Yield and Costs of Screening Growth-Retarded Infants for Torch Infections

Abstract

Many infants with intrauterine growth retardation (IUGR) are screened for TORCH infections. The yield and costs of such a practice may not be justifiable. Medical charts of infants with IUGR who had a workup for toxoplasmosis, other (infections), rubella, cytomegalovirus (infection), and herpes (simplex) (titer) (TORCH) infections were reviewed for the presence of clinical findings, laboratory and head ultrasound abnormalities associated with intrauterine infections. Maternal charts and reports of placental pathology were reviewed for identifying maternal illnesses and placental causes associated with IUGR. Seventy-five out of 182 infants (41%) with IUGR had a workup for TORCH infection. Maternal conditions associated with IUGR included: pregnancy-induced hypertension (19%), tobacco use (43%), alcohol abuse (21%), illicit drug use (24%), chronic hypertension, diabetic vasculopathy or collagen vascular disease (12%), and multiple gestation (3%). Placental pathology was available in 53/75 cases. Thirty-six of fifty-three (67%) placentae had abnormalities associated with IUGR: placental infarcts (22 of 36), vasculitis/villitis (15 of 36), placenta previa (1 of 36), abruptio placenta (2 of 36), and velamentous insertion of umbilical cord (1 of 36). Clinical findings among infants included hepatosplenomegaly, cataract or rash (1 of 75), thrombocytopenia and/or neutropenia and/or direct hyperbilirubinemia (11 of 75). Seven out of 75 infants had dysmorphic features. None of the infants (0 of 75) had positive IgM titers for toxoplasma, rubella, cytomegalovirus (CMV), or herpes simplex virus (HSV). No infants (0 of 43) had elevated total IgM titers; one infant (1 of 57) had a positive urine culture for CMV. One infant had evidence of calcifications on head ultrasound and a second infant had hydrocephalus (2 of 43). The costs associated with workup for TORCH infections among 75 infants included: TORCH titers determination: $17,816, total IgM titers: $1318, urine culture for CMV: $5734, and head ultrasound: $28,165. The yield of workup for TORCH infection among infants with IUGR is poor and does not justify the incurred costs.

Viruses and other infections in stillbirth: what is the evidence and what should we be doing?

“…It is only with the availability of such data that the significant human and economic cost of intrauterine deaths can be reduced. 164 …”

Multiplex Detection of IgM and IgG Class Antibodies toToxoplasma gondii, Rubella Virus, and Cytomegalovirus Using a Novel Multiplex Flow Immunoassay

“…This screening protocol is most often used to identify pregnant mothers at risk of transmitting viral or protozoan infections in utero to the fetus or to evaluate newborns presenting with nonspecific, unexplained symptoms thought to be due to infection. Although TORCH infections are a significant cause of morbidity and mortality worldwide (6), the implementation of widespread TORCH screening programs has been questioned due to several factors, including (i) potential overuse, (ii) lack of consistent and reliable serologic methods, (iii) cost, and (iv) misinterpretation of results (1,8,12,16). For example, the presence of TORCH IgG class antibodies in the mother does not differentiate between past exposure (i.e., low risk of congenital infection) and recent, acute infection (i.e., increased risk of congenital infection).…”

Torch Group Antibody Distribution in Patients' Blood Sent to Central Laboratories from Various Departments, in Dicle University Hospital

“…Therefore, all infection agents are risk for people including TORCH group. In this study, the prevalence of 3.664 suspected blood samples in a manner of TORCH was examined during one year period from January 1999 to January 2000 (2,14,15,18,22).…”