Feasibility and acceptability of targeted salivary cytomegalovirus screening through universal newborn hearing
Emma Webb1,2, Alanna N Gillespie1,2, Zeffie Poulakis1,2,3
1Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
Insights
Saliva screening for congenital cytomegalovirus (cCMV) in infants failing newborn hearing tests is feasible and parent-accepted. This approach enables timely diagnosis and treatment for cCMV.
Area of Science:
- Neonatal screening
- Infectious disease diagnostics
- Public health
Background:
- Congenital cytomegalovirus (cCMV) is a leading infectious cause of non-genetic sensorineural hearing loss in infants.
- Newborn hearing screening identifies infants at risk, but timely cCMV diagnosis and treatment remain challenging.
- Current diagnostic pathways may be delayed, impacting treatment initiation and outcomes.
Purpose of the Study:
- To assess the feasibility and parental acceptability of cCMV screening using saliva PCR in infants with failed newborn hearing screens.
- To evaluate the utility of this enhanced pathway in terms of time to diagnosis and treatment.
- To establish a targeted screening strategy for early cCMV detection.
Main Methods:
- The study involved infants referred from the Victorian Infant Hearing Screening Programme (VIHSP) across four Melbourne hospitals.
- Parents of eligible infants were approached for consent to collect a saliva swab for CMV PCR analysis.
- Feasibility was measured by the proportion of infants tested within 21 days of life; acceptability was assessed via parent surveys.
Main Results:
- Out of 126 eligible families, 96 (76.0%) completed salivary screening within 21 days.
- Over 92.0% of parents found the screening acceptable and straightforward.
- One infant tested positive, diagnosed, and commenced treatment within 3 days of initial screening.
Conclusions:
- Saliva-based cCMV screening in infants with failed newborn hearing tests is feasible and well-accepted by parents.
- This targeted approach offers a viable option for early cCMV detection, particularly with early hospital discharge.
- The method facilitates rapid diagnosis and treatment initiation, improving potential outcomes for affected infants.
Aim:
This study aimed to determine the feasibility and parental acceptability of screening for congenital cytomegalovirus (cCMV) through saliva polymerase chain reaction in infants who did not pass their newborn hearing screening. Additionally, the utility (i.e. time to diagnosis and treatment) of this enhanced clinical pathway was evaluated.
Methods:
The study was conducted through the Victorian Infant Hearing Screening Programme (VIHSP) across four maternity hospitals in Melbourne, Australia, during June 2019-March 2020. Parents were approached by VIHSP staff about obtaining a test for cytomegalovirus (CMV) at the time of their baby's second positive ('refer') result on the VIHSP screen. Participating parents collected a saliva swab for CMV polymerase chain reaction from their infants. Feasibility was determined by the proportion of 'referred' infants whose parents completed the salivary CMV screening test ≤21 days of life. Acceptability was measured through parent survey.
Results:
Of 126 eligible families, 96 (76.0%) had salivary screening swabs taken ≤21 days of life. Most families (>92.0%) indicated that screening was acceptable, straightforward and thought testing their baby for cCMV was a good idea. One infant screened positive on day 30, was diagnosed with cCMV via confirmatory testing by day 31 and commenced valganciclovir on day 32.
Conclusions:
Obtaining a saliva sample to screen for cCMV in infants who do not pass their newborn hearing screen is feasible and appears acceptable to parents. This targeted cCMV screening method could be an option where mothers are rapidly discharged from hospital, especially in the context of the COVID-19 pandemic.
