Vestibular Dysfunction and Postural Changes in Children With Congenital Cytomegalovirus: A Systematic Review

The aim of this study was to investigate the prevalence of vestibular and/or postural balance alterations in children with congenital cytomegalovirus (cCMV) and to determine the association between the infection and these impairments compared to a control group.

This systematic review was registered with Prospective Register of Systematic Reviews (CRD42024549387) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines consulted five databases (Embase, LILACS, PubMed/MEDLINE, Scopus, and Web of Science) and gray literature (Google Scholar and ProQuest). It included studies with children aged 0-12 years diagnosed with cCMV by laboratory tests performed in the first 21 days of life. Eligible studies assessed vestibular function and/or postural balance and compared children with cCMV with a control group of children without the infection. Only observational studies were included. A meta-analysis was performed to estimate the association between cCMV and vestibular changes, using a random-effects model and subgroup analysis. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

The qualitative synthesis included eight observational studies of the 2,840 studies identified. All reported vestibular and/or postural balance changes in children with cCMV. The meta-analysis demonstrated an approximately 10-fold increased risk of vestibular changes in this group, especially in symptomatic children. Although the pooled risk ratio suggested a strong association, the certainty of the evidence was rated very low according to GRADE, which considers study quality, consistency, precision, and risk of bias.

Children with cCMV, especially those with symptoms, have a significantly increased risk of vestibular and postural balance changes. However, given the very low certainty of the evidence, these results should be interpreted with caution. Future well-designed research should prioritize pediatric vestibular screening to confirm these associations and inform clinical practice.