{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:43:53Z","timestamp":1776311033927,"version":"3.50.1"},"reference-count":51,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,4,22]],"date-time":"2016-04-22T00:00:00Z","timestamp":1461283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J of Med Genetics Pt A"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec><jats:label\/><jats:p>Costello syndrome (CS) is a multisystem disorder caused by heterozygous germline mutations in the <jats:italic>HRAS<\/jats:italic> proto\u2010oncogene. Respiratory system complications have been reported in individuals with CS, but a comprehensive description of the full spectrum and incidence of respiratory symptoms in these patients is not available. Here, we report the clinical course of four CS patients with respiratory complications as a major cause of morbidity. Review of the literature identified 56 CS patients with descriptions of their neonatal course and 17 patients in childhood\/adulthood. We found that in the neonatal period, respiratory complications are seen in approximately 78% of patients with transient respiratory distress reported in 45% of neonates. Other more specific respiratory diagnoses were reported in 62% of patients, the majority of which comprised disorders of the upper and lower respiratory tract. Symptoms of upper airway obstruction were reported in CS neonates but were more commonly diagnosed in childhood\/adulthood (71%). Analysis of <jats:italic>HRAS<\/jats:italic> mutations and their respiratory phenotype revealed that the common p.Gly12Ser mutation is more often associated with transient respiratory distress and other respiratory diagnoses. Respiratory failure and dependence on mechanical ventilation occurs almost exclusively with rare mutations. In cases of prenatally diagnosed CS, the high incidence of respiratory complications in the neonatal period should prompt anticipatory guidance and development of a postnatal management plan. This may be important in cases involving rarer mutations. Furthermore, the high frequency of airway obstruction in CS patients suggests that otorhinolaryngological evaluation and sleep studies should be considered. \u00a9 2016 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajmg.a.37655","type":"journal-article","created":{"date-parts":[[2016,4,22]],"date-time":"2016-04-22T15:24:57Z","timestamp":1461338697000},"page":"1849-1857","source":"Crossref","is-referenced-by-count":14,"title":["Respiratory system involvement in Costello syndrome"],"prefix":"10.1002","volume":"170","author":[{"given":"Natalia","family":"Gomez\u2010Ospina","sequence":"first","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christin","family":"Kuo","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amitha Lakshmi","family":"Ananth","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Myers","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie\u2010Luise","family":"Brennan","sequence":"additional","affiliation":[{"name":"Epigenomics Menlo Park California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan A.","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louanne","family":"Hudgins","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/ajmg.b.32279","article-title":"Behavioral phenotype in Costello syndrome with atypical mutation: A case report","volume":"168","author":"Alfieri P","year":"2014","journal-title":"Am J Med Genet B Neuropsychiatr Genet"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ng1641"},{"key":"e_1_2_6_4_1","first-page":"453","article-title":"Costello syndrome: Report of a new case with choanal atresia and fatal outcome","volume":"11","author":"Boente MC","year":"2001","journal-title":"Eur J Dermatol"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.35296"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.735994"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2015.00225"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.31076"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/humu.20616"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.30288"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-007-0558-0"},{"key":"e_1_2_6_12_1","first-page":"582","article-title":"Costello syndrome and rhabdomyosarcoma","volume":"36","author":"Feingold M","year":"1999","journal-title":"J Med Genet"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.099754"},{"key":"e_1_2_6_14_1","first-page":"605","article-title":"[Costello syndrome associated to a neuroblastoma. 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