Feasibility and acceptability of targeted salivary cytomegalovirus screening through universal newborn hearing screening

Abstract

Aim This study aimed to determine the feasibility and parental acceptability of screening for congenital cytomegalovirus (cCMV) through saliva polymerase chain reaction in infants who did not pass their newborn hearing screening. Additionally, the utility (i.e. time to diagnosis and treatment) of this enhanced clinical pathway was evaluated. Methods The study was conducted through the Victorian Infant Hearing Screening Programme (VIHSP) across four maternity hospitals in Melbourne, Australia, during June 2019–March 2020. Parents were approached by VIHSP staff about obtaining a test for cytomegalovirus (CMV) at the time of their baby's second positive (‘refer’) result on the VIHSP screen. Participating parents collected a saliva swab for CMV polymerase chain reaction from their infants. Feasibility was determined by the proportion of ‘referred’ infants whose parents completed the salivary CMV screening test ≤21 days of life. Acceptability was measured through parent survey. Results Of 126 eligible families, 96 (76.0%) had salivary screening swabs taken ≤21 days of life. Most families (>92.0%) indicated that screening was acceptable, straightforward and thought testing their baby for cCMV was a good idea. One infant screened positive on day 30, was diagnosed with cCMV via confirmatory testing by day 31 and commenced valganciclovir on day 32. Conclusions Obtaining a saliva sample to screen for cCMV in infants who do not pass their newborn hearing screen is feasible and appears acceptable to parents. This targeted cCMV screening method could be an option where mothers are rapidly discharged from hospital, especially in the context of the COVID‐19 pandemic.

Targeted screening for congenital cytomegalovirus infection: clinical, audiological and neuroimaging findings

“…[4][5][6][7][8] While several reports of ongoing screening programmes offer insight into the feasibility of targeted screening, details on clinical, audiological and neuroimaging findings are scarce. [9][10][11][12][13][14] In case of future implementation, clinicians could increasingly encounter infants with cCMV and seemingly isolated HL. More data on this patient population are needed to provide appropriate parental guidance on treatment and prognosis.…”

“…Previous studies exploring incorporated targeted CMV screening into newborn hearing screening programmes suggest favourable cost-effectiveness 4–8. While several reports of ongoing screening programmes offer insight into the feasibility of targeted screening, details on clinical, audiological and neuroimaging findings are scarce 9–14. In case of future implementation, clinicians could increasingly encounter infants with cCMV and seemingly isolated HL.…”

Exploring Parent Support Needs during the Newborn Hearing Diagnosis Pathway

“…In the state of Victoria, Australia, the Victorian Infant Hearing Screening Program (VIHSP) finalised the roll-out of their UNHS program in 2012 and screens the hearing of >99.5% of newborns within the first few weeks of life [ 15 ]. Approximately 0.8% of infants who have their hearing screened by the VIHSP will obtain a ‘positive screen result’, requiring further diagnostic audiological testing [ 16 ]. Approximately 40% of the newborns who are referred to diagnostic audiology will be diagnosed with a hearing loss of varying type and degree [ 16 ].…”

“…Approximately 0.8% of infants who have their hearing screened by the VIHSP will obtain a ‘positive screen result’, requiring further diagnostic audiological testing [ 16 ]. Approximately 40% of the newborns who are referred to diagnostic audiology will be diagnosed with a hearing loss of varying type and degree [ 16 ]. The VIHSP has an Early Support Service (ESS) embedded within the program to support families whose newborns do not pass the hearing screen.…”

Letter to the Editor

“…1,2 Umberto Ambrosetti1 1 Department of Clinical Sciences and Community Health, University of Milan 2 Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy mirko.alde@unimi.it; umberto.ambrosetti@unimi.it Accepted for publication 6 April 2023.…”