A Targeted Approach for Congenital Cytomegalovirus Screening Within Newborn Hearing Screening
Karen B Fowler1, Faye P McCollister2, Diane L Sabo3
1Department of Pediatrics and Epidemiology, kfowler@uab.edu.
Insights
Targeted congenital cytomegalovirus (cCMV) screening of infants failing newborn hearing screening (NHS) identifies most cases of CMV-related hearing loss at birth. However, this approach misses infants at risk for late-onset hearing loss.
Area of Science:
- Pediatrics
- Infectious Diseases
- Audiology
Background:
- Congenital cytomegalovirus (cCMV) is a primary cause of sensorineural hearing loss (SNHL) in children.
- Universal newborn screening for cCMV is not standard practice in the United States.
- Targeted screening of infants with failed newborn hearing screening (NHS) is a potential alternative for identifying cCMV.
Purpose of the Study:
- To evaluate the effectiveness of a targeted approach for identifying infants with cCMV-related SNHL.
- To determine if testing infants who do not pass NHS for cCMV can detect CMV-related hearing loss.
Main Methods:
- Newborn hearing screening (NHS) and cCMV screening were performed on infants at 7 US medical centers.
- Infants testing positive for cCMV underwent diagnostic audiologic evaluations.
- Data collected between 2007 and 2012 from 99,945 newborns.
Main Results:
- 7.0% of cCMV-positive infants failed NHS versus 0.9% of cCMV-negative infants (P < .0001).
- 65% of cCMV-positive infants who failed NHS were diagnosed with SNHL.
- 3.6% of cCMV-positive infants who passed NHS also had confirmed SNHL, with some developing late-onset hearing loss.
Conclusions:
- A targeted cCMV screening strategy focusing on infants failing NHS successfully identified most cases of CMV-related SNHL at birth.
- This approach did not identify 43% of infants with neonatal CMV-related SNHL or those at risk for late-onset SNHL.
- The findings highlight limitations of NHS-based targeted screening for comprehensive cCMV-related hearing loss detection.
Background And Objective:
Congenital cytomegalovirus (cCMV) infection remains a leading cause of childhood hearing loss. Currently universal CMV screening at birth does not exist in the United States. An alternative approach could be testing infants who do not pass their newborn hearing screening (NHS) for cCMV. This study was undertaken to evaluate whether a targeted approach will identify infants with CMV-related sensorineural hearing loss (SNHL).
Methods:
Infants born at 7 US medical centers received NHS and were also screened for cCMV while in the newborn nursery. Infants who tested positive for CMV received further diagnostic audiologic evaluations to identify or confirm hearing loss.
Results:
Between 2007 and 2012, 99 945 newborns were screened for both hearing impairment and cCMV. Overall, 7.0% of CMV-positive infants did not pass NHS compared with 0.9% of CMV-negative infants (P < .0001). Among the cCMV infants who failed NHS, diagnostic testing confirmed that 65% had SNHL. In addition, 3.6% of CMV-infected infants who passed their NHS had SNHL confirmed by further evaluation during early infancy. NHS in this cohort identified 57% of all CMV-related SNHL that occurred in the neonatal period.
Conclusions:
A targeted CMV approach that tests newborns who fail their NHS identified the majority of infants with CMV-related SNHL at birth. However, 43% of the infants with CMV-related SNHL in the neonatal period and cCMV infants who are at risk for late onset SNHL were not identified by NHS.
