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Congenital cytomegalovirus infection and neonatal auditory screening
T Hicks1, K Fowler, M Richardson
1Department of Pediatrics, University of Alabama at Birmingham 35233.
Insights
Risk-based newborn hearing screening misses most cases of hearing loss from congenital cytomegalovirus (CMV) infection. Universal screening for congenital CMV is needed to identify infants with this treatable cause of sensorineural hearing loss.
Area of Science:
- Neonatology
- Audiology
- Infectious Diseases
Background:
- Congenital cytomegalovirus (CMV) infection is a leading cause of non-genetic sensorineural hearing loss in newborns.
- Current neonatal auditory screening protocols often rely on risk criteria, potentially missing cases.
- Early identification and intervention are crucial for managing hearing loss in infants.
Purpose of the Study:
- To evaluate the effectiveness of risk criteria-based neonatal auditory screening in identifying hearing loss caused by congenital CMV infection.
- To determine the prevalence of sensorineural hearing loss in infants with congenital CMV infection.
- To compare the yield of risk-based screening with universal screening for congenital CMV.
Main Methods:
- Retrospective analysis of 6.5 years of risk criteria-based auditory screening data.
- Comparison with results from universal congenital CMV infection screening.
- Follow-up hearing evaluations for infants diagnosed with congenital CMV infection.
Main Results:
- Congenital CMV infection was identified in 1.3% of 12,371 infants.
- 10.4% of infected infants had confirmed sensorineural hearing loss.
- Risk-based screening identified only 20% of infants with congenital CMV and 14% of those with CMV-related hearing loss.
Conclusions:
- Congenital CMV infection is a significant, under-identified cause of neonatal hearing impairment.
- Risk criteria-based auditory screening is insufficient for detecting the majority of hearing loss cases due to congenital CMV.
- Universal screening for congenital CMV infection should be considered to improve early detection and management of hearing loss.
Abstract:
Auditory screening of newborn infants has been recommended on the basis of the presence of risk criteria, including congenital infection. We assessed the ability of risk criteria-based neonatal auditory brain stem response to identify infants with hearing loss resulting from congenital cytomegalovirus (CMV) infection. Data from 6 1/2 years of risk criteria-based neonatal auditory screening were compared with the results of screening of all newborn infants for congenital CMV infection. Infants with congenital CMV infection received follow-up hearing evaluations. Congenital CMV infection was found in 167 (1.3%) of 12,371 infants; 134 had follow-up hearing evaluations, and 14 (10.4%) had confirmed sensorineural hearing loss. The rate of sensorineural hearing loss resulting from congenital CMV infection was 14 per 12,371 infants, of 1.1 per 1000 live births; the rate of bilateral loss > or = 50 dB was 0.6 per 1000. Although 2036 infants received auditory screening because of risk criteria, only 34 (20%) of 167 infants with congenital CMV infection were included. Only 2 (14%) of 14 children with sensorineural hearing loss caused by CMV were identified by risk criteria-based screening. We conclude that congenital CMV infection is an important cause of hearing impairment. Neonatal auditory screening based on the presence of risk criteria will fail to identify the majority of cases of sensorineural hearing loss caused by congenital CMV infection.