The risk of SNHL increased with DBS viral load. Further studies should investigate whether DBS CMV testing has a role in identifying asymptomatic congenitally infected neonates at risk of SNHL, and whether antiviral treatment can reduce this risk.

Targeted salivary screening for cCMV within the NHSP is feasible, acceptable and detects infants with cCMV-related SNHL who could benefit from early treatment.

Substantial progress has recently been made in diagnosis and treatment. If additional financial support were to be made available to evaluate existing vaccine candidates in controlled clinical trials, congenital cytomegalovirus could potentially become a vaccine-preventable disease.

The new 10% liquid immunoglobulin preparation was well tolerated and shown to have an excellent pharmacokinetic, efficacy and safety profile. The liquid formulation provides convenience to patients and healthcare professionals.

The diagnosis of congenital cytomegalovirus infection cannot be made with certainty in children presenting after the perinatal period, unless stored early samples are available for diagnostic testing. This has led to uncertainty in confirming the overall contribution of CMV to hearing loss and neurodevelopmental impairment. The use of dried blood spots (DBSs) to retrospectively diagnose infection in children with compatible symptoms may be helpful diagnostically although there are ongoing uncertainties regarding the stability of viral DNA in cards, the risk of contamination between cards, and sensitivity and specificity in a clinical setting. This report aims to address these areas and evaluate the use of DBS testing in our hands in the United Kingdom to date. Results from testing artificially prepared cards and cards from three populations of children suggest a high specificity for congenital CMV infection and a good sensitivity for cases where sensorineural hearing loss is caused by congenital CMV.

It is feasible for hearing screeners to obtain saliva swabs to test for CMV DNA using real-time PCR in newborns referred after their initial hearing screen. Rapid diagnostic testing for cCMV needs a more detailed clinical and cost-effectiveness analysis.

Background: Intravenous immunoglobulin (IGIV) 10% is a newly developed 10% liquid immunoglobulin preparation for intravenous use where 3 dedicated virus reduction steps have been integrated into the manufacturing process. The efficacy and safety of this product were assessed in a prospective multicenter study in chronic ITP (idiopathic thrombocytopenic purpura) patients with platelet counts of =20 × 109/l. Patients and Methods: 23 adult ITP patients received the product at a total dose of 2 g/kg body weight administered over 2-5 days, and were followed for 4 weeks. Results: Of the 21 subjects included in the Per-Protocol Analysis Data Set, 15 responded successfully to treatment (71.4%). Eleven subjects in this group attained a platelet count increase to >100 × 109/l, and 8 reached a platelet count of >200 × 109/l. All 15 responders achieved a platelet count of =50 × 109/l by day 8, and 14 of them reached this level by day 5. The median duration of platelet response was 25 days, and the highest median platelet count in the responders was 182 × 109/l. A total of 81 infusions were administered to the 23 subjects in the Safety Analysis Data Set over the course of the study. There were 40 non-serious adverse events related to the use of the study drug - 35 mild, 3 moderate, and 2 severe. The most frequent related adverse events were headache and pyrexia. Conclusion: The results obtained in this study demonstrate that IGIV 10% is effective in the treatment of adult subjects with chronic ITP and indicate a good safety profile.

ObjectiveThis systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities.DesignMEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.PatientsChildren with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture).InterventionStudies of vestibular function and/or balance assessments.Main outcome measuresVestibular function and balance.Results1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%–60%), than asymptomatic cCMV (0%–12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months.ConclusionsVestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case–controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions.PROSPERO registrationCRD42019131656.