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Published on: July 6, 2013
Healthcare outcomes and special education eligibility in children with congenital CMV
Ryan Rochat1, Elizabeth Goodman2, Jerry Miller1
1Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States of America.
Insights
Congenital cytomegalovirus (cCMV) disease often leads to health issues qualifying for special education, even in infants appearing healthy at birth. Continued monitoring is crucial for early intervention and support.
Area of Science:
- Pediatrics
- Public Health
- Developmental Pediatrics
Background:
- Congenital cytomegalovirus (cCMV) disease can cause lasting sensory and neurodevelopmental problems in children.
- Many cCMV-related sequelae align with criteria for special education services.
- Systematic study of special education needs in cCMV-affected children is lacking.
Purpose of the Study:
- To investigate the prevalence of health outcomes qualifying for special education services in children with cCMV.
- To compare these needs between infants symptomatic and asymptomatic at birth.
- To assess the long-term need for special education support.
Main Methods:
- Retrospective chart review of two cCMV cohorts (historical N=186, contemporary N=112).
- Utilized SNOMED-CT to identify ICD-10 codes for special education-qualifying outcomes under IDEA.
- Applied ICD-10 codes via manual review (historical) and electronic record extraction (contemporary).
Main Results:
- At least one special education-qualifying ICD-10 code was present in 94% of symptomatic (ScCMV) vs. 39% of asymptomatic (AcCMV) infants in the historical cohort.
- In the contemporary cohort, 95% of ScCMV and 67% of AcCMV infants had qualifying codes.
- Overall, 61% (historical) and 86% (contemporary) of cCMV patients had qualifying codes, with developmental, mobility, and hearing issues being common.
Conclusions:
- Health outcomes necessitating special educational services are frequent in children with cCMV, including those asymptomatic at birth.
- Qualifying conditions can emerge after the neonatal period, highlighting the need for ongoing surveillance.
- Early identification through continued monitoring can facilitate timely access to special educational services for this vulnerable group.
Objectives:
Congenital cytomegalovirus disease (cCMV) can have significant sensory and neurodevelopmental sequelae throughout childhood. Many of these sequalae are consistent with special education eligibility, but the special education needs of affected children have not been systematically studied.
Methods:
Retrospective chart reviews from two cohorts of cCMV children receiving care in a large tertiary care children's hospital were included in this study: a historical research cohort (N = 186, 41% symptomatic at birth) and a contemporary clinical cohort of cCMV patients (N = 112, 68% symptomatic at birth). SNOMED-CT was used to identify ICD-10 codes describing special education-qualifying health outcomes fitting the Individuals with Disabilities Education Act (IDEA) criteria. ICD-10 codes were retrospectively applied to the historical research cohort through manual chart review, whereas the ICD-10 billing codes were extracted from the electronic medical record for all encounters in the contemporary cohort.
Results:
Of the 56 unique special education-qualifying ICD-10 codes we identified as pertinent to the IDEA, at least one was noted in 39% of those asymptomatic at birth (AcCMV) as compared to 94% of the patients symptomatic at birth (ScCMV). In the contemporary clinical cohort, at least one of these codes was noted in 67% of the AcCMV patients as compared to 95% for ScCMV patients. 61% of patients in the historical and 86% in the contemporary cohort had at least one special education-qualifying ICD-10 code. Developmental, mobility, physical therapy and hearing-related health outcomes were common in both ScCMV and AcCMV patients.
Conclusions:
Health outcomes qualifying for special educational services occur commonly in children with cCMV, including those who are classified as asymptomatic at birth. The emergence of qualifying conditions beyond the neonatal period among these children suggests that continued surveillance of this vulnerable population throughout early childhood may facilitate the timely identification of health outcomes requiring special educational services.
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