Critical Trio Exome Benefits In-Time Decision-Making for Pediatric Patients with Severe Illnesses∗

En Ting Wu, Wuh Liang Hwu, Yin Hsiu Chien, Ching Hsu, Ting Fu Chen, Nai Qi Chen, Hung Chieh Chou, Po Nien Tsao, Pi Chuan Fan, I. Jung Tsai, Shuan Pei Lin, Wu Shiun Hsieh, Tung Ming Chang, Chi Nien Chen, Chen Hao Lee, Yen Yin Chou, Pao Chin Chiu, Wen Hui Tsai, Hann Chang Hsiung, Feipei LaiNi Chung Lee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: Critical illnesses caused by undiagnosed genetic conditions are challenging in PICUs. Whole-exome sequencing is a powerful diagnostic tool but usually costly and often fail to arrive at a final diagnosis in a short period. We assessed the feasibility of our whole-exome sequencing as a tool to improve the efficacy of rare diseases diagnosis for pediatric patients with severe illness. Design: Observational analysis. Method: We employed a fast but standard whole-exome sequencing platform together with text mining-assisted variant prioritization in PICU setting over a 1-year period. Setting: A tertiary referral Children's Hospital in Taiwan. Patients: Critically ill PICU patients suspected of having a genetic disease and newborns who were suspected of having a serious genetic disease after newborn screening were enrolled. Interventions: None. Measurements and Main Results: Around 50,000 to 100,000 variants were obtained for each of the 40 patients in 5 days after blood sampling. Eleven patients were immediately found be affected by previously reported mutations after searching mutation databases. Another seven patients had a diagnosis among the top five in a list ranked by text mining. As a whole, 21 patients (52.5%) obtained a diagnosis in 6.2 ± 1.1 working days (range, 4.3-9 d). Most of the diagnoses were first recognized in Taiwan. Specific medications were recommended for 10 patients (10/21, 47.6%), transplantation was advised for five, and hospice care was suggested for two patients. Overall, clinical management was altered in time for 81.0% of patients who had a molecular diagnosis. Conclusions: The current whole-exome sequencing algorithm, balanced in cost and speed, uncovers genetic conditions in infants and children in PICU, which helps their managements in time and promotes better utilization of PICU resources.

Original languageEnglish
Pages (from-to)1021-1026
Number of pages6
JournalPediatric Critical Care Medicine
Volume20
Issue number11
DOIs
Publication statusPublished - 2019 Nov 1

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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    Wu, E. T., Hwu, W. L., Chien, Y. H., Hsu, C., Chen, T. F., Chen, N. Q., Chou, H. C., Tsao, P. N., Fan, P. C., Tsai, I. J., Lin, S. P., Hsieh, W. S., Chang, T. M., Chen, C. N., Lee, C. H., Chou, Y. Y., Chiu, P. C., Tsai, W. H., Hsiung, H. C., ... Lee, N. C. (2019). Critical Trio Exome Benefits In-Time Decision-Making for Pediatric Patients with Severe Illnesses∗. Pediatric Critical Care Medicine, 20(11), 1021-1026. https://doi.org/10.1097/PCC.0000000000002068