[Analysis of genotypes on 850 newborns with single-allele mutation and the phenotypes of those with second variant].

To clarify the phenotypes of the newborns with single-allele mutation in deafness genetic screening and second variant; to analyze the genotype and hearing phenotype. 850 newborns born in Beijing from April 2015 to December 2019 were included and there were 468 males and 382 females. They received genetic deafness screening for 9 or 15 variants, with the result of single-allele mutation. Firstly, three step deafness gene sequencing was adopted in this work, i.e., the first step was " gene whole exons and splice sites" sequencing; the second step was " gene promoter, gene and gene whole exons" sequencing; and the third step was detection for " gene copy number variation". Secondly, we collected the results of newborn hearing screening for all patients with the second mutation found in the three step test, and conducted audiological examinations, such as acoustic immittance, auditory brainstem response and auditory steady state response. Thirdly, for novel/VUS mutations, we searched the international deafness gene database or software, such as DVD, ClinVar and Mutation Taster, to predict the pathogenicity of mutations according to the ACMG guideline. Lastly, we analyzed the relationship between genotype and phenotype of newborns with single allele mutation. Among 850 cases, the median age of diagnosis was 4 months. In the first step, 850 cases were sequenced. A total of 32 cases (3.76%, 32/850) of a second variants were detected, including 18 cases (2.12%, 18/850) with identified pathogenic variants; 832 cases were sequenced and 8 cases of gene missense variants were detected among the second step. No missense mutations in the gene and abnormal gene promoter were detected; the third step sequencing results were all negative. Genotypes and hearing phenotypes included 18 cases combined with the second clear pathogenic variant, 16 cases (16/18) referred newborn hearing screening and 2 cases (2/18) passed in both ears; degree of hearing loss consisted of 18 profound ears (18/36), 13 severe ears (13/36) and 5 moderate ears (5/36); audiogram patterns comprised 17 high frequency drop ears (17/36), 14 flat ears (14/36), 3 undistinguished ears (3/36), and 2 U shaped ears (2/36); 11 cases underwent imaging examination, all of which were bilateral enlarged vestibular aqueduct. As for 22 cases of other genotypes, all passed neonatal hearing screening and the hearing diagnosis was normal, including 9 cases with VUS or possibly novel benign variants, 8 cases with double gene heterozygous variants, and 5 cases with double heterozygous variants. The probability of individuals with single-allele variant who merge with a second pathogenic variant is 2.12%, all of which are SNV, which can provide scientific basis for the genetic diagnosis and genetic counseling of variants. Those who have merged with second pathogenic variant are all diagnosed with sensorineural hearing loss. Patients with gene mutations do not manifest hearing loss during the infancy, suggesting the need for further follow-up.