Risk stratification of hemodynamically significant patent ductus arteriosus by clinical and genetic factors

Background Hemodynamically significant patent ductus arteriosus(hsPDA)is associated with increased comorbidities in neonates.Early evaluation of hsPDA risk is critical to implement individualized intervention.The aim of the study was to provide a powerful reference for the early identification of high-risk hsPDA population and early treatment decisions.Methods We enrolled infants who were diagnosed with PDA and performed exome sequencing.The collapsing analyses were used to find the risk gene set(RGS)of hsPDA for model construction.The credibility of RGS was proven by RNA sequencing.Multivariate logistic regression was performed to establish models combining clinical and genetic features.The models were evaluated by area under the receiver operating curve(AUC)and decision curve analysis(DCA).Results In this retrospective cohort study of 2199 PDA patients,549(25.0%)infants were diagnosed with hsPDA.The model[all clinical characteristics selected by least absolute shrinkage and selection operator regression(all CCs)]based on six clinical variables was acquired within three days of life,including gestational age(GA),respiratory distress syndrome(RDS),the lowest platelet count,invasive mechanical ventilation,and positive inotropic and vasoactive drugs.It has an AUC of 0.790[95%confidence interval(CI)=0.749–0.832],while the simplified model(basic clinical characteristic model)including GA and RDS has an AUC of 0.753(95%CI=0.706–0.799).There was a certain consistency between RGS and differentially expressed genes of the ductus arteriosus in mice.The AUC of the models was improved by RGS,and the improvement was significant(all CCs vs.all CCs+RGS:0.790 vs.0.817,P<0.001).DCA demonstrated that all models were clinically useful.Conclusions Models based on clinical factors were developed to accurately stratify the risk of hsPDA in the first three days of life.Genetic features might further improve the model performance.

Genetic etiologies associated with infantile hydrocephalus in a Chinese infantile cohort

Background Infantile hydrocephalus(IHC)is commonly related to other central nervous system diseases,which may have adverse effects on prognosis.The causes of IHC are heterogeneous,and the genetic etiologies are not fully understood.This study aimed to analyze the genetic etiologies of an IHC cohort.Methods The data for 110 IHC patients who had received exome sequencing at the Clinical Genetic Center of the Children's Hospital of Fudan University between 2016 and 2019 were reviewed and analyzed retrospectively.An exome-wide association analysis(EWAS)was performed within this cohort using IHC as the study phenotype.Results Of the 110 IHC patients,a pathogenic or likely pathogenic variant was identified in 16(15%)patients,spanning 13 genes.The genes were mainly associated with metabolic disorders,brain abnormalities,and genetic syndromes.IHC patients who had unclear clinical etiology were more likely to possess a genetic etiology.Based on previous studies and on our EWAS results,ZEB1,SBF2,and GNAI2 were over-represented among IHC patients and might alfect the signaling pathways involved in IHC formation.Conclusions Our study showed heterogeneous genetic etiologies in an IHC cohort.It is essential to perform genetic testing on IHC patients who have unclear clinical etiology,and genes associated with metabolic disorders,brain abnormalities,and genetic syndromes should he noted.In addition,when aiming to discover IHC susceptibility genes,genes that might influence the signaling pathways involved in IHC formation should be prioritized.