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

Chung, Pui Khi; Schornagel, Fleurtje; Oudesluys‐Murphy, Anne Marie; Vries, Linda S. de; Soede, Wim; Zwet, Erik W. van; Vossen, A.C.T.M.

doi:10.1136/archdischild-2022-324699

Cited by 15 publications

(11 citation statements)

References 37 publications

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“…Our observational study could not ascertain treatment effectiveness in this population. New controlled trials or analysis of neuroimaging data from trials of antiviral treatment for infants with mildly symptomatic cCMV or isolated SNHL could shed further light on this question 30…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities

Alarcón,

de Vries,

Parodi

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs).MethodsMulticentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability.ResultsNeuroimaging scoring was associated with outcome (p<0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p<0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia.ConclusionsCategorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities

Alarcón,

de Vries,

Parodi

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…The targeted screening is performed in children who fail the neonatal hearing screening. 15 - 17 This strategy risks missing a considerable subgroup of children with late-onset hearing loss due to congenital CMV infection. Universal screening is applied to all newborns.…”

Section: Discussionmentioning

confidence: 99%

Congenital Cytomegalovirus Infection Screening in Newborns From Saliva Samples by Real-Time Polymerase Chain Reaction Analysis

Gunlemez,

Kolayli,

Yazici Ozcelik

et al. 2023

Turkish Archives of Pediatrics

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Objective: Congenital cytomegalovirus infection is the most common congenital infection. Although screening of congenital cytomegalovirus infection with polymerase chain reaction studies in blood, urine, and saliva samples has been developed in recent years, it is not yet in routine use in any country. Materials and Methods: In our study, cytomegalovirus deoxyribonucleic acid analysis was performed by real-time polymerase chain reaction method in saliva samples taken before the first feeding during the first day following birth in neonates born in a university hospital between January 2021 and January 2022. To support the diagnosis, additionally, cytomegalovirus deoxyribonucleic acid positivity in urine and blood samples was investigated in newborns with cytomegalovirus deoxyribonucleic acid positivity in saliva. Results: Cytomegalovirus deoxyribonucleic acid was investigated in saliva samples of 545 neonates by real-time polymerase chain reaction method in 1-year period and positivity was found in 6 neonates. Since cytomegalovirus deoxyribonucleic acid was found negative by the real-time polymerase chain reaction method in the urine and blood samples of 5 of these neonates, the positivity in the saliva sample was interpreted as false positivity. In 1 case, cytomegalovirus deoxyribonucleic acid positivity was detected in urine and blood samples 5 weeks later. As a result, definite congenital cytomegalovirus infection could not be diagnosed in 545 cases, while possible congenital cytomegalovirus infection was diagnosed in 1 case. Conclusion: It has been concluded that the frequency of congenital cytomegalovirus infection is low in our study group and studying saliva samples showed high false-positive rates. It is seen that saliva is not a suitable sample for detecting cytomegalovirus deoxyribonucleic acid by real-time polymerase chain reaction method.

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“…Reporting of cCMV was low in this cohort, it is possible that some of the ten babies who did not have any UK/US risk factors or genetic anomalies had cCMV. A recent study has shown that the yield of targeted cCMV screening following newborn hearing screening failure was eight times higher than the estimated national birth prevalence of cCMV and those babies with clinically unsuspected cCMV disease had confirmed HL [42]. Future research could investigate if those children without any neonatal indicators or risk factors for HL have cCMV.…”

Section: Individual Risk Factors For Hearing Lossmentioning

confidence: 99%

UK and US risk factors for hearing loss in neonatal intensive care unit infants

Thornton,

Hoare,

Yates

et al. 2023

Preprint

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ImportanceEarly detection and intervention of hearing loss may mitigate negative effects on children’s development. Children who were admitted to the neonatal intensive care unit (NICU) as babies are particularly susceptible to hearing loss and risk factors are vital for surveillance.Design, Setting and ParticipantsThis single-centre retrospective cohort study included data from 142 inborn infants who had been admitted to the NICU in a tertiary regional referral centre. Data were recorded for 71 infants with confirmed permanent congenital hearing loss hearing loss. To determine impact of NICU admission independently of prematurity babies were individually matched with 71 inborn infants on gestational age, birthweight, and sex.Main Outcomes and MeasuresNeonatal indicators were recorded for all children with permanent congenital hearing loss. Presence of UK and US risk factors for hearing loss were collected on the neonatal population with hearing loss and for the matched controls.ResultsA fifth (21%) of babies with hearing loss had one or more UK risk factors whereas most (86%) had at least one US risk factor. False positives would be evident if US factors were used whereas the matched controls had no UK risk factors. Ten babies who at birth had no UK or US risk factors did not have any significant neonatal indicators identified in their records, one was ventilated for one day and two had a genetic anomaly.Conclusions and RelevanceCurrent risk factors for hearing loss we identified for follow-up in this high-risk group are highly specific for congenital hearing loss. UK risk factors were highly specific for hearing loss but not sensitive and conversely, US risk factors are sensitive but not specific so false positives would be recorded. A national study of neonatal indicators could provide the utility to test which combinations of risk factors provide high sensitivity without losing specificity.Key pointsCurrent risk factors listed in UK guidance were highly specific for congenital hearing loss but not sensitive meaning cases would be missed. US risk factors were more sensitive for hearing loss but not very specific indicating false positives would be made in this population.Neonates with hearing loss who wouldnothave been identified solely according to US or UK risk factors were born close to term and had few neonatal indicators identified.

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

Cited by 15 publications

References 37 publications

Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities

Neuroimaging in infants with congenital cytomegalovirus infection and its correlation with outcome: emphasis on white matter abnormalities

Congenital Cytomegalovirus Infection Screening in Newborns From Saliva Samples by Real-Time Polymerase Chain Reaction Analysis

UK and US risk factors for hearing loss in neonatal intensive care unit infants

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