The C in TORCH: A Cost-Effective Alternative to Screening Small-for-Gestational-Age Infants

Abstract

Background: Infants born with birth weights under the 10th percentile for their gestational age are classified as small for gestational age (SGA). TORCH infections are reported to be associated with SGA infants. With the low incidence of infections, screening is likely to be expensive and of low utility. Objective: The objective of this study was to determine the utility and cost-effectiveness of screening SGA infants with TORCH serology titers, urine cytomegalovirus (CMV) cultures and cranial ultrasounds. Methods: A retrospective review was conducted on all infants admitted to the neonatal intensive care unit (NICU) at Los Angeles County and University of Southern California (LAC+USC) Medical Center from January 2003 to December 2011 with a diagnosis of SGA or intrauterine growth restriction. Birth characteristics such as birth weight, length, head circumference and gestational age were recorded. TORCH titer results, urine CMV results and cranial ultrasound findings were collected. Results: Between 2003 and 2011, 232 SGA infants were admitted to the NICU at LAC+USC Medical Center. Of these, 117 infants (50%) had TORCH titer testing performed; there was only 1 positive CMV IgM and 1 positive HSV IgM result. Repeat urine CMV testing was performed on 109 infants (47%), with a total of 296 urine CMV samples collected from these infants; 6 infants had positive results, of whom 3 had repeat positive urine CMV samples. Overall, 149 of the infants had a cranial ultrasound done, none of which were positive for calcifications. Conclusions: TORCH titer testing, urine CMV screening and cranial ultrasound screening are of low yield in screening clinically asymptomatic SGA infants for TORCH infections. Given the low number of positive results, a cost-effective alternative of selective TORCH testing may be limited to infants with additional clinical findings. This study serves as a reminder to periodically examine testing practices and patient population to maximize cost-effectiveness.

TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea

“…A Dutch study of TORCH screening in 112 SGA neonates found only 2 patients with evidence of congenital CMV infection. 11) In a study by Wei et al 9) of 117 SGA infants in whom TORCH titer testing was done, only two infants showed positive results (each positive for CMV IgM and HSV IgM).…”

“…With low incidence of TORCH in the general population, screening is likely to be of low utility and high expense. Studies reviewing TORCH screening have reported very low incidences of positive findings: 3 out of 23 SGA neonates in a Canadian study, 7) 9 out of 117 SGA neonates in a USA study, 9) and 1 out of 75 SGA in another USA study. 8) In addition, SGA and IUGR rarely present as unique features of TORCH infection.…”

“… 7) More recent studies have utilized shell vial culture for CMV and various methods of polymerase chain reaction (PCR). 8 9 10 11 12) …”

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

“…La infección por CMV es una causa conocida de retardo en el crecimiento intrauterino secundario a la insuficiencia placentaria generada por la infección de las células trofoblásticas 97,98 (v. apartado «Fisiopatología de la infección en el feto»). El estudio de CMV en un RN PEG (menor que el percentil 10) sin otro síntoma es controversial 44,96,99 ; sin embargo, en el contexto de una búsqueda activa o un cribado selectivo de CMV en RN, Lorenzoni et al 100 estudiaron 504 RN prematuros o PEG graves (menor que el percentil 3) y encontraron un 3,7% de RN positivos para CMV. A su vez, en una experiencia nacional de cribado de CMV en RN hospitalizados se observó que el 3,3% de los PEG graves estudiados presentaron una infección congénita por CMV, sin hallar otra causa atribuible al bajo peso en un 40% de ellos 101 .…”

Perfil Neuropsicológico em pacientes adultos submetidos ao implante coclear unilateral

“…Além das causas congênitas, existem as causas adquiridas após o nascimento e podem ocorrer devido a medicamentos ototóxicos, infecção por meningite e infecções congênitas causadas por Toxoplasma gondii, Rubeolla vírus, Citomegalovírus e Herpes simplex vírus, conhecidas como TORCHS. Existem outras causas menos frequentes de origem adquirida, como traumatismo cranioencefálico e doenças que acometem a orelha, como a otosclerose, petrosite e outras (WEI et al, 2014;SIMÕES, 2017).…”