural history and biomarkers, and enroll in clinical studies and trials.