Genomic Sequencing for Childhood Risk and Newborn Illness

The objective of this research protocol is to conduct a randomized clinical trial to assess
the benefits and risks of adding the information from a genomic sequencing report to
physician-mediated medical care of newborns during their pediatric years.

The investigators will enroll 240 healthy infants and their parents from the Brigham and
Women's Hospital (BWH) Well Newborn Nursery and 240 sick infants and their parents at Boston
Children's Hospital (BCH) or the BWH Neonatal Intensive Care Unit (NICU).

A small blood sample will be obtained from each enrolled infant. Samples will be collected
from all infants enrolled, regardless of the arm to which they are assigned, in order to
follow the same protocol for all subjects prior to randomization.

Infants within each cohort will be randomized (1:1) to either standard-of-care (family
history and standard newborn screening report) or to standard-of-care plus genomic
sequencing.

A study physician and genetic counselor will disclose the infant's randomization assignment
and study results during an in-person consultation with each family. The study physician and
genetic counselor will provide the consultation to families utilizing all available medical
information. In the sequencing arm of the study, this will include the medical history,
physical exam, family history, standard newborn screening (NBS) report and sequencing
report(s). In the non-sequencing arm of the study, this will include the medical history,
physical exam, family history and standard NBS report.

Parents will be surveyed at four points over the 12 months after enrollment: baseline,
immediately post-disclosure (approximately 6 weeks after enrollment), 3 months
post-disclosure, and at 10 months post-disclosure.

Newborns and Parents at Brigham and Women's Hospital (BWH) Well Newborn Nursery:

Inclusion Criteria :

1. Infants born at BWH and admitted to the Well Newborn Nursery

2. At least one biological parent is physically available to have genetic counseling,
donate DNA, and provide consent for testing the infant. If the second biological
parent is known but not physically present, the second biological parent must be
available to have genetic counseling by phone, return a signed consent form by mail,
and donate DNA via a mailed saliva kit. If there is a "rearing parent" (an individual
who is not biologically related to the infant, but who is dedicated to raising the
child), that individual must also provide consent but will not be asked to submit a
saliva sample.

3. Mother (either rearing or biological) carried the pregnancy

Exclusion Criteria:

1. Parents are non-English speaking

2. Parents are unwilling to have genomic reports placed in the medical record or sent to
their primary care pediatrician

3. Mother or father younger than 18 years of age

4. Mother or father with impaired decisional capacity

5. Age of infant is older than 30 days

6. One of a multiple gestation

7. Any infant in which clinical considerations preclude drawing 1.0 ml of blood

8. Missing consent of either biological parent (if known) or rearing parent (if
applicable)

Sick Newborns and Parents at Boston Children's Hospital (BCH) or the BWH NICU:

Inclusion Criteria:

1. Infants admitted to BCH or the BWH NICU

2. At least one biological parent is physically available to have genetic counseling,
donate DNA, and provide consent for testing the infant. If the second biological
parent is known but not physically present, the second biological parent must be
available to have genetic counseling by phone, return a signed consent form by mail,
and donate DNA via a mailed saliva kit. If there is a "rearing parent" (an individual
who is not biologically related to the infant, but who is dedicated to raising the
child), that individual must also provide consent but will not be asked to submit a
saliva sample.

3. Mother (either biological or rearing) carried the pregnancy

Exclusion Criteria:

1. Parents are non-English speaking

2. Parents are unwilling to have genomic reports placed in the medical record or sent to
their primary care pediatrician

3. Mother or father younger than 18 years of age

4. Mother or father with impaired decisional capacity

5. Age of infant is older than 30 days

6. One of a multiple gestation

7. Any infant in which clinical considerations preclude drawing 1.0 ml of blood

8. Hospital admission expected to be less than 72 hours

9. Missing consent of either biological parent (if known) or rearing parent (if
applicable)

10. Previously performed exome/genome sequencing on patient