DNA Day Illinois 2013 Webinar: Newborn Screening and Family Health History. Tuesday, April 16, 2013

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1 DNA Day Illinois 2013 Webinar: Newborn Screening and Family Health History Tuesday, April 16, 2013

2 Objectives Recognize the importance & impact of newborn screening Describe the process of newborn screening Identify disorders being screened for and new disorders being added to newborn screening in Illinois Identify connection between family health history and newborn screening Recognize how disorders and health risks are inherited Outline benefits to gathering family health history Illustrate importance of family health history and newborn screening

3 Acknowledgments

4 Place of employment Poll What type of health center do you work in? a) Local public health department b) State public health department c) Hospital d) Federally Qualified Health Center e) Private Practice f) Other

5 Job position poll What is your job position? a) Nurse b) Doctor c) Genetic Counselor d) Social Worker e) Other health related position f) Other non health related position

6 Presenters Michelle Gilats Marie Vonesh

7 Newborn Screening

8 History and Impact Approximate No. of Newborns in IL Annually Screened Diagnosed 165,

9 Introduction to Genetics Genes are like the body s blueprints Some mutations lead to different traits Other mutations alter function of protein and lead to disease

10 Newborn Screening Process What: A blood test performed by heel stick Screening also includes a hearing test and can include pulse oximetry When: hours after birth Where: In hospital Why: To determine if a baby has a serious medical condition that needs early intervention

11 Screening in Illinois Screening differs from state to state IL currently screens for 29 core conditions IL is adding 7 Lyosomal Storage Disorders and Severe Combined Immunodeficiency Disorder to its newborn screening panel

12 Lyosomal Disorders Fabry Gaucher Krabbe MPS I MPS II Niemann-Pick Pompe

13 Fabry Disease NBS measures: alpha-galactosidase Symptoms/Signs Treatment Pain Gastrointestinal Issues Possible stroke Renal damage Cardiomyopathy Enzyme replacement therapy Medications to treat existing symptoms

14 Gaucher Disease NBS measures: β - glucosylceramidase Symptoms/Signs Treatment Type I Bone disease Anemia Enlarged spleen Lung disease Type II Neurological disease Enzyme replacement therapy Substrate reduction therapy Bone Marrow Transplant

15 Krabbe Disease NBS measures: galactocerebrosidase Symptoms/Signs Treatment Infantile Type Irritability Hypertonicity Progressive neurologic deterioration Late Onset Forms Weakness Vision Loss Intellectual regression Supportive care Stem cell transplant

16 Mucopolysaccharidosis Type I (MPS I) NBS measures: alpha-l-iduronidase Symptoms/Signs Treatment Severe Type Coarse facial features Enlarged liver and spleen Skeletal abnormalities Hearing loss Corneal clouding Intellectual disability Attenuated Type Severity and rate of progression varies Enzyme replacement therapy Stem cell transplant

17 Mucopolysaccharidosis Type II (MPS II) NBS measures: Iduronate-2-sulfatase Symptoms/Signs Treatment Enlarged liver and spleen Skeletal abnormalities Severe Type Progressive cognitive deterioration Progressive airway disease Cardiac disease Chronic diarrhea Attenuated Type No CNS involvement Enzyme replacement therapy

18 Niemann-Pick Disease NBS measures: Acid sphingomyelinase Symptoms/Signs Treatment Type A Enlarged liver and spleen Cherry red spot in retina Recurrent respiratory infections Neurological deterioration Type B No neurological involvement Enlarged liver and spleen Pulmonary function deterioration Supportive care

19 Symptoms/Signs Infantile Onset Hypotonia Muscle weakness Cardiomegaly & hypertrophic cardiomyopathy Feeding difficulties Failure to thrive Respiratory distress Hearing loss Late Onset Proximal muscle weakness Respiratory insufficiency without cardiac involvement Pompe Disease NBS measures: alpha-glucosidase Treatment Enzyme replacement therapy Physical therapy Respiratory support

20 SCID and CCHD Severe Combined Immunodeficiency (SCID) Known as Bubble Boy disease Inheritance: Autosomal recessive or X-linked Group of disorders that lead to absence of T- lymphocytes Symptoms: Recurrent infections, death within 1 year if not treated Treatment: Stem cell transplant (within first 3 months of life), bone marrow transplant, immunoglobulin injections, prophylactic antibiotics Critical Congenital Heart Disease (CCHD) ~15% due to genetic causes Group of defects that typically require treatment within first year of life Symptoms: Cyanosis, breathing difficulty, poor weight gain Treatment: Possible surgery, medications, catheterization NBS measure: Pulse oximetry (not a blood test) NBS measure: Lymphocytes

21 Limitations Additional testing needed Importance of genetic counseling Consumer education important

22 Family Health History

23 Types of inheritance Autosomal Recessive

24 Types of inheritance Autosomal Dominant

25 Types of inheritance X-Linked

26 Living with Fabry Disease

27 Discovery Gynecologist Primary Doctor Nephrologist Biopsy Screening DNA Testing December 2002 January May2003 June 2003 June 2003

28 Symptoms Sweating Heat & Cold Intolerance Skin Issues Eye Issues High Fevers Stomach Issues Hearing Loss Kidney Problems Heart Atrial Fibrillation

29 Treatment October 2003 Hospitals Centers Home

30 Family Health History Grandparents Male Female Not Affected by Fabry Disease John Yanoula Affected by Fabry Disease Uncles Deceased Parents Gus Sam Peggy Chris George Bill Harry Siblings Martha Joanne Marie Me

31 Family Health History Siblings Martha Joanne Me Jessica Rebecca Brandon Ryan Ian Sophia Ella Quinn Gavin

32 Effects on Family

33 Newborn Screening

34 Questions

35 Resources Illinois Department of Public Health Genetics Program: Genetic Education for Illinois: Newborn Screening in Illinois: Newborn Screening for Practitioners: Family Health History: National Fabry Disease Foundation

36 References American College of Medical Genetics and Genomics. (2012). Newborn screening ACT sheets and confirmatory algorithms. Retrieved October 11, 2012 from acmg.net/am/template.cfm?section=nbs_act_sheets_and_algorithms_table& Template=/CM/HTMLDisplay.cfm&ContentID=5072 Baby s First Test. (2012). Homepage. Retrieved January 24, 2013 from test.org/ Burke, S. & Kirk, M. (2006). Genetics education in the nursing profession: Literature review. Journal of Advanced Nursing, 54(2), Davis, T.C., Humiston, S.G., Arnold, C.L, Bocchini, J.A., Bass, P.F., Kennen, E.M.Lloyd- Puryear, M. (2006). Recommendations for effective newborn screening communication: Results of focus groups with parents, providers, and experts. Pediatrics, 117(5), S Genetic Alliance. (2009). Understanding genetics: A New York, Mid-Atlantic guide for patients and health professionals. Retrieved October 11, 2012 from resourcerepository.org/documents/1247/understandinggenetics:aneyyork,mid-atlantic guideforpatientsandhealthprofessionals Kemper, A.R., Fant, K.E. & Clark, S.J. (2005). Informing parents about newborn screening. Public Health Nursing, 22(4), Mehta, A. & Hughes, D. (2011). Fabry Disease. Retrieved October 29, 2012 from ncbi.nlm.nih.gov/books/nbk1292/ McCabe, L.L., Therrell, B.L., & McCabe, E.R. (2002). Newborn screening: Rationale for a comprehensive, fully integrated public health system. Molecular Genetics and Metabolism, 77, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2012). Pulse oximetry screening for critical congenital heart defects. Retrieved January 17, 2013 from

37 References National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2013). Newborn screening. Retrieved January 24, 2012 from National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2013). Screening for critical congenital heart defects. Retrieved January 24, 2013 from National Fabry Disease Foundation. (2012). Fabry disease symptoms overview. Retrieved March 12, 2013, from symptoms-overview National Institute of Neurological Disorders and Stroke, National Institutes of Health. (2011). NINDS Gaucher Disease information page. Retrieved October 29, 2012 from National Institute of Neurological Disorders and Stroke, National Institutes of Health. (2011). NINDS Krabbe Disease information page. Retrieved October 29, 2012 from National Society of Genetic Counselors. (n.d.). Your family history. Retrieved January 24, 2013 from U.S. Department of Health and Human Services. (n.d.). My family health portrait: A tool from the Surgeon General. Retrieved January 24, 2013 from fhh-web/popup/gethelp/helpdetailslearnmore.action#users U.S. National Library of Medicine, National Institutes of Health. (2013). Inheriting genetic conditions: Inheritance patterns and understanding risk. Retrieved October 11, 2011 from

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