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Published on: July 6, 2013
Targeted and universal screen in term and preterm infants for congenital CMV infection
Rimma Melamed1,2, Yonat Shemer-Avni2,3, Eilon Shany2,4
1Pediatric Infectious Diseases Unit, Soroka Medical Center, Beer Sheva, Israel.
Insights
Congenital cytomegalovirus (CMV) screening in infants failing hearing tests and premature infants identified those at risk. This targeted approach enables early treatment for congenital CMV associated sensorineural hearing loss.
Area of Science:
- Neonatal Medicine
- Virology
- Public Health
Background:
- Congenital cytomegalovirus (CMV) is a leading cause of non-genetic sensorineural hearing loss (SNHL) in infants.
- Early detection and intervention are crucial for managing CMV-related hearing impairment.
- Current screening strategies vary, impacting timely diagnosis and treatment.
Purpose of the Study:
- To determine the incidence of congenital CMV in infants failing hearing screens (targeted screening).
- To assess congenital CMV incidence in preterm infants (<33 weeks gestation) via universal screening.
- To evaluate the need for pharmacologic treatment in infants with CMV-associated SNHL.
Main Methods:
- Retrospective cohort study of infants born between 2014-2017.
- Group 1: Term/near-term infants (33-42 weeks) with failed hearing screen or growth retardation underwent targeted CMV screening.
- Group 2: Preterm infants (<33 weeks) received universal CMV screening via urine real-time PCR.
Main Results:
- In Group 1 (n=2078), 19 infants (0.9%) tested positive for CMV; 9 (42%) received valganciclovir treatment.
- In Group 2 (n=549), no infants tested positive for CMV shortly after birth.
- The study identified a low incidence of congenital CMV in the screened populations.
Conclusions:
- A combined strategy of targeted screening (failed hearing screen) and universal screening (preterm infants) effectively identifies infants at risk for congenital CMV.
- This approach facilitates early diagnosis and timely initiation of treatment for congenital CMV-associated SNHL.
- The proposed screening protocol aids in managing congenital CMV diagnosis, especially until universal screening is widely implemented.
Abstract:
Background: The aims of this study were to evaluate the incidence of congenital cytomegalovirus (CMV) in term and near-term infants who fail hearing screen (target screening), the incidence of congenital CMV infections in infants born before 33 weeks of gestation (universal screening) and the incidence of infants who need pharmacologic treatment for congenital CMV associated sensorineural hearing loss (SNHL).Methods: This was a retrospective cohort study that assessed two groups of infants born between 2014 and 2017. The first group consisted of infants born between 33 and 42 weeks gestation and the second group, of infants born before 33 weeks gestation. Targeted CMV screening was performed in the first group who either failed neonatal hearing screen or were growth retarded. Universal screen was performed in the second group of infants. CMV DNA was tested in urine samples using real time PCR soon after birth.Results: In the first group, 2078 infants were assessed, 19 (0.9%) were found to be CMV positive and in 9 (42%) valganciclovir treatment was initiated. In the second group, out of 549 urine samples/infants, none was positive for CMV DNA soon after birth.Conclusions: A joint strategy of targeted CMV screening in infants who fail hearing screen test with universal screen of premature infants can select infants at risk of hearing impairment due to congenital CMV soon after birth, allows for timely initiation of treatment and prevents dilemmas regarding congenital CMV diagnosis in infants who fail hearing screen in a later age until universal screen will be widely adopted.
