Prognostic determinants of hearing outcomes in children with congenital cytomegalovirus infection

Lo, Ta-Hsuan; Lin, Pei‐Hsuan; Hsu, Wei‐Chung; Tsao, Po-Nien; Liu, Tien‐Chen; Yang, Tzong Hann; Hsu, Chuan‐Jen; Huang, Li‐Min; Lu, Chun‐Yi; Wu, Chen‐Chi

doi:10.1038/s41598-022-08392-w

Cited by 7 publications

(10 citation statements)

References 43 publications

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“…Several researchers expressed the need to further establish the predictive role of viral load (33,34,51). Our results showed that viral load is not associated with clinical, neurological or laboratory findings at birth.…”

Section: Discussionmentioning

confidence: 57%

“…In contrast, significantly higher mean or median values of blood viral load in newborns with symptomatic cCMV infection compared with those with asymptomatic infection have been described . In addition, some studies have reported that newborns with congenital hearing loss had an equal or higher initial viral load compared with newborns with normal hearing at birth. The contradictory results of these different studies might be explained by the low sample size, different definitions, inclusion criteria, or outcome measurements.…”

Section: Discussionmentioning

confidence: 95%

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Risk Factors for Hearing Loss at Birth in Newborns With Congenital Cytomegalovirus Infection

Cuyper

Acke

Keymeulen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceWith a prevalence between 0.2% and 6.1% of all live births, congenital cytomegalovirus (cCMV) infection is a major cause of congenital nonhereditary sensorineural hearing loss. Despite the large amount of research on cCMV-related hearing loss, it is still unclear which newborns are at risk of hearing loss.ObjectiveTo identify independent risk factors for cCMV-related congenital hearing loss and predictors of hearing loss severity at birth.Design, Setting, and ParticipantsThis cross-sectional study of newborns with cCMV infection used data included in the Flemish CMV registry that was collected from 6 secondary and tertiary hospitals in Flanders, Belgium, over 15 years (January 1, 2007, to February 7, 2022). Data were analyzed March 3 to October 19, 2022. Patients were included in the study after confirmed diagnosis of cCMV infection and known hearing status at birth. Patients who presented with other possible causes of sensorineural hearing loss were excluded.Main Outcomes and MeasuresPrimary outcome was hearing status at birth. Clinical, neurological, and laboratory findings along with the timing of seroconversion and blood viral load were separately considered as risk factors. Binary logistic regression was performed to identify independent risk factors for congenital hearing loss in newborns with cCMV. Effect sizes were measured using Hedges g, odds ratio, or Cramer V.ResultsOf the 1033 newborns included in the study (553 of 1024 [54.0%] boys), 416 (40.3%) were diagnosed with symptomatic cCMV infection and 617 (59.7%) with asymptomatic cCMV infection. A total of 15.4% of the patients (n = 159) presented with congenital hearing loss; half of them (n = 80 [50.3%]) had isolated hearing loss. The regression model revealed 3 independent risk factors for congenital hearing loss: petechiae at birth (adjusted odds ratio [aOR], 6.7; 95% CI, 1.9-23.9), periventricular cysts on magnetic resonance imaging (MRI; aOR, 4.6; 95% CI, 1.5-14.1), and seroconversion in the first trimester (aOR, 3.1; 95% CI, 1.1-9.3). Lower viral loads were seen in patients with normal hearing compared with those with congenital hearing loss (median [IQR] viral load, 447.0 [39.3-2345.8] copies per milliliter of sample [copies/mL] vs 1349.5 [234.3-14 393.0] copies/mL; median difference, −397.0 [95% CI, −5058.0 to 174.0] copies/mL).Conclusions and RelevanceFindings of this cross-sectional study suggest that newborns with cCMV infection and petechiae at birth, periventricular cysts on MRI, or a seroconversion in the first trimester had a higher risk of congenital hearing loss. Clinicians may use these risk factors to counsel parents in the prenatal and postnatal periods about the risk of congenital hearing loss. Moreover, linking clinical features to hearing loss may provide new insights into the pathogenesis of cCMV-related hearing loss. The importance of viral load as a risk factor for congenital hearing loss remains unclear.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 95%

Risk Factors for Hearing Loss at Birth in Newborns With Congenital Cytomegalovirus Infection

Cuyper

Acke

Keymeulen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…However, the small cohort size limits the significance of the findings. In two different cohorts of cCMV from Taiwan, identified by a combination of newborn screening and screening of symptomatic infants, symptomatic infection, high CMV viral load at birth and failed newborn hearing screening were identified as prognostic indicators for SNHL in the newborn period [43 ▪ ] whereas low birth weight, gestational age and prolonged viral shedding correlated with late-onset SNHL [44]. None of these risk-factors predicted vestibular dysfunction.…”

Section: Managementmentioning

confidence: 98%

Congenital cytomegalovirus infection diagnostics and management

Pinninti

Boppana

2022

Current Opinion in Infectious Diseases

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Purpose of the reviewCongenital cytomegalovirus infection (cCMV) is the most frequent congenital infection and a leading nongenetic cause of sensorineural hearing loss (SNHL) and brain disease. The purpose of this review is to highlight recent developments in the diagnosis and management of children with cCMV. Recent FindingsProgress is being made in the efforts to identify more infants with cCMV, especially those with asymptomatic infection. Largely due to efforts by various advocacy/parent groups, a number of states in the United States and many hospital systems have implemented hearing targeted CMV screening and mandated education of pregnant women about CMV. SummarycCMV is an important cause of SNHL and neurologic morbidity worldwide. Early identification of infected children is critical to improve outcomes by providing timely interventions and guidance for long-term follow up. The fact that most infants with cCMV have no abnormal clinical findings, and the need to obtain samples for diagnosis within the first 2--3 weeks of life, makes it challenging to identify a majority of infants with cCMV without universal newborn CMV screening.

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“…Infants with SNHL need hearing screening at frequent intervals as SNHL is the most common sequelae of cCMV and 40% of SNHLs are late onset, i.e., after one month of age. The Incidence of SNHL is 25% to 65 % in symptomatic and 6% to 25% in asymptomatic infants [11]. Other permanent sequelae, including microcephaly, motor deficits, and chorioretinitis, have also been reported in infants with asymptomatic cCMV [12].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Congenital Cytomegalovirus (cCMV) in an Asymptomatic Neonate on Placental Pathology

Boddu¹,

Velumula²,

Jacques³

et al. 2022

Cureus

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Congenital Cytomegalovirus (cCMV) is the most common intrauterine infection, with an incidence of 0.5% to 1.3% in the United States of America (USA). The majority of cCMV infections are asymptomatic at birth. In this case report, we present a full-term neonate who was admitted to the neonatal intensive care unit (NICU) for early onset sepsis and had an incidental finding in the placenta suggestive of Cytomegalovirus infection that was later confirmed on polymerase chain reaction (PCR) test in the blood. The infant was further evaluated for signs of CMV infection: complete blood count (CBC), head ultrasound, audiology, and ophthalmology exams were performed that did not show any abnormality. He was discharged home with audiology, ophthalmology, primary care, and infectious disease specialties follow-up appointments. Our case emphasizes the role of placental examination in looking for evidence of CMV infection so that infants can be diagnosed as well as followed up appropriately and necessary interventions can be provided on time for the best possible outcomes.

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Prognostic determinants of hearing outcomes in children with congenital cytomegalovirus infection

Cited by 7 publications

References 43 publications

Risk Factors for Hearing Loss at Birth in Newborns With Congenital Cytomegalovirus Infection

Risk Factors for Hearing Loss at Birth in Newborns With Congenital Cytomegalovirus Infection

Congenital cytomegalovirus infection diagnostics and management

Diagnosis of Congenital Cytomegalovirus (cCMV) in an Asymptomatic Neonate on Placental Pathology

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