Vestibular and balance dysfunction in children with congenital CMV: a systematic review

Abstract

ObjectiveThis systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities.DesignMEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.PatientsChildren with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture).InterventionStudies of vestibular function and/or balance assessments.Main outcome measuresVestibular function and balance.Results1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%–60%), than asymptomatic cCMV (0%–12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months.ConclusionsVestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case–controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions.PROSPERO registrationCRD42019131656.

Long-term outcome of vestibular function and hearing in children with congenital cytomegalovirus infection: a prospective cohort study

“…Only a few previous studies have investigated vestibular dysfunction in cCMV [5,11,12,[22][23][24]. The incidence of vestibular dysfunction varied widely in these studies likely due to differences in factors, such as age of testing, follow-up duration, vestibular assessment tools, and the proportion of children with symptomatic and asymptomatic cCMV.…”

“…Vestibular dysfunction and balance disorders have been reported in children with cCMV [4,5,[9][10][11][12], but evidence from prospective population-based cohorts is scarce. It is crucial to study the long-term burden of vestibular dysfunction in cCMV, because vestibular dysfunction may result in functional deficits in children with cCMV [5]. The characteristics of hearing loss in cCMV are variable; it can be early or late-onset, fluctuating, or progressive [13].…”

Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection

“…Interestingly, Figure 3 did not show an important protective effect of postnatal antiviral treatment on the vestibular function, as significant vestibular deteriorations were certainly not confined to untreated patients. However, more extensive research in a more standardized setting is necessary to make meaningful statements about this complicated issue (Shears et al 2022).…”

Newborn cytomegalovirus screening: is this the new standard?

“…Therefore, the majority (∼80%) of children with cCMV may not have any complications. However, more subtle complications, such as vestibular dysfunction, are increasingly recognized among children who are asymptomatic at birth [20 ▪▪ ].…”