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Risk Factors for Natural Hearing Evolution in Newborns With Congenital Cytomegalovirus Infection
Elise De Cuyper1, Frederic Acke1,2, Annelies Keymeulen3
1Department of Head and Skin, Ghent University, Ghent, Belgium.
Insights
Congenital cytomegalovirus (cCMV) can cause sensorineural hearing loss in children. This study found that the timing of infection influences late-onset hearing loss risk, highlighting the need for ongoing audiological follow-up.
Area of Science:
- Pediatrics
- Infectious Diseases
- Audiology
Background:
- Congenital cytomegalovirus (cCMV) is a leading cause of nonhereditary sensorineural hearing loss in infants.
- Current criteria for identifying infants at high risk for unfavorable hearing outcomes are limited.
Purpose of the Study:
- To identify risk factors for hearing improvement, deterioration, and late-onset hearing loss in infants with cCMV.
- To inform parental counseling and patient management strategies.
Main Methods:
- A multicenter cohort study analyzed data from 387 newborns with untreated cCMV infection.
- Audiological follow-up was conducted for at least 4 years.
- Risk factors including gestational characteristics, clinical findings, viral load, and timing of seroconversion were investigated.
Main Results:
- Most ears (90%) maintained stable hearing.
- Late-onset hearing loss occurred in 6.3% of ears, with a higher prevalence in first-trimester infections.
- Prematurity was linked to improved hearing, while third-trimester seroconversion showed no late-onset hearing loss.
- Hearing deterioration was observed in 70.6% of ears with pre-existing hearing loss.
Conclusions:
- Ongoing audiological follow-up is crucial for children with congenital hearing loss due to cCMV.
- Timing of maternal seroconversion is associated with the risk of late-onset hearing loss.
- Further research is needed on treatment effects and identifying new risk factors.
Importance:
Congenital cytomegalovirus (cCMV) is the major cause of congenital nonhereditary sensorineural hearing loss in children. Currently, criteria to identify infants at increased risk for unfavorable hearing outcome are lacking.
Objective:
To identify risk factors associated with cCMV-related hearing improvement, hearing deterioration, and late-onset hearing loss.
Design, Setting, And Participants:
This multicenter cohort study included patients from 6 secondary and tertiary hospitals enrolled in the Flemish CMV registry (Belgium). Newborns with untreated cCMV infection with at least 4-year audiological follow-up were included. Patients who presented with other possible causes of sensorineural hearing loss were excluded. Data were collected for 15 years (January 1, 2007, to February 7, 2022) and analyzed from September 26, 2022, to January 16, 2023.
Main Outcomes And Measures:
Primary outcome was hearing evolution (per-ear analysis; described as stable hearing, improvement, or deterioration). The association of gestational characteristics, clinical findings, timing of seroconversion, viral load, and hearing status at birth with hearing evolution was investigated using effect sizes (Cramer V, odds ratio [OR], or Hedges g).
Results:
Of the 387 children, 205 of 385 with nonmissing data were male (53.2%), 113 (29.2%) had a symptomatic infection, and 274 (70.8%) had an asymptomatic infection. Every child was 4 years or older at final hearing evaluation. A total of 701 of 774 ears (90%) showed stable hearing (normal hearing or stable hearing loss since birth) over time. Late-onset hearing loss (normal hearing at birth followed by hearing loss) was present in 43 of 683 ears (6.3%). Among children with hearing loss present at birth, 24 of 34 ears (70.6%) had hearing deterioration, and 6 of 91 ears (6.6%) had hearing improvement. Prematurity was associated with a higher chance of hearing improvement (OR, 12.80; 95% CI, 2.03-80.68). Late-onset hearing loss was more prevalent in a first trimester infection (OR, 10.10; 95% CI, 2.90-34.48). None of the 104 ears of children with a third trimester seroconversion developed late-onset hearing loss.
Conclusions And Relevance:
Findings of this cohort study support that ongoing audiological follow-up for untreated children with congenital hearing loss is important, as the majority of patients had hearing deterioration. The timing of seroconversion was associated with the risk of developing late-onset hearing loss. These insights can aid in parental counseling, patient stratification, and follow-up. Future research should focus on the effect of treatment, the influence of determined risk factors, and the study of eventual new risk factors in patients at high risk to develop hearing loss.
