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Published on: July 6, 2013
The Yield of Targeted Examination for the Detection of Symptomatic Congenital Cytomegalovirus Infection
Kamal Masarweh1, Clari Felszer-Fisch1, Eric Shinwell2,3
1Department of Pediatrics A, Emek Medical Center, Afula, Israel.
Insights
Targeted screening for symptomatic congenital cytomegalovirus (CMV) infection in newborns is effective. This approach identified the expected number of infants needing valganciclovir therapy, improving outcomes.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Public Health
Background:
- Congenital cytomegalovirus (CMV) infection affects 0.7% of newborns in Israel, with 10-15% exhibiting symptoms.
- Valganciclovir treatment improves hearing and neurodevelopmental outcomes in symptomatic neonates.
- Targeted screening may be a cost-effective strategy for early detection.
Purpose of the Study:
- To evaluate the feasibility of targeted newborn screening for symptomatic congenital CMV infection.
- To determine if this strategy can efficiently identify infants requiring treatment.
Main Methods:
- A prospective observational study conducted in two Israeli medical centers (2014-2015).
- Urine CMV DNA polymerase chain reaction (PCR) testing was performed on 692 newborns within the first 3 days of life.
- Infants were selected based on failed hearing screening (78%) or clinical/laboratory findings suggestive of symptomatic congenital CMV infection (22%).
Main Results:
- Out of 15,433 births, 15 infants (0.11%) were diagnosed with symptomatic congenital CMV infection.
- The incidence aligned with predictions (0.07-0.105%).
- Symptomatic infections were detected in 0.37% of infants with failed hearing screens and 8% of those with clinical/laboratory findings.
Conclusions:
- Targeted examination of a small percentage (4.5%) of newborns successfully identified the predicted number of infants with symptomatic congenital CMV infection.
- This strategy is effective for detecting neonates who would benefit from recommended valganciclovir therapy.
Background:
The incidence of congenital cytomegalovirus (CMV) infection in Israel is 0.7%. Only 10-15% are symptomatic. Valganciclovir has been shown to improve hearing and neurodevelopmental outcomes in neonates with symptomatic congenital CMV infection. Targeted examination of infants who fail routine neonatal hearing screening or have clinical or laboratory findings suggestive of symptomatic congenital CMV infection may be a cost-effective approach.
Objectives:
To assess the possibility of targeted examination for the detection of newborns with symptomatic congenital CMV infection.
Methods:
A prospective observational study was conducted in 2014-2015 at two medical centers in northern Israel. Included were all newborns who were tested in the first 3 days of life by polymerase chain reaction (PCR) for urine CMV DNA (n=692), either for failure the hearing screening (n=539, 78%), clinical or laboratory findings suggestive of symptomatic congenital CMV infection, or primary CMV infection during pregnancy (n=153, 22%).
Results:
During the study period 15,433 newborns were born. The predicted rate of infection was 10-15% (symptomatic) of 0.7% of newborns, namely 0.07-0.105% or 10-15 infants. In fact, 15 infants (0.11%, 95% confidence interval 0.066-0.175) were diagnosed with symptomatic congenital CMV infection, 2/539 (0.37%) in the failed hearing group and 13/153 (8%) in the clinical/laboratory findings group. The incidence of symptomatic congenital CMV infection was within the predicted range.
Conclusions:
Targeted examination of only 4.5% (n=692) of newborns detected the predicted number of infants with symptomatic congenital CMV infection in whom valganciclovir therapy is recommended.
