Extended-hearing targeted screening for congenital cytomegalovirus infection

Forlì, Francesca; Lazzerini, Francesco; Canelli, Rachele; Lorenzoni, Francesca; Franciosi, Beatrice; Berrettini, Stefano; Bruschini, Luca

doi:10.23736/s2724-5276.21.06287-x

Cited by 8 publications

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“…Since 2012, following the guidelines of the Italian Society of Neonatology, CMV DNA research has consistently been performed in the following cases: preterm newborns (born before the 36th week of gestational age), small-for-gestational-age babies (SGA, birth weight < 3 • percentile), neonates born to CMV-infected mothers, babies showing abnormal prenatal cerebral aspects at ultrasound, babies with microcephaly (head circumference < 3 • percentile), and those with persistent jaundice, thrombocytopenia, and/or neutropenia [15,16]. Beginning in 2008 in Center 1 and from 2014 in Center 2, viral DNA research was performed in all newborns that failed the newborn hearing screening.…”

Section: Testingmentioning

confidence: 99%

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The Audiological Follow-Up of Children with Symptomatic Congenital Cytomegalovirus Infection: An Experience in Two Italian Centers

et al. 2023

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Background: Congenital cytomegalovirus (cCMV) infection is the leading cause of non-hereditary sensorineural hearing loss in children. While about 10% of children reportedly display symptoms at birth, 85–90% of cCMV infection cases are asymptomatic. However, 10–15% of these asymptomatic infants may later develop hearing, visual, or neurodevelopmental impairments. This study aimed to evaluate the impact of cCMV infection on newborns’ hearing function with a particular emphasis on progressive and late-onset cases. Methods: This study is a retrospective chart analysis with longitudinal character and was conducted in two Italian centers: Center 1 (from 1 November 2007 to 31 December 2021) and Center 2 (from 1 January 2012 to 31 December 2021). Data collected included newborn hearing screening results, characterization of hearing loss (unilateral/bilateral, degree of impairment), and audiological follow-up. Results: The cohort consisted of 103 children (42% males, 58% females). In total, 28 children presented with hearing impairment; 71.4% (20 out of 28) of the cases of hearing loss were severe/profound, with 35.7% of the cases due to unilateral hearing loss. Out of twenty-eight, six experienced progression of hearing loss and four had late-onset hearing loss. Conclusions: In the absence of universal cCMV screening, hearing screening at birth for cCMV remains a critical factor for early diagnosis. A significant percentage of children affected by cCMV with normal audiological evaluations at birth is easily lost to follow-up. Close collaboration between neonatologists, pediatricians, and audiological services is fundamental to ensure timely diagnosis and treatment of cCMV-related hearing loss.

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Section: Testingmentioning

confidence: 99%

“…Universal newborn hearing screening allows for the early detection of hearing impairment in neonatal infants. In both regions, the NHS program is based on a two-stage protocol and is differentiated according to the Joint Committee on Infant Hearing (JCIH) guidelines, for well babies and children with risk factors for hearing [16,17].…”

Section: Nhs Programmentioning

confidence: 99%

The Audiological Follow-Up of Children with Symptomatic Congenital Cytomegalovirus Infection: An Experience in Two Italian Centers

et al. 2023

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“…The trial demonstrated that early treatment with valganciclovir results in CMV virological control, reduced rates of hearing impairment and improved neurodevelopmental scores (11,12). However, without universal screening it is estimated that <25% of children are diagnosed due to variable, non-specific and delayed clinical manifestations (1,3,9,(13)(14)(15)(16)(17)(18)(19)(20). Limitations to clinical diagnosis arise from the variable presentation of clinical signs and symptoms of the disease; signs that may be subtle or non-specific and potentially attributable to numerous other conditions e.g., intrauterine growth restriction (IUGR), petechiae, anemia, hepatosplenomegaly, jaundice and microcephaly.…”

Section: Introductionmentioning

confidence: 99%

Delays in diagnosis and treatment initiation for congenital cytomegalovirus infection - Why we need universal screening

et al. 2022

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IntroductionCongenital cytomegalovirus (cCMV) is the leading cause of neurodevelopmental and hearing impairment from in-utero infection. Late diagnosis results in limited treatment options and may compromise long-term outcome.MethodsA retrospective audit of infants with cCMV referred to a Tertiary Pediatric Infectious Diseases center from 2012–2021. Data collected included timing of diagnostics, treatment initiation and reasons for delays.Results90 infants with confirmed cCMV were included, 46/90 (51%) were symptomatic at birth. Most common reasons for diagnostics in asymptomatic infants were failed newborn hearing screening (17/44, 39%) and antenatal risk-factors (14/44, 32%). Median age at cCMV diagnosis was 3 (range 0–68) and 7 (0–515) days, with median referral age 10 (1–120) and 22 (2–760) days for symptomatic and asymptomatic infants respectively. There was a significant risk of delay in diagnosis (>21 days) for asymptomatic infants [RR 2.93 (1.15–7.45); p = 0.02]. Of asymptomatic infants who received treatment, 13/24 (54%) commenced it within 28 days of life, a significant delay in treatment compared to 30/36 (83%) symptomatic infants [RR 2.75 (1.18–6.43); p = 0.02]. The commonest reason for delayed treatment initiation was delayed first diagnostic test for both symptomatic 4/6 (67%) and asymptomatic infants 9/11 (82%).ConclusionsDelays in diagnosis and treatment for cCMV are unacceptably frequent and significantly higher in asymptomatic infants. Our study highlights the need for increased awareness among healthcare professionals, reconsideration of age-targets for Newborn Hearing Screening, and research that addresses the barriers to implementation of universal screening, which would ultimately facilitate prompt diagnosis and management of all infants with cCMV.

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“…Although there have been several single‐center pilot studies examining cCMV screening/testing, 17,19‐34 to date there have been no multicenter studies comparing the positivity rates of different cCMV screening/testing approaches in the United States. Furthermore, there have been no prior multicenter studies examining factors associated with the successful implementation of these approaches.…”

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confidence: 99%

“…However, DBS retention laws vary by state, and such testing is subject to lower sensitivity as mentioned earlier compared to that from saliva or urine. 18 Although there have been several single-center pilot studies examining cCMV screening/testing, 17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] to date there have been no multicenter studies comparing the positivity rates of different cCMV screening/testing approaches in the United States. Furthermore, there have been no prior multicenter studies examining factors associated with the successful implementation of these approaches.…”

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Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial

Orb,

Pesch,

Allen

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing‐targeted CMV testing (HT‐cCMV) and delayed targeted dried blood spot (DBS) testing newborn screening programs, and to examine the characteristics of successful HT‐cCMV testing programs.Study DesignProspective survey of birth hospitals performing early CMV testing.SettingMultiple institutions.MethodsBirth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT‐cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT‐cCMV screening and specific screening protocols.ResultsEighty‐two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT‐cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID‐19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT‐cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs.ConclusionRates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT‐cCMV testing.

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Extended-hearing targeted screening for congenital cytomegalovirus infection

Cited by 8 publications

References 0 publications

The Audiological Follow-Up of Children with Symptomatic Congenital Cytomegalovirus Infection: An Experience in Two Italian Centers

The Audiological Follow-Up of Children with Symptomatic Congenital Cytomegalovirus Infection: An Experience in Two Italian Centers

Delays in diagnosis and treatment initiation for congenital cytomegalovirus infection - Why we need universal screening

Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial

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