Abstract: Introduction: In newborns with respiratory failure and interstitial lung disease, it should be approached as chILD (Childhood Interstitial Lung Disease) syndrome to rule out alterations in surfactant metabolism and brain-lung-thyroid syndrome caused by pathogenic variants in the NKX2-1 gene. Objective: To pre sent a newborn with chILD syndrome and a large deletion in chromosome 14q12-q21.1. Clinical Case: Newborn patient with respiratory distress since birth, chILD syndrome, and hypothyroidism, in which brain-lung-thyroid syndrome was suspected. He also presented seizures, minor and ma jor abnormalities on physical examination. Microarray analysis revealed a 14.7 Mb deletion in the chromosome 14q12-q21.1, which includes the NKX2-1 gene. Conclusion: The brain-lung-thyroid syndrome should be considered in newborns with respiratory distress syndrome and diffuse lung disease (chILD syndrome), especially if they present hypotonia, choreoathetosis, or hypothyroidism. Diagnosis confirmation requires genetic analysis, even more, when there are other abnormalities not explained by the suspected syndrome.

Resumen: Introducción: En recién nacidos con falla respiratoria y enfermedad pulmonar intersticial se debe realizar el abor daje del Síndrome chILD (children’s Interstitial Lung Disease) descartando alteraciones del metabo lismo del surfactante y el síndrome cerebro-pilmón-tiroides que se produce por variantes patogé nicas en el gen NKX2-1. Objetivo: Presentar el caso clínico de un paciente con clínica de síndrome chILD, y estudio genético que informa una gran deleción a nivel del cromosoma 14q12-q21.1. Caso Clínico: Paciente que presenta falla respiratoria al nacimiento, síndrome CHILD e hipotiroidismo, por lo que se sospechó síndrome cerebro-pulmón-tiroides. Presentó además convulsiones y malformaciones menores y mayores al examen físico. Su estudio genético evidenció una deleción a nivel de cromosoma 14q12-q21.1 de 14.7 Mb incluido el gen NKX2-1. Conclusión: El síndrome cerebro- pulmón-tiroides se debe considerar en recién nacidos con síndrome de dificultad respiratoria y en fermedad pulmonar difusa (síndrome chILD), especialmente si presenta hipotonía, coreoatetosis o hipotiroidismo. El diagnóstico definitivo requiere análisis genético, más aún cuando se evidencian otras anomalías no explicadas por el síndrome sospechado.

Abstract Hemophilia A (HA) is an X-linked recessive disorder and the second most common coagulation disorder with an incidence of 1 in 5,000 live born males. Worldwide, there are 178,500 affected individuals, 60% with the severe form of the disease. Intron 22 and 1 inversions (Inv22 and Inv1) are the most frequent molecular alterations found in severe HA patients with a frequency of 45-50% and 0.5-5%, respectively. We have implemented a systematic cost-effective strategy for the identification of the molecular alteration in HA patients using Inverse shifting-PCR for Inv22 and Inv1, followed by the analysis of the F8 gene coding region by means of high resolution melting (HRM) PCR and Sanger sequencing in Inv22 and Inv1 negative patients. A total of 33 male HA patients and 6 women were analyzed. Inversion 22 was detected in 14/33 male patients (42.4%), 3/33 (9.1%) had Inv1, 3/33 (9.1%) had large structural variants, and 11/33 (33.3%) single nucleotide/ small frameshift variants. No genetic variant was found in 2/33 patients (6%). With this systematic approach we detected pathogenic variants in 31 out of 33 male affected individuals (94%) tested for the first time.in a cohort of patients from Colombia.