Hearing Loss With Congenital Cytomegalovirus Infection

Foulon, Ina; Brucker, Yannick De; Buyl, Ronald; Lichtert, Elke; Verbruggen, Katia; Piérard, Denis; Camfferman, Fleur; Gucciardo, Léonardo; Gordts, Frans

doi:10.1542/peds.2018-3095

Cited by 69 publications

(112 citation statements)

References 26 publications

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“…Most cCMV infections are asymptomatic and do not present a risk for the onset of late sequelae (5). Recent data demonstrated that primary maternal infections before the 14th week of pregnancy, the presence of a disseminated infection at birth, and imaging abnormalities in the neonate were risk factors for SNHL (52). This is a step toward the development of neonatal predictive markers that can be used to identify those at high risk of developing sequelae.…”

Section: Neonatal CMV Screeningmentioning

confidence: 99%

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

et al. 2020

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Maternal primary and non-primary cytomegalovirus (CMV) infection during pregnancy can result in in utero transmission to the developing fetus. Congenital CMV (cCMV) can result in significant morbidity, mortality or long-term sequelae, including sensorineural hearing loss, the most common sequela. As a leading cause of congenital infections worldwide, cCMV infection meets many of the criteria for screening. However, currently there are no universal programs that offer maternal or neonatal screening to identify infected mothers and infants, no vaccines to prevent infection, and no efficacious and safe therapies available for the treatment of maternal or fetal CMV infection. Data has shown that there are several maternal and neonatal screening strategies, and diagnostic methodologies, that allow the identification of those at risk of developing sequelae and adequately detect cCMV. Nevertheless, many questions remain unanswered in this field. Well-designed clinical trials to address several facets of CMV treatment (in pregnant women, CMV-infected fetuses and both symptomatic and asymptomatic neonates and children) are required. Prevention (vaccines), biology and transmission factors associated with non-primary CMV, and the cost-effectiveness of universal screening, all demand further exploration to fully realize the ultimate goal of preventing cCMV. In the meantime, prevention of primary infection during pregnancy should be championed to all by means of hygiene education.

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Section: Neonatal CMV Screeningmentioning

confidence: 99%

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

et al. 2020

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“…This hypothesis is supported by the existence of a difference in the mean age at first ABR between the two study groups, whereas AN infants underwent first ABR significantly earlier (p = 0.007) than not affected ones. In this light, also the distribution of AN cases along all trimesters of maternal infection (Table 1) suggests that a different pathogenesis is involved in these cases if compared to SNHL cases reported in medical literature, where a primary maternal infection of the first trimester of pregnancy is demonstrated to be a major risk factor [15,16].…”

Section: Discussionmentioning

confidence: 89%

Isolated auditory neuropathy at birth in congenital cytomegalovirus infection

et al. 2020

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Background: Congenital cytomegalovirus (cCMV) infection is the most frequent non-genetic cause of sensorineural hearing-loss (SNHL) (i.e., hearing loss due to a cochlear and/or auditory nerve damage). It is widely accepted that SNHL at birth, when associated to cCMV symptomatic infection involving the central nervous system, benefits from antiviral therapy started in the neonatal period. Conversely, there is no consensus for antiviral treatment in congenitally infected infants diagnosed with isolated SNHL (i.e., SNHL in an otherwise asymptomatic infant) at birth. Our aim was to assess the frequency and the auditory outcome of isolated SNHL at birth due to auditory neuropathy (AN) (i.e., SNHL in a patient with normal cochlear function and auditory nerve dysfunction) in infants with cCMV infection. Methods: We retrospectively reviewed the clinical history of 60 infants, born at term, with cCMV asymptomatic infection, without additional risk factors for SNHL, and exhibiting bilateral "pass" otoacustic emissions (OAE). None of them underwent antiviral therapy. Hearing thresholds were assessed by means of Auditory Brainstem Responses (ABR). AN affected children were followed up until possible normalization of the hearing thresholds or definitive diagnosis of AN. Each infant diagnosed with monolateral or bilateral AN was classified according to the worst ear threshold. Results: In our population, the first ABR was performed at a mean age of 5.00 ± 2.79 (SD) months and AN was diagnosed in 16/60 (26.67%) infants; in 4 infants the AN was defined as mild (4/4 monolateral), moderate in 11 (5/ 11 bilateral), and severe in 1 (bilateral). The mean age at first ABR was 3.69 ± 2.80 (SD) months in the 16 babies with AN and 5.48 ± 2.66 (SD) months in the 44 infants with normal hearing (p = 0.007). All AN cases spontaneously recovered a normal auditory threshold over time. The mean length of the audiological follow-up was 32.44 ± 17.58 (SD) months (range 5-60 months). Conclusion: A delayed maturation of the auditory pathways should be considered when a mild/moderate isolated AN at birth is detected in cCMV infected infants. Prospective studies conducted on larger populations, and with a longer audiological follow-up, are needed to confirm our findings.

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“…Conflicting opinions exist about the influence of the type and timing of maternal CMV infection during pregnancy and the outcome in the child. Most studies stress the importance of primary maternal CMV infections, especially those occurring early in pregnancy, as having the greatest impact on the outcome of the newborn and child [7][8][9][10][11][12][13][14]. The relative contribution of maternal primary CMV infection during pregnancy to the risk of transmission to the fetus and newborn has been estimated at 40% (range 25 to 50%) for proven maternal primary CMV infections during pregnancy, and 1-2% for maternal non-primary or recurrent CMV infections during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…The relative contribution of maternal primary CMV infection during pregnancy to the risk of transmission to the fetus and newborn has been estimated at 40% (range 25 to 50%) for proven maternal primary CMV infections during pregnancy, and 1-2% for maternal non-primary or recurrent CMV infections during pregnancy. In addition, primary maternal infections are more often associated with symptomatic congenital CMV infection, and long term sequelae, including hearing loss [7].…”

Section: Introductionmentioning

confidence: 99%