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Delayed hearing loss in congenital cytomegalovirus infection: systematic review and meta-analysis
Nicolau Moreira Abrahão1, Arthur Menino Castilho1, Eduardo Tanaka Massuda2
1Universidade Estadual de Campinas (UNICAMP), Department of Otolaryngology, Campinas, SP, Brazil.
Insights
Universal screening for congenital Cytomegalovirus (CMV) infection in newborns is crucial. Early identification via urine PCR helps detect asymptomatic cases and monitor for late-onset hearing loss, preventing long-term complications.
Area of Science:
- Neonatal screening
- Infectious disease epidemiology
- Audiology
Background:
- Congenital Cytomegalovirus (CMV) infection is a leading cause of non-genetic sensorineural hearing loss in newborns.
- Many infants with congenital CMV are asymptomatic at birth but may develop progressive hearing impairment.
- Current screening protocols may miss infants who develop late-onset hearing loss.
Purpose of the Study:
- To evaluate the importance of universal newborn screening for congenital CMV infection using urine PCR.
- To identify asymptomatic congenital CMV cases at birth.
- To monitor these infants for the development of late-onset hearing loss.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Literature search conducted across PUBMED, PUBMED PMC, BVS/BIREME, and EMBASE until January 2025.
- Risk of bias assessed using the Newcastle-Ottawa Scale; meta-analysis employed a random-effects model.
Main Results:
- Three prospective studies involving 56,892 newborns met the criteria.
- The prevalence of congenital CMV infection was 0.46%.
- 83.4% of infected infants were asymptomatic at birth, with 13.9% developing late hearing impairment; 12% had early hearing impairment.
Conclusions:
- Universal screening for congenital CMV infection is vital for identifying infants at risk of hearing loss.
- Asymptomatic congenital CMV cases frequently develop late-onset hearing loss, underscoring the need for structured screening.
- Failure to screen risks missed diagnoses, increased long-term healthcare costs, and delayed interventions.
Objectives:
This study aims to evaluate the importance of universal screening for congenital Cytomegalovirus (CMV) infection in newborns using urine PCR to identify asymptomatic cases at birth, with or without early hearing impairment, and to monitor this population for the development of late-onset hearing loss.
Methods:
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search was conducted through four online databases ‒ PUBMED, PUBMED PMC, BVS/BIREME, and EMBASE ‒ for papers published until January 2025. The Newcastle-Ottawa Scale was used to assess the risk of bias.
Results:
The search strategy identified 824 articles. Following the abstract screening, 22 studies were selected for full-text review, of which three met the criteria for data synthesis. All three studies were prospective, applied universal CMV screening through urine PCR, and followed patients with auditory brainstem response for at least four years. A meta-analysis was performed using a random-effects model with inverse-variance weighting and the Restricted Maximum Likelihood estimator. Among the three studies included in the assessment, 56,892 newborns were screened with urine samples. The meta-analysis found a proportion of prevalence of congenital CMV infection of 0.46%. The proportions of asymptomatic cases and late hearing impairment was 83.4% and 13.9%, respectively. Additionally, early hearing impairment was detected in 22 (12%) newborns, and one study demonstrated that 11% of asymptomatic patients developed long-term neurological sequelae in addition to hearing loss.
Conclusion:
Our meta-analysis evaluated epidemiological aspects of hearing loss associated with cCMV infection and found that a significant proportion of infants with asymptomatic infection develop late-onset hearing loss. The absence of structured screening risks missing these patients in long-term follow-up and may increase costs related to delayed diagnosis and investigation.
Level Of Evidence:
Level 2.
