Diagnostic Clues for Congenital Cytomegalovirus Infection: Association with Newborn Hearing Screening Tests

Abstract

Purpose: To investigate clinical markers for the diagnosis of congenital cytomegalo virus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. Methods: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into "symptomatic, " "asymptomatic, " and "asymptomatic with isolated abnormal auto mated auditory brainstem response (AABR)" groups. Clinical data were analyzed based on this classification. Results: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial compli cated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and cotwin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. Conclusion:The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.

Audiologic Status of Children with Confirmed Cytomegalovirus Infection: a Case Series

“…Kim et al's study 19 included three distinct groups of children: those diagnosed clinically with congenital CMV, those recruited from neonatal intensive care units (NICU), and SNHL patients with confirmed congenital CMV infection who underwent cochlear implantation. As Kim et al 22 noted, NICU patients more commonly arrive preterm than other infants, and their prevalence of hearing loss may not reflect that of the general infant population. Our retrospective study enrolled children with confirmed CMV infection; these are also not representative of the general population.…”

“…While the diagnostic benefits of universal screening of congenital CMV infection in all newborns are undebatable, targeted CMV screening of newborns who do not pass NHS has been adopted in some hospitals and locations. 5 22 23 However, targeted screening of CMV inevitably will miss cases of delayed onset hearing loss in patients with congenital CMV infection. A recent study suggested that addition of genetic and CMV screening to preexisting NHS programs would help identify newborns with increased risk of hearing loss due to congenital CMV infection.…”

“…One recent study reported that targeted CMV screening in infants who did not pass the NHS were diagnosed with congenital CMV infection. 22 Here, we performed a retrospective review of children with confirmed CMV infection, including congenital CMV infection, to describe their hearing status and describe their NHS results to provide basic information relevant to future implementation of CMV screening programs.…”