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Yoshinaga-Itano C, Carr G, Davis A, Ching TYC, Chung K, Clark J, Harkus S, Kuan ML, Garg S, Balen SA, O’Leary S. Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs. Ear Hear 2024; 45:1071-1088. [PMID: 38783422 PMCID: PMC11325981 DOI: 10.1097/aud.0000000000001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/02/2024] [Indexed: 05/25/2024]
Abstract
Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.
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Affiliation(s)
- Christine Yoshinaga-Itano
- University of Colorado, Boulder, Colorado, USA
- University of Witwatersrand, Johannesburg, South Africa
| | - Gwen Carr
- UCL Ear Institute London, London, United Kingdom
| | - Adrian Davis
- UCL Ear Institute London, London, United Kingdom
- London School of Economics, London, United Kingdom
- Imperial College London, London, United Kingdom
- Anglia Ruskin University, Cambridge, United Kingdom
| | - Teresa Y. C. Ching
- Macquarie University, Sydney, New South Wales, Australia
- NextSense Institute, Sydney, New South Wales, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - King Chung
- MGH Institute of Health Professions, Department of Communication Sciences and Disorders, Charlestown, Massachusetts, United States
| | | | | | - Meei-ling Kuan
- National Women’s League Hearing Health Foundation, Taipei, Taiwan
| | | | - Sheila Andreoli Balen
- Speech, Language and Hearing Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Forli F, Capobianco S, Berrettini S, Bruschini L, Lorenzoni F, Fiori S, Lazzerini F. Long-term outcomes of congenital cytomegalovirus infection in children early identified by extended hearing-targeted screening. Int J Pediatr Otorhinolaryngol 2024; 184:112070. [PMID: 39191004 DOI: 10.1016/j.ijporl.2024.112070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES Congenital Cytomegalovirus (cCMV) has been associated with hearing, vision, and neurodevelopmental long-term sequelae. Despite the social burden associated with the disease, a universally accepted consensus on screening, diagnostic, therapeutic and follow-up approaches has not been reached. The present observational retrospective study aims at describing long-term sequelae and radiological abnormalities associated with cCMV in children early identified by extended hearing-targeted screening and evaluated by audiological follow-up in a single III Level Audiological Referral Center for at least 2 years. METHODS Audiological neonatal and follow-up data were available for all subjects. Data collection included clinical neonatal and virological assessment at birth. Ophthalmological, neurodevelopmental and neuroradiological follow-up abnormalities compatible with cCMV sequelae were collected by clinical reports. Spearman's rank correlation coefficient (rho-ρ) was used to evaluate possible correlations among the considered parameters. RESULTS 61 newborns were identified by extended hearing-targeted cCMV screening and diagnosed mostly (83.6 %) by PCR viral DNA extraction in urine collected within the 15° day of life. Seventeen babies were born preterm, with a mean gestational age of 33.5 weeks. Sixteen patients (26.2 %) were admitted to an Intensive or sub-Intensive Neonatal Care Unit. At birth, 35 newborns were symptomatic (57.3 %), and 19 of them received antiviral treatment by valganciclovir or ganciclovir. Overall, 20 children (32.7 %) were diagnosed with sensorineural hearing loss (SNHL), among them 17 (85 %) were refer at the newborn hearing screening while 3 (15 %) were Pass. 5/20 children (25 %) presented isolated SNHL, while in 15/20 (75 %) children SNHL was associated to other long-term sequelae. In 5 patients (25 %) a progression of the hearing threshold was observed, with a mean age of progression of 26 months of age. Risk factors for progression were a worse final hearing threshold (Spearman's ρ = 0.434; p = 0.0001) and a worse hearing threshold at birth (Spearman's ρ = 0.298; p = 0.020). Thirteen children were fitted with hearing aids, 8 of whom subsequently underwent cochlear implantation. Concerning long term impairments, 10/61 children (17 %) presented a variety of ophthalmological sequelae, while 16/40 cCMV patients (40 %) were diagnosed with neurodevelopmental abnormalities. Language delays were significantly associated with a worse hearing threshold (ρ = 0.582; p = 0.0001) and with other neurocognitive abnormalities (ρ = 0.677, p = 0.0001). 30 children underwent radiological brain evaluation by Magnetic Resonance Imaging, and 63.3 % of them presented abnormalities compatible with cCMV. Mean viral load at birth did not show significant associations with long-term sequelae. CONCLUSIONS The study highlights the diverse and significant long-term sequelae of cCMV infection detected through early screening. With a significant proportion of cCMV children developing sensorineural hearing loss, ophthalmological and neurodevelopmental issues, the results emphasize the importance of continuous, multidisciplinary follow-up. Early identification and tailored interventions are crucial for improving the long-term health and quality of life of children affected by cCMV.
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Affiliation(s)
- Francesca Forli
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy.
| | - Silvia Capobianco
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Francesca Lorenzoni
- Neonatal Unit and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Lazzerini
- Otolaryngology, Audiology, and Phoniatrics Unit, University of Pisa, Pisa, Italy
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Howard A, Nishikawa JK, Sánchez PJ. "Minimally symptomatic" congenital cytomegalovirus infection: latest data and emerging concepts. Curr Opin Pediatr 2024; 36:480-488. [PMID: 38747205 DOI: 10.1097/mop.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Universal and targeted screening of newborns for congenital cytomegalovirus (CMV) infection is increasing globally. Questions remain concerning the management of infants who have been identified with congenital CMV infection, especially those with "minimally symptomatic" or clinically inapparent infection. Our objective is to discuss current management of CMV-infected neonates with a focus on less affected infants with or without sensorineural hearing loss (SNHL). RECENT FINDINGS Valganciclovir is being prescribed increasingly in neonates with congenital CMV infection for improvement in hearing outcomes through 2 years of age. Treatment initiated in the first month of age is recommended for clinically apparent disease. A recent study showed hearing improvement at 18-22 months of age when therapy was initiated at age 1-3 months in infants with clinically inapparent CMV infection and isolated SNHL. SUMMARY Antiviral therapy with either ganciclovir or valganciclovir has shown moderate benefit in prevention of hearing deterioration among infants with clinically apparent CMV infection or isolated SNHL. Sustainability of benefit beyond 2 years of age remains unknown. At present, infants with clinically inapparent CMV infection (normal complete evaluation including hearing) should not receive antiviral therapy. All CMV-infected infants require close audiological and neurodevelopmental follow-up.
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Affiliation(s)
- Ashley Howard
- Department of Pediatric Infectious Diseases and Immunology, Connecticut Children's Hospital, Hartford, Connecticut
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut
| | - Javier K Nishikawa
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Perinatal Research, Ohio Perinatal Research Network, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Webb E, Hodgson J, Gillespie AN, Jones CA, Poulakis Z, Wong J, Sung V. Hearing Screening for Congenital CytoMegaloVirus-Exploring Parents' Experiences of Completing Targeted Congenital Cytomegalovirus Screening at the Time of Their Infants' Newborn Hearing Screening. J Clin Med 2024; 13:4367. [PMID: 39124634 PMCID: PMC11313214 DOI: 10.3390/jcm13154367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disabilities, with prompt detection (<21 days of life) required to enable accurate diagnosis and anti-viral treatment where clinically appropriate. International guidelines recommend cCMV screening for infants who do not pass their Universal Newborn Hearing Screening (UNHS). This study aimed to explore parental experiences of targeted cCMV screening through the UNHS in Victoria, Australia between 2019 and 2020 (HearS-cCMV study). Methods: A qualitative study comprising 18 semi-structured interviews with parents who took saliva swabs from their infants who did not pass their UNHS. A maximum variation sampling strategy was used with data analysed using thematic analysis. Results: Four themes described 18 parents' experiences of cCMV screening: (1) parents' lack of CMV awareness prior to cCMV screening; (2) overall positive experience; (3) varied understanding of CMV post screening; and (4) parents were glad to screen their infant for cCMV. Enablers of targeted cCMV screening included the swab being simple and non-invasive, being easier to complete in the hospital than at home, and the screening being well delivered by the staff. Barriers included a potential increase in anxiety, especially with false positives, and the timing of cCMV screening coinciding with their infant not passing UNHS being difficult for some parents. Conclusions: Parent experiences of targeted cCMV screening were positive. Increasing public knowledge of cCMV and training staff members to complete the CMV swab would reduce the risk of false positives and associated parental anxiety. This would facilitate successful routine targeted cCMV screening.
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Affiliation(s)
- Emma Webb
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Jan Hodgson
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Alanna N. Gillespie
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
| | - Cheryl A. Jones
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- Medicine and Health, The University of New South Wales, Sydney, NSW 2050, Australia
- Sydney Children’s Hospital Network (Westmead), Sydney, NSW 2145, Australia
| | - Zeffie Poulakis
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Janis Wong
- Faculty of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Valerie Sung
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (E.W.)
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia
- The Royal Children’s Hospital, Melbourne, VIC 3052, Australia
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Poletti de Chaurand V, Scandella G, Zicoia M, Arienti F, Fernicola F, Lanteri L, Guglielmi D, Carli A, Vasarri MV, Iozzi L, Cavallero A, Malandrin SMI, Locatelli A, Ventura ML, Sinelli M, Ornaghi S. Useful Clinical Criteria for Identifying Neonates with Congenital Cytomegalovirus Infection at Birth in the Context of an Expanded Targeted Screening Program. Viruses 2024; 16:1138. [PMID: 39066300 PMCID: PMC11281348 DOI: 10.3390/v16071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/07/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Cytomegalovirus (CMV) is the leading infectious cause of brain defects and neurological dysfunctions, including sensorineural hearing loss (SNHL). Targeted screening in neonates failing the hearing screen is currently recommended in Italy according to national guidelines. However, SNHL may not be present at birth; also, congenital CMV (cCMV) may manifest with subtle signs other than SNHL. Therefore, the inclusion of additional criteria for cCMV screening appears clinically valuable. Starting January 2021, we have implemented expanded targeted cCMV screening at our center, with testing in case of maternal CMV infection during pregnancy, inadequate antenatal care, maternal HIV infection or immunosuppression, birthweight and/or head circumference < 10th centile, failed hearing screen, and prematurity. During the first three years of use of this program (2021-2023), 940 (12.3%) of 7651 live-born infants were tested. The most common indication was birthweight < 10th centile (n = 633, 67.3%). Eleven neonates were diagnosed as congenitally infected, for a prevalence of 1.17% (95%CI 0.48-1.86) on tested neonates and of 0.14% (95%CI 0.06-0.23) on live-born infants. None of the cCMV-infected newborns had a failed hearing screen as a testing indication. Implementation of an expanded cCMV screening program appears feasible and of clinical value.
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Affiliation(s)
- Valeria Poletti de Chaurand
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Gaia Scandella
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Marianna Zicoia
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Francesca Arienti
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Federica Fernicola
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Laura Lanteri
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Diletta Guglielmi
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Anna Carli
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
| | - Maria Viola Vasarri
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Lucia Iozzi
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Annalisa Cavallero
- Microbiology Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (A.C.); (S.M.I.M.)
| | | | - Anna Locatelli
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Mariateresa Sinelli
- Neonatal Intensive Care Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (L.I.); (M.L.V.); (M.S.)
| | - Sara Ornaghi
- Obstetric Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, MB, Italy; (V.P.d.C.); (G.S.); (F.A.); (F.F.); (L.L.); (D.G.); (A.C.); (M.V.V.); (A.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy;
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Izquierdo G, Guerra C, Reyes R, Araya L, Sepulveda B, Cabrera C, Medina P, Mardones E, Villavicencio L, Montecinos L, Tarque F, Acevedo W, Barraza M, Farfán M, Mendez J, Torres JP. Universal and Expanded Screening Strategy for Congenital Cytomegalovirus Infection: Is Pool Testing by a Rapid Molecular Test in Saliva a New Choice in Developing Countries? Viruses 2024; 16:772. [PMID: 38793653 PMCID: PMC11125597 DOI: 10.3390/v16050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Several screening strategies for identifying congenital CMV (cCMV) have been proposed; however, the optimal solution has yet to be determined. We aimed to determine the prevalence of cCMV by universal screening with saliva pool testing and to identify the clinical variables associated with a higher risk of cCMV to optimize an expanded screening strategy. METHODS We carried out a prospective universal cCMV screening (September/2022 to August/2023) of 2186 newborns, analyzing saliva samples in pools of five (Alethia-LAMP-CMV®) and then performed confirmatory urine CMV RT-PCR. Infants with risk factors (small for gestational age, failed hearing screening, HIV-exposed, born to immunosuppressed mothers, or <1000 g birth weight) underwent expanded screening. Multivariate analyses were used to assess the association with maternal/neonatal variables. RESULTS We identified 10 infants with cCMV (prevalence: 0.46%, 95% CI 0.22-0.84), with significantly higher rates (2.1%, 95% CI 0.58-5.3) in the high-risk group (p = 0.04). False positives occurred in 0.09% of cases. No significant differences in maternal/neonatal characteristics were observed, except for a higher prevalence among infants born to non-Chilean mothers (p = 0.034), notably those born to Haitian mothers (1.5%, 95% CI 0.31-4.34), who had higher odds of cCMV (OR 6.82, 95% CI 1.23-37.9, p = 0.04). Incorporating maternal nationality improved predictive accuracy (AUC: 0.65 to 0.83). CONCLUSIONS For low-prevalence diseases such as cCMV, universal screening with pool testing in saliva represents an optimal and cost-effective approach to enhance diagnosis in asymptomatic patients. An expanded screening strategy considering maternal nationality could be beneficial in resource-limited settings.
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Affiliation(s)
- Giannina Izquierdo
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
- Centro de Investigación Clínica Avanzada (CICA), Hospital Exequiel González Cortés, Santiago, Chile
| | - Carolina Guerra
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Roberto Reyes
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Leslie Araya
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Belén Sepulveda
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Camila Cabrera
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Pamela Medina
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Eledier Mardones
- Neonatal Intensive Care Unit, Hospital Barros Luco Trudeau, Santiago, Chile
| | | | - Luisa Montecinos
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - Felipe Tarque
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - William Acevedo
- Molecular Biology Laboratory, Hospital Lucio Córdova, Santiago, Chile
| | - Marlon Barraza
- Pharmacy Unit Santiago, Hospital Luis Calvo Mackenna, Santiago, Chile;
| | - Mauricio Farfán
- Molecular Biology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Jocelyn Mendez
- Molecular Biology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - Juan Pablo Torres
- Department of Pediatrics, Faculty of Medicine, University of Chile, Santiago 8820808, Chile
- Division of Pediatric Infectious Diseases, Hospital Luis Calvo Mackenna, Santiago, Chile
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7
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Orb QT, Pesch M, Allen CM, Wilkes A, Ahmad I, Alfonso K, Antonio SM, Mithal LB, Brinkmeier JV, Carvalho D, Chan D, Cheng AG, Chi D, Cohen M, Discolo CM, Duran C, Germiller J, Gibson L, Grunstein E, Harrison G, Lee K, Hawley K, Kohlhoff S, Melvin A, MacArthur C, Nassar M, Neff L, Pecha P, Salvatore C, Schoem S, Virgin F, Saunders J, Schleiss M, Smith RJH, Sood S, Park AH. Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial. Otolaryngol Head Neck Surg 2024; 170:1430-1441. [PMID: 38415855 PMCID: PMC11060929 DOI: 10.1002/ohn.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing-targeted CMV testing (HT-cCMV) and delayed targeted dried blood spot (DBS) testing newborn screening programs, and to examine the characteristics of successful HT-cCMV testing programs. STUDY DESIGN Prospective survey of birth hospitals performing early CMV testing. SETTING Multiple institutions. METHODS Birth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT-cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT-cCMV screening and specific screening protocols. RESULTS Eighty-two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT-cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID-19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT-cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs. CONCLUSION Rates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT-cCMV testing.
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Affiliation(s)
- Quinn T Orb
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Pesch
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Chelsea M Allen
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ashlea Wilkes
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Iram Ahmad
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | | | | | | | - Dylan Chan
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Alan G Cheng
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - David Chi
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Carlos Duran
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | - Laura Gibson
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Kenneth Lee
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Karen Hawley
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | - Ann Melvin
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Laura Neff
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Scott Schoem
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Frank Virgin
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | | | - Sunil Sood
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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8
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Tan D, Fujiwara RJ, Lee KH. Current Issues With Pediatric Cochlear Implantation. J Audiol Otol 2024; 28:79-87. [PMID: 38695052 PMCID: PMC11065545 DOI: 10.7874/jao.2024.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Cochlear implants (CIs) have demonstrated a clear functional benefit in children with severe-to-profound sensorineural hearing loss (SNHL) and thus have gained wide acceptance for treating deafness in the pediatric population. When evaluating young children for cochlear implantation, there are unique considerations beyond the standard issues addressed during surgery in adults. Because of advances in genetic testing, imaging resolution, CI technology, post-implant rehabilitation, and other factors, issues related to CI surgery in children continue to evolve. Such factors have led to changes in candidacy guidelines, vaccine requirements, and lowering of age requirement for surgery. In addition, differences in the anatomy and physiology of infants require special attention to ensure safety when operating on young children. This review summarizes these issues and provides guidance for surgeons treating children with SNHL.
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Affiliation(s)
- Donald Tan
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rance J.T. Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kenneth H. Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Pediatric Otolaryngology, Children’s Health, Dallas, TX, USA
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9
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Merav L, Ofek Shlomai N, Oiknine-Djian E, Caplan O, Livneh A, Sido T, Peri A, Shtoyer A, Amir E, Ben Meir K, Daitch Y, Rivkin M, Kripper E, Fogel I, Horowitz H, Greenberger S, Cohen M, Geal-Dor M, Gordon O, Averbuch D, Ergaz-Shaltiel Z, Eventov Friedman S, Wolf DG, Yassour M. Implementation of pooled saliva tests for universal screening of cCMV infection. Nat Med 2024; 30:1111-1117. [PMID: 38459181 PMCID: PMC11031397 DOI: 10.1038/s41591-024-02873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.
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Affiliation(s)
- Lior Merav
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Livneh
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Sido
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Peri
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aviad Shtoyer
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eden Amir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Kerem Ben Meir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Yutti Daitch
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Kripper
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Fogel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Horowitz
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sraya Greenberger
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Miriam Geal-Dor
- Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
| | - Oren Gordon
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel.
| | - Moran Yassour
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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10
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Hernandez-Alvarado N, Bierle CJ, Schleiss MR. Droplet Digital PCR (ddPCR) Does Not Enhance the Sensitivity of Detection of Cytomegalovirus (CMV) DNA in Newborn Dried Blood Spots Evaluated in the Context of Newborn Congenital CMV (cCMV) Screening. Int J Neonatal Screen 2023; 10:1. [PMID: 38501568 PMCID: PMC10954086 DOI: 10.3390/ijns10010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 03/20/2024] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in children worldwide. Some regions in the United States and Canada have implemented universal newborn screening for cCMV, which requires molecular diagnostic technologies for identifying cCMV, such as PCR testing of newborn dried blood spots (DBS). This study aimed to evaluate the sensitivity of droplet digital PCR (ddPCR) compared to quantitative real-time PCR to detect CMV DNA in newborn DBS. The limit of detection of various ddPCR primer/probe combinations (singleplex UL55-HEX, singleplex UL83-FAM, and multiplex UL55-HEX/UL83-FAM) was evaluated using the National Institute of Standards and Technology's (NIST) CMV quantitative standard. Singleplex UL55-HEX ddPCR exhibited the lowest limit of detection among the primer/probe combinations tested for ddPCR. UL55 ddPCR was then compared to real-time PCR in 49 infants with confirmed cCMV identified through newborn screening for CMV in saliva swabs and confirmed by a urine test. The results showed that ddPCR was only positive for 59% (29 out of 49) of the cCMV infants, while real-time PCR was positive for 80% (39 out of 49). Due to its lower sensitivity and throughput, ddPCR may not be suitable for cCMV newborn screening.
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Affiliation(s)
| | | | - Mark R. Schleiss
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN 55455, USA; (N.H.-A.); (C.J.B.)
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11
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Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg 2023; 31:382-387. [PMID: 37820202 DOI: 10.1097/moo.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Congenital cytomegalovirus infection (cCMV) is a major cause of childhood hearing loss and neurodevelopmental delay. Early identification of cCMV allows for interventions that improve outcomes, particularly for cCMV-related hearing loss that develops in early childhood. Most cCMV is asymptomatic at birth and is rarely diagnosed without newborn screening. Therefore, various approaches to cCMV screening are increasingly being adopted. RECENT FINDINGS Both universal screening (testing all newborns) and targeted screening (testing triggered by failed hearing screening) for cCMV appear valuable, feasible and cost-effective, though universal screening is predicted to have greatest potential overall benefits. CMV PCR testing of newborn oral swabs is sensitive and practical and is therefore widely used in targeted screening programs. In contrast, PCR using dried-blood spots (DBS) is less sensitive but was adopted by current universal cCMV screening initiatives because DBS are already collected from all newborns in high-income countries, which circumvents large-scale oral swab collection. SUMMARY Targeted screening is widely recommended as standard of care, while universal screening is less common but is progressively considered as the optimal strategy for identification of children with cCMV. As with all screening programs, cCMV screening requires commitments to equitable and reliable testing, follow-up and services.
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Affiliation(s)
- Soren Gantt
- Sainte Justine University Hospital Research Centre and Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, Canada
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12
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Salomè S, Corrado FR, Mazzarelli LL, Maruotti GM, Capasso L, Blazquez-Gamero D, Raimondi F. Congenital cytomegalovirus infection: the state of the art and future perspectives. Front Pediatr 2023; 11:1276912. [PMID: 38034830 PMCID: PMC10687293 DOI: 10.3389/fped.2023.1276912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/18/2023] [Indexed: 12/02/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with an estimated incidence of approximately one in 200 infants in high-income settings. Approximately one in four children may experience life-long consequences, including sensorineural hearing loss and neurodisability. Knowledge regarding prevention, diagnosis, and treatment increased in the recent years, but some challenges remain. In this review, we tried to summarize the current knowledge on both the obstetrical and pediatric areas, while also highlighting controversial aspects and future perspectives. There is a need to enhance awareness among the general population and pregnant women through specific information programs. Further research is needed to better define the classification of individuals at birth and to have a deeper understanding of the long-term outcomes for so defined children. Finally, the availability of valaciclovir medication throughout pregnancy, where appropriate, has prompted the assessment of a universal serological antenatal screening. It is recommended to establish a dedicated unit for better evaluation and management of both mothers and children.
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Affiliation(s)
- S. Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - F. R. Corrado
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - L. L. Mazzarelli
- Division of Obstetrician and Gynecologist, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - G. M. Maruotti
- Division of Obstetrician and Gynecologist, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - L. Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - D. Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (Imas12), Translational Research Network in Pediatric Infectious Diseases (RITIP), Universidad Complutense, Madrid, Spain
| | - F. Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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13
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Singh S, Maheshwari A, Boppana S. CMV-induced Hearing Loss. NEWBORN (CLARKSVILLE, MD.) 2023; 2:249-262. [PMID: 38348106 PMCID: PMC10860330 DOI: 10.5005/jp-journals-11002-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Congenital cytomegalovirus (cCMV) infection is the most common fetal viral infection and contributes to about 25% of childhood hearing loss by the age of 4 years. It is the leading nongenetic cause of sensorineural hearing loss (SNHL). Infants born to seroimmune mothers are not completely protected from SNHL, although the severity of their hearing loss may be milder than that seen in those whose mothers had a primary infection. Both direct cytopathic effects and localized inflammatory responses contribute to the pathogenesis of cytomegalovirus (CMV)-induced hearing loss. Hearing loss may be delayed onset, progressive or fluctuating in nature, and therefore, a significant proportion will be missed by universal newborn hearing screening (NHS) and warrants close monitoring of hearing function at least until 5-6 years of age. A multidisciplinary approach is required for the management of hearing loss. These children may need assistive hearing devices or cochlear implantation depending on the severity of their hearing loss. In addition, early intervention services such as speech or occupational therapy could help better communication, language, and social skill outcomes. Preventive measures to decrease intrauterine CMV transmission that have been evaluated include personal protective measures, passive immunoprophylaxis and valacyclovir treatment during pregnancy in mothers with primary CMV infection. Several vaccine candidates are currently in testing and one candidate vaccine in phase 3 trials. Until a CMV vaccine becomes available, behavioral and educational interventions may be the most effective strategy to prevent maternal CMV infection.
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Affiliation(s)
- Srijan Singh
- Department of Neonatology, Kailash Hospital, Noida, Uttar Pradesh, India
- Global Newborn Society (https://www.globalnewbornsociety.org/), Clarksville, Maryland, United States of America
| | - Akhil Maheshwari
- Global Newborn Society (https://www.globalnewbornsociety.org/), Clarksville, Maryland, United States of America
- Department of Pediatrics, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Suresh Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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14
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Suarez D, Nielson C, McVicar SB, Sidesinger M, Ostrander B, O'Brien E, Ampofo K, Ling CY, Miner LJ, Park AH. Analysis of an Expanded Targeted Early Cytomegalovirus Testing Program. Otolaryngol Head Neck Surg 2023; 169:679-686. [PMID: 36884018 DOI: 10.1002/ohn.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Determine the detection rate from an expanded targeted early cytomegalovirus (CMV) testing program implemented from a large healthcare system (Intermountain Healthcare, IHC). STUDY DESIGN Retrospective review. SETTING Tertiary medical center. METHODS An electronic system was modified to include indications for testing whenever a provider placed an order for CMV testing. A retrospective analysis of this database was performed. RESULTS From March 1, 2021 to August 31, 2022, there were 3450 (8.8%) patients who underwent CMV testing out of 39,245 total live births within the IHC system. Since the formal implementation of this program in 2019, annual CMV testing has increased almost 10-fold: 2668 CMV tests were performed in 2021 compared to 289 CMV tests in 2015. The most frequent indication for congenital CMV (cCMV) testing was small for gestational age (SGA) (68.2%), followed by macrocephaly (13.5%), an abnormal hearing test (5.0%), and microcephaly (4.4%). Fourteen cCMV-infected infants were diagnosed all of them meeting the criteria for symptomatic cCMV. The most common indication resulting in a positive diagnosis was those who presented with SGA (n = 10 patients). The positivity rate would result in a prevalence of 35.7 symptomatic cCMV cases diagnosed per 100,000 live births, numbers comparable to those expected for universal cCMV screening. CONCLUSION An expanded targeted early cCMV testing program may improve detection rates of symptomatic cCMV cases and should be considered as a feasible alternative approach to universal or hearing-targeted early CMV testing.
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Affiliation(s)
- Daniel Suarez
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher Nielson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Max Sidesinger
- Utah Department of Health and Human Services, Salt Lake City, Utah, USA
| | - Betsy Ostrander
- Department of Pediatrics, Division of Pediatric Neurology and Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elizabeth O'Brien
- Department of Pediatrics, Division of Neonatology and Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Krow Ampofo
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Con Y Ling
- Department of Pediatrics, Division of Neonatology and Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lonnie J Miner
- Department of Pediatrics, Division of Neonatology and Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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15
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Kettler M, Shoup A, Moats S, Steuerwald W, Jones S, Stiell SC, Chappetto J. American Academy of Audiology Position Statement on Early Identification of Cytomegalovirus in Newborns. J Am Acad Audiol 2023. [PMID: 36972678 DOI: 10.1055/s-0043-1768036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The American Academy of Audiology recommends early identification of congenital cytomegalovirus (cCMV) through screening to allow for appropriate early diagnosis, intervention, and monitoring for congenital, progressive, and delayed-onset hearing loss in infants with cCMV.Early identification of cCMV is a valuable component in the diagnostic evaluation of infants with sensorineural hearing loss. The Academy recognizes the important role audiologists serve as clinical care providers and educators and advocates for early identification and audiological management of infants with cCMV.
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Affiliation(s)
- Maggie Kettler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Shoup
- Callier Center for Communication Disorders, The University of Texas at Dallas, Dallas, Texas
| | - Shelley Moats
- Norton Children's Medical Group, Louisville, Kentucky
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Hoki C, White M, Pesch MH, Melvin AJ, Park AH. A Cross-Sectional Survey of Pediatric Infectious Disease Physicians' Approach to Congenital Cytomegalovirus Infection. Int J Neonatal Screen 2023; 9:ijns9020017. [PMID: 37092511 PMCID: PMC10123618 DOI: 10.3390/ijns9020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) continues to be a major public health care issue due to its high prevalence throughout the world. However, there is a paucity of studies evaluating how providers manage this infection. This study surveyed North American Pediatric Infectious Disease (PID) physicians to elicit their approach towards the evaluation and treatment of this condition. Thirty-two PID physicians responded to this survey. Institutional testing and screening for cCMV were infrequently reported. The respondents in general agreed upon most laboratory and diagnostic testing except for neuroimaging. For those tests, there was a disparity in indications for head ultrasound versus brain MRI imaging. Most (68.8%) agreed with the clinical practice of starting valganciclovir in an infant less than 1 month of age with one sign or symptom of disease, and 62.5% would do so for an infant with isolated sensorineural hearing loss. However, only 28.1% would treat cCMV-infected infants older than 1 month of age. In conclusion, few healthcare institutions represented by PID physicians in this cohort had a cCMV screening or testing initiative, yet most respondents would test at a much higher level based on their clinical practice. While there is general consensus in evaluation and treatment of these children, there are disparities in practices regarding neuroimaging and indications for antiviral treatment with respect to age and severity of disease. There is a great need for an evidence based policy statement to standardize cCMV workup and treatment.
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Affiliation(s)
- Chieko Hoki
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Michelle White
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Megan H Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ann J Melvin
- Pediatric Infectious Disease, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - Albert H Park
- Department of Otolaryngology- Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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17
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Improved Dried Blood Spot PCR Assay for Universal Congenital Cytomegalovirus Screening in Newborns. Microbiol Spectr 2023:e0404122. [PMID: 36939327 PMCID: PMC10100720 DOI: 10.1128/spectrum.04041-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Congenital cytomegalovirus (cCMV) is the most common perinatal infection, the leading cause of nongenetic sensorineural hearing loss, and one of the leading causes of neurodevelopmental impairment in the developed world. Early identification via newborn screening (NBS) would benefit the many undiagnosed infants who are either asymptomatic or mildly to moderately symptomatic, of whom 20% develop sequelae. The sensitivity of a recently developed PCR-based method to detect CMV in dried blood spots (DBS) is less than 80% and requires significantly more specimen than any other NBS test. We sought to improve the analytical sensitivity of the screening method by using droplet digital PCR and direct PCR and decreasing the amount of specimen utilized. The methods were tested with CMV-spiked filters, DBS from CMV-spiked cord blood, and DBS from neonates with cCMV. The results showed that the analytical sensitivity of all modified methods was equivalent to that of the reference method, with consistent CMV detection at high viral loads and inconsistent detection at low viral loads. IMPORTANCE Implementation of screening for cCMV in public health programs is hindered by feasibility challenges, including limited specimen availability and an insufficiently sensitive DBS-based screening assay. We report on efforts to improve the currently available DBS-based molecular assay to increase its feasibility of implementation in newborn screening programs. Although the analytical sensitivity of the modified methods was similar at the lower IU, equivalent CMV detection was achieved using one punch instead of the required three punches for the reference method. This reduction in sample size has the potential to substantially improve feasibility of NBS for cCMV. A population-based study is needed to further evaluate the clinical sensitivity of the improved assay.
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18
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Phillips VL, Xu J, Park A, Gantt S, Dedhia K. The cost-effectiveness of targeted screening for congenital cytomegalovirus in newborns compared to clinical diagnosis in the US. Int J Pediatr Otorhinolaryngol 2023; 166:111450. [PMID: 36773448 DOI: 10.1016/j.ijporl.2023.111450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) is the leading environmental cause of hearing loss (HL) among children, affecting four in one thousand newborns. cCMV testing in the US is currently based on clinical diagnosis which does not consistently identify cCMV cases and precludes early intervention to prevent and reduce the severity of HL. We estimated the cost-effectiveness of targeted newborn screening and cCMV testing among newborns compared to clinical diagnosis. METHODS We use a decision-analytic model to estimate the costs of preventing HL progression, of additional cases of severe HL, of identifying a case of HL one year earlier, and of identifying an additional case of cCMV, through targeted screening and cCMV testing for infants failing two newborn hearing screens with follow-up to age five. We also estimate the costs of nationwide implementation of a newborn screening and testing program. Model pathways were based on best practices for screening, testing, and treatment. Probabilities were drawn from the published literature; costs were estimated based on Medicare reimbursement rates. Probabilistic and scenario analyses were conducted to determine the robustness of results. RESULTS Targeted testing and cCMV screening, compared to standard of care, cost an additional $2.96 (±2.26) per infant screened and identified 0.00038 (±0.00022) cases of HL, 3.8 in 10000 children, at a cost of $8197 (±4217) per case of HL identified. Implementing targeted screening for all children in the US was estimated to cost $193,229. CONCLUSIONS Although cases numbers are small, our model shows that targeted newborn screening and cCMV testing reduced cases of HL progression. Adoption of newborn targeted screening as standard of care should be considered given it may prevent disability at very low cost.
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Affiliation(s)
- Victoria L Phillips
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Albert Park
- University of Utah, Department of Pediatric Otolaryngology, Salt Lake City, UT, USA
| | - Soren Gantt
- Departments of Microbiology, Infectiology & Immunology and Pediatrics, University of Montreal, Research Centre of the Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, USA
| | - Kavita Dedhia
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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19
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Chung PK, Schornagel F, Oudesluys-Murphy AM, de Vries LS, Soede W, van Zwet E, Vossen A. Targeted screening for congenital cytomegalovirus infection: clinical, audiological and neuroimaging findings. Arch Dis Child Fetal Neonatal Ed 2022; 108:302-308. [PMID: 36549893 PMCID: PMC10176415 DOI: 10.1136/archdischild-2022-324699] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate clinical, audiological and neuroimaging findings in a cohort of infants diagnosed with congenital cytomegalovirus (cCMV) infection after failure at newborn hearing screening. METHODS A prospective observational study in the Netherlands, using the existing newborn hearing screening infrastructure for well babies. Between July 2012 and November 2016, cytomegalovirus (CMV) PCR testing of neonatally obtained dried blood spots (DBS) was offered to all infants who failed newborn hearing screening. Clinical, neuroimaging and audiological data were collected. RESULTS DBS of 1374 infants were successfully tested and 59 were positive for CMV (4.3%). Data of 54 infants were retrieved. Three were small for gestational age and six had microcephaly. Forty-eight (89%) had sensorineural hearing loss (SNHL), of whom half had unilateral SNHL. In both unilaterally and bilaterally affected children, the majority of the impaired ears had severe or profound hearing loss. Neuroimaging abnormalities were found in 40 of 48 (83%) children who had evaluable cranial ultrasound and/or cerebral MRI. The abnormalities were mild in 34, moderate in 3 and severe in 3 infants. The degree of SNHL and the severity of neuroimaging abnormalities were found to be correlated (p=0.002). CONCLUSIONS The yield of targeted cCMV screening following newborn hearing screening failure was eight times higher than the estimated national birth prevalence of cCMV. The majority of this cohort of infants with clinically unsuspected cCMV disease had confirmed SNHL, neuroimaging abnormalities and lower than average birth weights and head circumferences. Newborns who fail newborn hearing screening should be tested for CMV to ensure appropriate clinical, neurodevelopmental and audiological follow-up.
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Affiliation(s)
- Pui Khi Chung
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fleurtje Schornagel
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linda S de Vries
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim Soede
- Center for Audiology at the Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ann Vossen
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Glovsky CK, Carroll K, Clark N, Colleran P, Colleran V, Gaffney S, Kenna M, Kuhns-Rankin E, Luiselli TE, Mango T, Morris B, Mullen C, Stenerson M, Gibson L, Cohen MS. Congenital Cytomegalovirus Screening in Massachusetts Birth Hospitals: A Statewide Survey. Int J Neonatal Screen 2022; 8:ijns8040065. [PMID: 36547382 PMCID: PMC9780908 DOI: 10.3390/ijns8040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
This study sought to assess the current state of screening for congenital cytomegalovirus infection in newborns among birth hospitals and newborn nurseries in the state of Massachusetts. A survey assessing hospital protocols for cytomegalovirus testing in newborns was distributed to all birth hospitals and newborn nurseries in Massachusetts from November 2020 to February 2021. 73.3% of hospitals responded to at least one survey question. Of these, fewer than half (48.5%) had any established approach for neonatal cytomegalovirus screening. Salivary polymerase chain reaction was the most common testing modality. Most hospitals did not perform confirmatory testing for positive test results. Most respondents (87.9%) did not know or did not answer how results of cCMV screening were reported to families and who was responsible for coordinating care for cCMV-infected infants. We conclude that congenital cytomegalovirus screening protocols are absent or incomplete in most Massachusetts birth hospitals and newborn nurseries. A cohesive strategy involving standardized education and screening guidelines is needed to reduce the incidence and burden of congenital cytomegalovirus disease on children and their families.
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Affiliation(s)
- Cheryl K. Glovsky
- Department of Audiology, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Massachusetts CMV Coalition, Boston, MA 02115, USA
| | - Kendall Carroll
- Department of Audiology, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Naomi Clark
- Massachusetts CMV Coalition, Boston, MA 02115, USA
| | | | | | | | - Margaret Kenna
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, MA 02115, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA 02115, USA
| | | | - Tracy Evans Luiselli
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- New England Consortium on Deafblindness, Watertown, MA 02472, USA
| | - Talia Mango
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- New England Consortium on Deafblindness, Watertown, MA 02472, USA
| | | | - Charlotte Mullen
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, MA 02115, USA
| | - Matthew Stenerson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Laura Gibson
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- Infectious Diseases and Immunology, Department of Medicine and Pediatrics, UMass Memorial Medical Center, Worcester, MA 01605, USA
| | - Michael S. Cohen
- Massachusetts CMV Coalition, Boston, MA 02115, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA 02115, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Correspondence:
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21
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Inconsistent Provider Testing Practices for Congenital Cytomegalovirus: Missed Diagnoses and Missed Opportunities. Int J Neonatal Screen 2022; 8:ijns8040060. [PMID: 36412586 PMCID: PMC9680485 DOI: 10.3390/ijns8040060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Newborn congenital cytomegalovirus (cCMV) screening programs have been found to increase the rates of early diagnosis and treatment. In North America, newborn cCMV screening programs have not been widely implemented, leaving healthcare providers to rely on clinical suspicion alone to prompt testing. This study sought to examine healthcare providers' cCMV testing practices at a quaternary children's hospital. A retrospective review of the electronic health record was completed for eligible infants over a six-year period. Bivariate calculations and analyses were performed. Between 2014 and 2019, a total of 40,091 infants were cared for at the study institution, of which 178 were tested for cCMV and 10 infants were diagnosed with cCMV. Isolated small-for-gestational age was the most common indication (53/178) to prompt testing. Overall, the cCMV testing rate was 4.5 tests per 1000 infants, with a resulting diagnostic prevalence of 0.2 cases per 1000 infants, which is 15-fold lower than the expected prevalence. Providers relying on clinical suspicion alone are infrequently testing infants for cCMV, resulting in missed diagnoses and missed opportunities for treatment. Systematic cCMV screening practices may improve diagnosis, treatment, and childhood outcomes.
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22
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Raynor EM, Martin HL, Poehlein E, Lee H, Lantos P. Impact of maternal cytomegalovirus seroconversion on newborn and childhood hearing loss triological thesis 2022–2023. Laryngoscope Investig Otolaryngol 2022; 7:1626-1633. [PMID: 36258861 PMCID: PMC9575047 DOI: 10.1002/lio2.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives/hypothesis The objective of this study is to describe long‐term hearing outcomes in infants born to mothers with a known cytomegalovirus (CMV) positivity who were not tested for congenital CMV. Study type Clinical research study. Design Retrospective cohort study. Methods Retrospective chart review was performed for mothers seropositive to CMV. Mother–infant dyads (130) were identified between January 1, 2013 and January 1, 2017. Outcomes data was collected through June 1, 2020. Demographics, risk factors for hearing loss, evidence of CMV infection, other causes of hearing loss, need for speech therapy services, and results of all hearing tests were collected. Results All 130 infants were asymptomatic and 5 were tested for congenital CMV. Five were negative for CMV and excluded from analyses. Of the remaining 125, only 1 had low‐viral avidity IgG antibodies. None had IgM antibodies. Four children (3.2%) had hearing loss at last audiogram and one child had delayed onset SNHL due to an enlarged vestibular aqueduct. Speech therapy for communication was required for 33 children (26.4%). Conclusions Knowledge of maternal perinatal CMV status can allow for education about possible sequelae of cCMV, as well as trigger an alert for testing babies born to mothers with low‐viral avidity IgG during the first trimester, when the risk of vertical transmission is highest. Also, babies born to CMV positive mothers may be more at risk for communication delays necessitating intervention. Studies focusing on the impact of maternal CMV related to childhood communication deficits could elucidate any direct relationships.
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Affiliation(s)
- Eileen M. Raynor
- Department of Head and Neck Surgery and Communication Sciences Duke University Durham North Carolina USA
| | - Hannah L. Martin
- Department of Head and Neck Surgery and Communication Sciences Duke University Durham North Carolina USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Hui‐Jie Lee
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Paul Lantos
- Department of Pediatric Infectious Disease Duke University Durham North Carolina USA
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23
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Childhood Hearing Health and Early Language Exposure: A Culturally Sensitive Approach. Adv Pediatr 2022; 69:23-39. [PMID: 35985712 DOI: 10.1016/j.yapd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Implementation of the universal newborn hearing screening has changed the landscape for children born deaf or hard of hearing, and with this, pediatricians must be knowledgeable about the screening and referral process, state protocols, and how to support patients and their families in their unique journeys. Early access to language-spoken, signed, both-forms the foundation for successful outcomes for the development of fluent language. For children using spoken language, early access to sound is critical and can often be achieved with the assistance of hearing devices, even in the newborn period. For all language modalities, state-funded Deaf mentor programs allow families to have meaningful exposure to the Deaf community. The authors come from different professions in the health care and education fields, including General Pediatrics, Otolaryngology Head and Neck Surgery, and the state Department of Education, and use different languages, including spoken and American Sign Language.
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24
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Pesch MH, Danziger P, Ross LF, Antommaria AHM. An Ethical Analysis of Newborn Congenital Cytomegalovirus Screening. Pediatrics 2022; 149:188128. [PMID: 35641472 DOI: 10.1542/peds.2021-055368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) affects approximately 1 in every 200 US infants and can be associated with long-term neurodevelopmental sequelae, including sensorineural hearing loss, cerebral palsy, and intellectual disability. As cCMV is infrequently diagnosed based on clinical suspicion alone, newborn cCMV screening programs have been gaining traction, especially hearing-targeted programs which only test infants who fail their newborn hearing screen. cCMV screening programs raise unique ethical dilemmas of both under- and over-diagnosis of cCMV. In this Ethics Rounds, we present a case in which the parents of a child with symptomatic cCMV that was not recognized until 4 years of age urge the birth hospital to implement a cCMV screening program. We then ask a parent-clinician, a medical ethicist and pediatrician, and a primary care pediatrician to comment on how they would advise the hospital administration and consider the ethical and clinical implications of a cCMV screening program. The commentaries herein arrive at differing conclusions about cCMV screening. The first highlights the developmental advantages of early cCMV detection, supporting a broad approach to treatment beyond antiviral medication alone. The second explores cCMV screening from the perspective of newborn screening as a public health program, noting shortcomings in available testing platforms, and raising concerns about overdiagnosis and overtreatment. The final commentary challenges the risks of undue parental anxiety and vulnerable child syndrome as a barrier to screening, instead considering cCMV screening as a controlled opportunity to understand and support the experiences of affected children and their families.
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Affiliation(s)
- Megan H Pesch
- University of Michigan and CS Mott Children's Hospital, Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Ann Arbor, Michigan
| | - Phoebe Danziger
- Munson Healthcare Otsego Memorial Hospital, Gaylord, Michigan
| | - Lainie Friedman Ross
- Department of Pediatrics.,MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois
| | - Armand H Matheny Antommaria
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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25
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Fourgeaud J, Boithias C, Walter-Nicolet E, Kermorvant E, Couderc S, Parat S, Pol C, Mousset C, Bussières L, Guilleminot T, Ville Y, Nkam L, Grimaldi L, Parodi M, Leruez-Ville M. Performance of Targeted Congenital Cytomegalovirus Screening in Newborns Failing Universal Hearing Screening: A Multicenter Study. Pediatr Infect Dis J 2022; 41:478-481. [PMID: 35093998 DOI: 10.1097/inf.0000000000003474] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most frequent cause of congenital infection and ≈20% of all infected neonates present or will develop sensorineural hearing loss. Targeted congenital CMV (cCMV) screening in newborns who failed universal newborn hearing screening has been proposed as a strategy to identify neonates with both hearing loss and cCMV infection who could benefit from antiviral treatment implemented within the first month of life. OBJECTIVES To evaluate the feasibility and performance of cCMV targeted screening in a French setting. METHODS Neonates were recruited in 5 maternity centers in greater Paris. A saliva sample for CMV polymerase chain reaction (PCR) testing was collected in neonates who failed newborn hearing screening. Outcomes including CMV PCR result and confirmation of hearing loss by an otorhinolaryngologist specialist were documented. RESULTS Two-hundred thirty-six newborns were included and a saliva sample was collected in 98% (231/236) of them. The result of CMV PCR was available at a median of 9 days (7-10 days) of life and in 96% of cases within the first month of life. Two neonates were infected with CMV. The result of the otorhinolaryngologist assessment was available in 75% (178/236) of cases at a median of 16 days (9-26 days). Hearing loss was confirmed in 2.8% (5/178). The 2 infected neonates had hearing loss confirmed at 5 and 8 days of life and were treated with valganciclovir at days 9 and 16, respectively. CONCLUSIONS The result of this study confirms that targeted cCMV screening is feasible in these French settings.
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Affiliation(s)
- Jacques Fourgeaud
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Claire Boithias
- AP-HP, Hospital Bicêtre, Neonatal Intensive Care Unit, Le Kremlin-Bicêtre, France
| | - Elisabeth Walter-Nicolet
- INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center; and Medicine and Neonatal Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elsa Kermorvant
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Université de Paris, Paris, France
| | - Sophie Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - Sophie Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - Christine Pol
- AP-HP, Hospital Bicêtre, Otology Department, Le Kremlin-Bicêtre, France
| | - Carole Mousset
- Hospital Saint Joseph, Otology Department, Paris, France
| | - Laurence Bussières
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Clinical Research Unit
| | - Tiffany Guilleminot
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - Yves Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Maternity
| | - Lionelle Nkam
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Lamiae Grimaldi
- AP-HP, Hôpital Ambroise Paré, Unité de Recherche Clinique, Paris Saclay Ouest, Boulogne, France
| | - Marine Parodi
- AP-HP, Hospital Necker-E.M, Otology Department, Paris, France
| | - Marianne Leruez-Ville
- From the EA 73-28, Université de Paris
- AP-HP, Hospital Necker-E.M., Virology Department, Reference Laboratory for Cytomegalovirus Infections, Paris, France
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26
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Faramarzi M, Babakhani Fard S, Bayati M, Jafarlou F, Parhizgar M, Rezaee M, Keshavarz K. Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz. BMC Pediatr 2022; 22:318. [PMID: 35637460 PMCID: PMC9150379 DOI: 10.1186/s12887-022-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz. METHODS This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data. RESULTS The hearing screening data obtained during 6 years (2015-2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results. CONCLUSIONS According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Babakhani Fard
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafarlou
- Department of Audiology, School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Parhizgar
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. .,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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27
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Reid A, Bowen AC, Brennan‐Jones CG, Kuthubutheen JB. Congenital cytomegalovirus: the case for targeted infant screening in Australia. Med J Aust 2022; 216:167-171. [DOI: 10.5694/mja2.51406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Allison Reid
- Perth Children's Hospital Perth WA
- University of Western Australia Perth
| | - Asha C Bowen
- Perth Children's Hospital Perth WA
- University of Western Australia Perth
- Wesfarmers Centre for Vaccines and Infectious Diseases Telethon Kids Institute Perth WA
| | - Christopher G Brennan‐Jones
- Perth Children's Hospital Perth WA
- University of Western Australia Perth
- Wesfarmers Centre for Vaccines and Infectious Diseases Telethon Kids Institute Perth WA
- Curtin University Perth WA
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28
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Yassine BB, Hulkower R, Dollard S, Cahill E, Lanzieri T. A Legal Mapping Assessment of Cytomegalovirus-Related Laws in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E624-E629. [PMID: 34225306 DOI: 10.1097/phh.0000000000001401] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Congenital cytomegalovirus (CMV) infection is the leading infectious cause of birth defects in the United States, affecting approximately 1 out of 200 newborns. Increasing awareness of congenital CMV infection among policy makers and the public is critical for advancing the evidence base for prevention and intervention strategies, including behavioral interventions for pregnant women, newborn screening to enable timely interventions, and garnering support for vaccine development. OBJECTIVE To understand the current landscape of CMV-related statutes and regulations, we conducted a 50-state legal epidemiology study of laws expressly referencing "cytomegalovirus." EVIDENCE REVIEW Our search yielded 101 statutes and regulations from 35 jurisdictions (34 states and District of Columbia). We systematically reviewed and coded the texts for themes. FINDINGS Laws addressed 3 main themes: (1) CMV awareness and education; (2) testing and reporting; and (3) the provision of services. CONCLUSIONS AND RELEVANCE State-level CMV laws have been enacted to increase CMV awareness and to implement CMV testing for infants at a higher risk for infection, such as those who do not pass newborn hearing screening. This study provides a complete legal assessment of existing ways law is used to address CMV infection in the United States.
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Affiliation(s)
- Brianne B Yassine
- Center for State, Tribal, Local, and Territorial Support (Drs Yassine and Hulkower), Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (Drs Dollard and Lanzieri), and Division of Human Development and Disability, National Center for Birth Defects and Developmental Disabilities (Mr Cahill), Centers for Disease Control and Prevention, Atlanta, Georgia
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29
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Webb E, Gillespie AN, Poulakis Z, Gartland T, Buttery J, Casalaz D, Daley AJ, Donath S, Gwee A, Jacobs SE, Phuong LK, Pszczola R, Purcell R, Saunders K, Kadambari S, Jones CA, Sung V. Feasibility and acceptability of targeted salivary cytomegalovirus screening through universal newborn hearing screening. J Paediatr Child Health 2022; 58:288-294. [PMID: 34520069 DOI: 10.1111/jpc.15705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to determine the feasibility and parental acceptability of screening for congenital cytomegalovirus (cCMV) through saliva polymerase chain reaction in infants who did not pass their newborn hearing screening. Additionally, the utility (i.e. time to diagnosis and treatment) of this enhanced clinical pathway was evaluated. METHODS The study was conducted through the Victorian Infant Hearing Screening Programme (VIHSP) across four maternity hospitals in Melbourne, Australia, during June 2019-March 2020. Parents were approached by VIHSP staff about obtaining a test for cytomegalovirus (CMV) at the time of their baby's second positive ('refer') result on the VIHSP screen. Participating parents collected a saliva swab for CMV polymerase chain reaction from their infants. Feasibility was determined by the proportion of 'referred' infants whose parents completed the salivary CMV screening test ≤21 days of life. Acceptability was measured through parent survey. RESULTS Of 126 eligible families, 96 (76.0%) had salivary screening swabs taken ≤21 days of life. Most families (>92.0%) indicated that screening was acceptable, straightforward and thought testing their baby for cCMV was a good idea. One infant screened positive on day 30, was diagnosed with cCMV via confirmatory testing by day 31 and commenced valganciclovir on day 32. CONCLUSIONS Obtaining a saliva sample to screen for cCMV in infants who do not pass their newborn hearing screen is feasible and appears acceptable to parents. This targeted cCMV screening method could be an option where mothers are rapidly discharged from hospital, especially in the context of the COVID-19 pandemic.
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Affiliation(s)
- Emma Webb
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Prevention Innovation, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alanna N Gillespie
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Prevention Innovation, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Zeffie Poulakis
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Prevention Innovation, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Tim Gartland
- Prevention Innovation, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Dermatology Department, Western Health, Sunshine, Victoria, Australia.,Dermatology Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jim Buttery
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.,Health Informatics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Dan Casalaz
- Neonatal Paediatrics Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Gwee
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infection and Immunity, Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan E Jacobs
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Linny K Phuong
- Infection and Immunity, Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Rosalynn Pszczola
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neonatology, Western Health, Sunshine, Victoria, Australia
| | - Rachael Purcell
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kerryn Saunders
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Paediatric Hearing Services, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.,Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cheryl A Jones
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Infection and Immunity, Infectious Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Perinatal Infection Research, Sydney Children's Hospital Network (Westmead), Sydney, New South Wales, Australia
| | - Valerie Sung
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Prevention Innovation, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Parkville, Victoria, Australia
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Pesch MH, Muldoon KM. Congenital Cytomegalovirus Knowledge, Practices, and Beliefs Among Primary Care Physicians and Newborn Hospitalists. J Prim Care Community Health 2022; 13:21501319221106880. [PMID: 35758615 PMCID: PMC9244937 DOI: 10.1177/21501319221106880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) affects 1 in every 200 United States infants, at present there are 9 states which mandate newborn cCMV screening. With more infants being diagnosed, more children will need continuing care from providers who are knowledgeable about cCMV. OBJECTIVES To examine pediatric provider knowledge, practices, and beliefs around cCMV. METHODS Primary care and newborn hospitalist pediatricians (N = 103) from Michigan, who "regularly care for infants" were invited to participate in a survey about their cCMV-related knowledge, clinical practices, and beliefs. RESULTS Respondents had low knowledge of typical cCMV presentation and sequelae, with mixed knowledge of screening and testing standards. Most (68%) reported rarely/never screening for cCMV, though 71% strongly agreed/agreed that primary care providers should test for cCMV. Most (90%) strongly agreed/agreed that infants who fail/refer on their newborn hearing screen should be tested for cCMV, yet 81% expressed not being comfortable diagnosing and managing cCMV. Most (72%) felt that cCMV was not sufficiently covered in their medical training; almost all respondents endorsed interest in learning more. CONCLUSIONS Primary care and newborn hospitalists in this study expressed mixed knowledge about, infrequent practice of and low comfort with screening and caring for children with cCMV. This may present a prime opportunity for education and clinician support by professional organizations.
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Affiliation(s)
- Megan H Pesch
- University of Michigan and CS Mott Children's Hospital, Ann Arbor, MI, USA
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Ronner EA, Glovsky CK, Herrmann BS, Woythaler MA, Pasternack MS, Cohen MS. Congenital Cytomegalovirus Targeted Screening Implementation and Outcomes: A Retrospective Chart Review. Otolaryngol Head Neck Surg 2021; 167:178-182. [PMID: 34520270 DOI: 10.1177/01945998211044125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effectiveness and outcomes of a targeted cytomegalovirus (CMV) testing protocol. STUDY DESIGN Retrospective chart review. SETTING Tertiary care institution. METHODS Targeted screening for CMV in children who did not pass the newborn hearing screening (NHS) was introduced in July 2015 for the level 2 and 3 nurseries at our hospital. In January 2016, this policy was extended to include all nurseries. Retrospective chart review was performed for all newborns who did not pass their NHS between 2013 and 2020. CMV testing rates and related outcomes were compared before and after rollout. RESULTS A total of 891 charts were reviewed for infants who did not pass their NHS: 530 (60%) had CMV testing, of which 8 (1.5%) tested positive. Three cases were detected prior to and 5 occurred after initiation of targeted screening. Six CMV+ infants demonstrated hearing loss on confirmatory auditory brainstem response, all of whom began treatment with oral valganciclovir. Hearing remained stable in 3 patients, progressed in 2, and improved in 1. The rate of CMV testing in children who did not pass their NHS increased from 14% to 88% after full implementation of targeted screening (P < .001). The average age at initial infectious disease consultation was significantly younger for infants born after targeted screening (P < .001). CONCLUSION Targeted screening is a feasible and effective method to identify CMV+ infants early in life. Implementation of a targeted screening program for CMV in children who do not pass the NHS resulted in significantly higher rates of CMV testing and earlier referral to infectious disease.
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Affiliation(s)
- Evette A Ronner
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Cheryl K Glovsky
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara S Herrmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Woythaler
- Division of Neonatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark S Pasternack
- Division of Pediatric Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA
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Liu PH, Hao JD, Li WY, Tian J, Zhao J, Zeng YM, Dong GQ. Congenital cytomegalovirus infection and the risk of hearing loss in childhood: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2021; 100:e27057. [PMID: 34516495 PMCID: PMC8428733 DOI: 10.1097/md.0000000000027057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection is the most common cause of childhood hearing loss (HL), although the strength of this association remains limited and inconclusive. Thus, the purpose of this study was to summarize evidence regarding the strength of the relationship between cCMV and childhood HL and to determine whether this relationship differs according to patient characteristics. METHODS The PubMed, EmBase, and Cochrane Library databases were searched for studies evaluating the relationship between cCMV and HL from inception to September 2019. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to calculate the investigated outcomes in a random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. RESULTS A total of 15 studies involving 235,026 children met the inclusion criteria and were included in the final analysis. The summary results indicated that cCMV infection was associated with an increased risk of HL (odds ratio [OR]: 8.45; 95% confidence interval [CI]: 3.95-18.10; P < .001), irrespective of whether studies reported sensorineural HL (OR: 5.42; 95% CI: 1.98-14.88; P = .001), or did not evaluate HL types among their patients (OR: 11.04; 95% CI: 3.91-31.16; P < .001). However, in studies conducted in the United States (P < 0.001) and published in or after 2000 (P = 0.026), the study populations included <60% males (P < 0.001). Moreover, studies of high quality (P < .001) demonstrated a significantly greater risk of HL with cCMV infection than that in the corresponding subgroups. CONCLUSIONS The study results suggest that cCMV infection increases the risk of HL. Further studies are required to investigate the association of cCMV infection with the risk of specific subtypes of HL.
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Raynor E, Holmes C, Crowson M, Peskoe S, Planey A, Lantos PM. Loss to follow up of failed hearing screen and missed opportunities to detect congenital cytomegalovirus are better identified with the implementation of a new electronic health record system protocol. Int J Pediatr Otorhinolaryngol 2021; 148:110818. [PMID: 34198229 DOI: 10.1016/j.ijporl.2021.110818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Congenital CMV (cCMV) is the leading cause of non-genetic sensorineural hearing loss. Babies with cCMV can present with hearing loss any time but failing the initial hearing screen should trigger cCMV testing. cCMV must be identified within 3 weeks after birth to differentiate congenital from acquired CMV, yet follow-up hearing screens may not occur until after 21 days. A new electronic health record protocol to test cCMV in babies who fail their initial hearing screen was established at our institution in 2013. The purpose of this study is to evaluate adherence and deviations from this protocol. METHODS All term infants born in 2013-2016 who failed initial hearing screen were included. The records were reviewed retrospectively. Demographic data, dates of hearing screens, CMV testing results and follow-up hearing test results were collected. RESULTS A total of 19,069 newborn babies were screened between 2013 and 2016. Babies who were in the neonatal intensive care unit whether premature or not were excluded as these infants are often in the hospital longer than 3 weeks so audiologic diagnostic testing may be delayed. Among term newborns screened, 1358 failed initial screen and 444 failed subsequent hearing testing prior to discharge. We identified 60 babies who did not follow up and 59 underwent additional audiologic testing. Overall 38 babies were tested for cCMV with 2 positives. We found an increase in cCMV testing over time and a significant decrease between physical distance from birth hospital and outpatient audiologic follow-up testing within 21 days of birth. DISCUSSION Our results are consistent with a 0.4% rate of cCMV in full-term babies who failed their newborn hearing screen. From 2013 to 2016, more babies received CMV tests, but post-screening follow up was still delayed. Further research is necessary to address factors affecting follow up. Use of electronic health record eased identification of results and improved tracking.
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Affiliation(s)
- Eileen Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, USA.
| | - Christine Holmes
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, USA
| | - Matthew Crowson
- Department of Otolaryngology-Head & Neck Surgery, Toronto, Canada
| | - Sarah Peskoe
- Department of Surgery Biostatistics Core, Duke University Medical Center, USA
| | - Arrianna Planey
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, USA
| | - Paul M Lantos
- Departments of Internal Medicine and Pediatrics, Duke University Medical Center, USA
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Congenital Human Cytomegalovirus Infection: A Narrative Review of Maternal Immune Response and Diagnosis in View of the Development of a Vaccine and Prevention of Primary and Non-Primary Infections in Pregnancy. Microorganisms 2021; 9:microorganisms9081749. [PMID: 34442828 PMCID: PMC8398868 DOI: 10.3390/microorganisms9081749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Congenital cytomegalovirus infection (cCMV) may affect about 1% of all newborns all over the world as a result of either a primary or recurrent human cytomegalovirus (HCMV) infection. While about 90% of infants affected by cCMV are asymptomatic at birth, the remaining 10% are symptomatic often with neurodevelopmental impairment and sensorineural hearing loss. In view of identifying the best approach to vaccine prevention of cCMV, this review will examine the most important steps made in the study of the immune response to, and diagnosis of, HCMV infection. The maternal immune response and immune correlates of protection are being partially identified with a partial contribution given by our laboratory. The diagnosis of primary infection is often difficult to achieve in the first three months of pregnancy, which is the time primarily involved in virus transmission to the fetus in association with the most severe symptoms and sequelae. Prevention of cCMV is anticipated by prevention of primary infection in early pregnancy by means of different measures, such as (i) behavioral-educational measures, (ii) immunoglobulin administration, (iii) antiviral treatment with valaciclovir. However, the most promising approach to cCMV prevention appears to be the development of a non-living vaccine, including at least three viral antigens: gB, pentamer complex gHgLpUL128L, and pp65, which have been shown to be able to stimulate both the humoral and the cellular arms of the maternal immune response. Primary HCMV infection may be managed in pregnancy by counseling of the couples involved by a team of specialists that includes virologists, obstetricians, infectivologists and neonatologists.
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The Term Newborn: Postnatal Screening and Testing. Clin Perinatol 2021; 48:555-572. [PMID: 34353580 DOI: 10.1016/j.clp.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Prenatal genetic screening, including evaluation for inherited genetic disorders, aneuploidy risk assessment, and sonographic assessment, combined with a thorough newborn examination and standard newborn screening, including blood, hearing, and congenital heart disease screening, can reveal conditions requiring further evaluation after delivery. Abnormal prenatal or newborn screening results should prompt additional diagnostic testing guided by maternal fetal medicine, perinatal genetics, or pediatric specialists.
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Scarpini S, Morigi F, Betti L, Dondi A, Biagi C, Lanari M. Development of a Vaccine against Human Cytomegalovirus: Advances, Barriers, and Implications for the Clinical Practice. Vaccines (Basel) 2021; 9:551. [PMID: 34070277 PMCID: PMC8225126 DOI: 10.3390/vaccines9060551] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022] Open
Abstract
Human cytomegalovirus (hCMV) is one of the most common causes of congenital infection in the post-rubella era, representing a major public health concern. Although most cases are asymptomatic in the neonatal period, congenital CMV (cCMV) disease can result in permanent impairment of cognitive development and represents the leading cause of non-genetic sensorineural hearing loss. Moreover, even if hCMV mostly causes asymptomatic or pauci-symptomatic infections in immunocompetent hosts, it may lead to severe and life-threatening disease in immunocompromised patients. Since immunity reduces the severity of disease, in the last years, the development of an effective and safe hCMV vaccine has been of great interest to pharmacologic researchers. Both hCMV live vaccines-e.g., live-attenuated, chimeric, viral-based-and non-living ones-subunit, RNA-based, virus-like particles, plasmid-based DNA-have been investigated. Encouraging data are emerging from clinical trials, but a hCMV vaccine has not been licensed yet. Major difficulties in the development of a satisfactory vaccine include hCMV's capacity to evade the immune response, unclear immune correlates for protection, low number of available animal models, and insufficient general awareness. Moreover, there is a need to determine which may be the best target populations for vaccine administration. The aim of the present paper is to examine the status of hCMV vaccines undergoing clinical trials and understand barriers limiting their development.
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Affiliation(s)
- Sara Scarpini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (S.S.); (F.M.); (L.B.)
| | - Francesca Morigi
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (S.S.); (F.M.); (L.B.)
| | - Ludovica Betti
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy; (S.S.); (F.M.); (L.B.)
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (M.L.)
| | - Carlotta Biagi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (M.L.)
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (C.B.); (M.L.)
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Ross SA, Kimberlin D. Clinical outcome and the role of antivirals in congenital cytomegalovirus infection. Antiviral Res 2021; 191:105083. [PMID: 33964331 DOI: 10.1016/j.antiviral.2021.105083] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of hearing loss and neurological disabilities in children worldwide. Although a minority of infants with cCMV will have symptoms at a birth, these children are at high risk of long-term sequelae. Most infants with cCMV have no clinical signs at birth (asymptomatic), but 10-15% will develop hearing loss. The diagnosis of cCMV relies on detection of the virus from urine or saliva within the first three weeks of life, with saliva PCR being the preferred method due to ease of collection and high sensitivity of the assay. Measures to prevent mother-to-child transmission of CMV are limited, and antiviral therapy with valganciclovir for 6 months is the standard of care for infants with symptomatic cCMV. As more infants with cCMV are being identified through newborn screening, studies are urgently needed to address antiviral treatment in asymptomatic infants and the implementation of prevention strategies to prevent fetal infection. This article is part of the symposium "New drugs and vaccines for DNA virus infections: a symposium in memory of Mark Prichard."
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Affiliation(s)
- Shannon A Ross
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David Kimberlin
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Grosse SD, Dollard SC, Ortega-Sanchez IR. Economic assessments of the burden of congenital cytomegalovirus infection and the cost-effectiveness of prevention strategies. Semin Perinatol 2021; 45:151393. [PMID: 33551180 PMCID: PMC8335728 DOI: 10.1016/j.semperi.2021.151393] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This is a critical review of published economic analyses on congenital cytomegalovirus infection and strategies for its detection and prevention. FINDINGS The review identified four cost-of-illness studies and nine cost-effectiveness analyses: three of vaccination of young women, two of prenatal screening, and four of newborn screening. All reported either large economic costs or favorable cost-effectiveness of interventions. However, sensitivity analyses did not address some of the most critical assumptions. CONCLUSIONS Reviewed economic analyses overattributed certain adverse long-term outcomes to congenital cytomegalovirus infection, while other long-term costs were not included. Overall, limited conceptual frameworks, unrepresentative data sources, and unsupported or inadequately documented assumptions regarding outcomes and costs hinder the ability of policymakers to draw conclusions. A major challenge is the limited information on long-term outcomes and costs for representative cohorts of individuals with congenital cytomegalovirus, which further research could helpfully address.
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Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Corresponding author. (S.D. Grosse)
| | - Sheila C. Dollard
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ismael R. Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dedhia K, Fifer RC, Muldoon KM, Park A. A Cross-Sectional Survey Evaluating Awareness of Congenital Cytomegalovirus Among Audiologists and Speech-Language Pathologists. Am J Audiol 2021; 30:145-159. [PMID: 33621115 DOI: 10.1044/2020_aja-20-00167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Congenital cytomegalovirus (cCMV) is the most common congenital infection worldwide and a leading environmental cause of pediatric hearing loss (HL). The objective of this study was to evaluate audiologists and speech-language pathologists (SLPs) on awareness and knowledge of cCMV. Method A multiple-choice survey assessing awareness, knowledge, and practice patterns was sent electronically to audiologists and SLPs of the American Speech-Language-Hearing Association. Results were compared between audiologists and SLPs and within stratified groups of audiologists. Data were collected, and descriptive analysis was performed. Results Ninety-four audiologists and 317 SLPs responded. Most audiologists were somewhat or very familiar with cCMV (85.9%), while only 26% of SLPs responded that they were at least somewhat familiar with cCMV (p < .0001). When comparing audiologists' and SLPs' knowledge of symptoms, transmission, and diagnostic age for cCMV, audiologists had higher scores in all categories (p < .0001). Audiologists were then stratified into subgroups to evaluate the association of the given subgroup with their overall knowledge. The more advanced audiology training, the more knowledgeable the respondent was regarding HL progression (p = .002). Audiologists who were more familiar with cCMV scored better in most categories compared to those reporting somewhat or less familiar; these findings were only significant for knowledge of symptoms (p < .0001). Audiologists who were sometimes or frequently evaluating children less than 5 years of age had a better understanding of HL presentation among cCMV patients than those who rarely saw this patient population. Those who were in practice for < 20 years frequently knew the time-sensitive age of diagnosis than respondents in practice longer. Conclusions As a leading environmental cause of pediatric HL, cCMV is frequently encountered by audiologists and SLPs. This study highlights knowledge gaps and areas where targeted education is needed for both groups.
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Affiliation(s)
- Kavita Dedhia
- Department of Otolaryngology—Head and Neck Surgery, Children's Hospital of Philadelphia, University of Pennsylvania
| | - Robert C. Fifer
- Department of Audiology and Speech-Language Pathology, Center for Child Development, University of Miami, FL
| | - Kathleen M. Muldoon
- College of Graduate Studies, Midwestern University, Glendale, AZ
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale
| | - Albert Park
- Department of Pediatric Otolaryngology, The University of Utah, Salt Lake City
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Beswick R, McHugh L, Clark JE. Integrating congenital cytomegalovirus screening within a newborn hearing screening program: Is it worthwhile? Int J Pediatr Otorhinolaryngol 2021; 142:110594. [PMID: 33422993 DOI: 10.1016/j.ijporl.2020.110594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of the present study was to review the potential impacts and barriers to upscaling a pilot congenital Cytomegalovirus (cCMV) screening program into a state-wide permanent universal newborn hearing screening (UNHS) program. DESIGN This study reviewed the outcomes of the cCMV screening program pilot operating at three maternity hospitals to standard state-wide laboratory notifications in Queensland, Australia between August 2014 to April 2018. Stakeholder interviews were also conducted to inform state-wide program implementation. RESULTS Of the 485 infants tested for CMV on a saliva swab at the pilot sites, 4 (0.8%) returned a positive result. Review of the state-wide laboratory infant CMV PCR notifications for the same time-period revealed more than half of infants with cCMV (63.7%) would not have been detected under a state-wide targeted screening program as they either passed newborn hearing screening, were deceased, symptomatic, or were born <34 weeks gestational age. Barriers to state-wide program implementation included program-level factors (timing of the cCMV screen, funding, cross-agency communication, workforce and training) and community-level factors (low public cCMV awareness and prevalence). CONCLUSIONS Although cCMV screening alongside UNHS is achievable, a number of barriers need to be addressed prior to state-wide program implementation.
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Affiliation(s)
- Rachael Beswick
- Children's Health Queensland Hospital and Health Service, Queensland, PO Box 930, Nundah, Queensland, 4012, Australia.
| | - Lauren McHugh
- Children's Health Queensland Hospital and Health Service, Queensland, PO Box 930, Nundah, Queensland, 4012, Australia
| | - Julia E Clark
- Children's Health Queensland Hospital and Health Service, Queensland, PO Box 930, Nundah, Queensland, 4012, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, 501 Stanley Street, PO Box 3474, South Brisbane, QLD, 4101, Australia
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Qian ZJ, Chang KW, Ahmad IN, Tribble MS, Cheng AG. Use of Diagnostic Testing and Intervention for Sensorineural Hearing Loss in US Children From 2008 to 2018. JAMA Otolaryngol Head Neck Surg 2021; 147:253-260. [PMID: 33377936 PMCID: PMC7774052 DOI: 10.1001/jamaoto.2020.5030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/05/2020] [Indexed: 12/30/2022]
Abstract
Importance Early detection and intervention of pediatric hearing loss is critical for language development and academic achievement. However, variations in the diagnostic workup and management of pediatric sensorineural hearing loss (SNHL) exist. Objective To identify patient and clinician factors that are associated with variation in practice on a national level. Design, Setting, and Participants This cross-sectional study used the Optum claims database to identify 53 711 unique children with SNHL between January 1, 2008, and December 31, 2018. Main Outcomes and Measures National use rates and mean costs for diagnostic modalities (electrocardiogram, cytomegalovirus testing, magnetic resonance imaging, computed tomography, and genetic testing) and interventions (speech-language pathology, billed hearing aid services, and cochlear implant surgery) were reported. The associations of age, sex, SNHL laterality, clinician type, race/ethnicity, and household income with diagnostic workup and intervention use were measured in multivariable analyses. Results Of 53 711 patients, 23 735 (44.2%) were girls, 2934 (5.5%) were Asian, 3797 (7.1%) were Black, 5626 (10.5%) were Hispanic, 33 441 (62.3%) were White, and the mean (SD) age was 7.3 (5.3) years. Of all patients, 32 200 (60.0%) were seen by general otolaryngologists, while 7573 (14.10%) were seen by pediatric otolaryngologists. Diagnostic workup was received by 14 647 patients (27.3%), while 13 482 (25.1%) received intervention. Use of genetic testing increased (odds ratio, 1.22 per year; 95% CI, 1.20-1.24), whereas use of computed tomography decreased (odds ratio, 0.93 per year; 95% CI, 0.92-0.94) during the study period. After adjusting for relevant covariables, children who were seen by pediatric otolaryngologists and geneticists had the highest odds of receiving workup and intervention. Additionally, racial/ethnic and economic disparities were observed in the use of most modalities of diagnostic workup and intervention for pediatric SNHL. Conclusions and Relevance This cross-sectional study identified factors associated with disparities in the diagnostic workup and intervention of pediatric SNHL, thus highlighting the need for increased education and standardization in the management of this common sensory disorder.
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Affiliation(s)
- Z. Jason Qian
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Kay W. Chang
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Iram N. Ahmad
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Melissa S. Tribble
- Pediatric Audiology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Alan G. Cheng
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Timing of newborn hearing screening in the neonatal intensive care unit: implications for targeted screening for congenital cytomegalovirus infection. J Perinatol 2021; 41:310-314. [PMID: 32893264 DOI: 10.1038/s41372-020-00801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/28/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine when infants in the neonatal intensive care unit (NICU) have the first hearing screen performed, and thus inform targeted testing for cytomegalovirus (CMV)-related hearing loss. STUDY DESIGN Retrospective review of electronic health records of infants admitted to a Level 4 outborn NICU and had a first hearing screen performed from 8/2016-8/2018. RESULT Among 1498 infants, 546 (36%) had a first hearing screen performed at age >21 days when a positive CMV PCR test cannot distinguish congenital from postnatal CMV acquisition. While most infants tested at >21 days of age were <34 weeks' gestational age (71%), 18% (n = 100) and 11% (n = 59) were ≥34 and ≥37 weeks' gestation, respectively. CONCLUSION Targeted CMV testing for failed hearing screen in the NICU is problematic as 36% of infants did not have a hearing screen performed before 21 days of age, supporting the need for CMV screening at NICU admission.
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Gordon-Lipkin E, Hoon A, Pardo CA. Prenatal cytomegalovirus, rubella, and Zika virus infections associated with developmental disabilities: past, present, and future. Dev Med Child Neurol 2021; 63:135-143. [PMID: 33084055 PMCID: PMC7785600 DOI: 10.1111/dmcn.14682] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
Prenatal infections have long been recognized as important, preventable causes of developmental disabilities. The list of pathogens that are recognized to have deleterious effects on fetal brain development continues to grow, most recently with the association between Zika virus (ZIKV) and microcephaly. To answer clinical questions in real time about the impact of a novel infection on developmental disabilities, an historical framework is key. The lessons learned from three historically important pathogens: rubella, cytomegalovirus, and ZIKV, and how these lessons are useful to approach emerging congenital infections are discussed in this review. Congenital infections are preventable causes of developmental disabilities and several public health approaches may be used to prevent prenatal infection. When they cannot be prevented, the sequelae of prenatal infection may be treatable. WHAT THIS PAPER ADDS: The list of prenatal infections associated with developmental disabilities continues to increase. Lessons learned from rubella, cytomegalovirus, and Zika virus have implications for new pathogens. Severity of illness in the mother does not correlate with severity of sequelae in the infant.
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Affiliation(s)
- Eliza Gordon-Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Hoon
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of hearing loss and neurological disabilities in children, with the disease burden and disabilities due to cCMV greater than many other well recognized childhood conditions. A minority of infants with cCMV will have symptoms at birth. Infants with symptomatic cCMV are at higher risk for sequelae than those born without symptoms. The majority of infants with cCMV are asymptomatic at birth, but 10%-15% will develop hearing loss. Although clinical symptoms can help predict which infants will have sensorineural hearing loss, among asymptomatic cCMV there are currently no predictors of adverse outcome. The identification of a biomarker to identify those at highest risk of sequelae is highly desirable to target interventions to those who could potentially benefit. Because there is increasing rationale for establishing both targeted and universal screening programs for cCMV in the United States and worldwide, this is an urgent priority.
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Affiliation(s)
- Nazia Kabani
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shannon A Ross
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chen K, Zhong Y, Gu Y, Sharma R, Li M, Zhou J, Wu Y, Gao Y, Qin G. Estimated Cost-effectiveness of Newborn Screening for Congenital Cytomegalovirus Infection in China Using a Markov Model. JAMA Netw Open 2020; 3:e2023949. [PMID: 33275150 PMCID: PMC7718603 DOI: 10.1001/jamanetworkopen.2020.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Congenital cytomegalovirus infection (cCMVi) is one of the most common infections associated with childhood hearing loss. Prevention and mitigation of cCMVi-related hearing loss will require an increase in newborn screening, which is not yet available in China. OBJECTIVE To estimate the cost-effectiveness of newborn screening strategies for cCMVi from the perspective of the Chinese health care system. DESIGN, SETTING, AND PARTICIPANTS A decision tree for a simulated cohort population of 15 000 000 live births was developed to compare the costs and health effects of 3 mutually exclusive interventions: (1) no screening, (2) targeted screening using CMV polymerase chain reaction assay for newborns who fail a universal hearing screening, and (3) universal screening for CMV among all newborns. Markov diagrams were used to evaluate the lifetime horizon (76 years). MAIN OUTCOMES AND MEASURES Cost, hearing-related health outcomes, and incremental cost-effectiveness ratios (ICERs) were estimated based on a direct medical costs perspective. Costs and ICERs were reported in 2018 US dollars. RESULTS Incidence of cCMVi among newborns was reported to be approximately 0.7% in China. Targeted screening was less costly but also less effective than universal screening, identifying 41% of cases needing antiviral treatment and preventing nearly half of less severe or profound hearing loss. To avoid 1 CMV-related severe or profound hearing loss, 13 and 16 newborns need to be treated by targeted and universal screening, respectively. The ICERs of targeted and universal screening vs no screening were $79 and $2087 per quality-adjusted life-year gained, respectively, at the discounted rate of 3.5%. Both screening options were cost-effective for the Chinese health care system based on the willingness-to-pay threshold of 3 × gross domestic product per capita. The sensitivity analysis showed that the prevalence of cCMVi, as well as diagnosis and treatment costs, were key factors that may be associated with decision-making. CONCLUSIONS AND RELEVANCE To achieve cost-effectiveness and best health outcomes, universal screening could be considered for the Chinese population. While the results are specific to China, the model may easily be adapted for other countries.
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Affiliation(s)
- Kai Chen
- Department of Internal Medicine, Nantong University Medical School, Nantong, Jiangsu, China
| | - Yaqin Zhong
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Yuanyuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Rajan Sharma
- Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Muting Li
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Jinjun Zhou
- Department of Pediatrics, Nantong Maternal and Child Health Hospital, Nantong University, Nantong, Jiangsu, China
| | - Youjia Wu
- Department of Pediatrics, Nantong University Affiliated Hospital, Nantong, Jiangsu, China
| | - Yuexia Gao
- Department of Health Management, Nantong University School of Public Health, Nantong, Jiangsu, China
| | - Gang Qin
- Department of Infectious Diseases, Nantong Third People’s Hospital Affiliated to Nantong University, Nantong, Jiangsu, China
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Satterfield-Nash A, Umrigar A, Lanzieri TM. Etiology of Prelingual Hearing Loss in the Universal Newborn Hearing Screening Era: A Scoping Review. Otolaryngol Head Neck Surg 2020; 163:662-670. [PMID: 32423335 PMCID: PMC7541667 DOI: 10.1177/0194599820921870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/26/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To conduct a scoping review on etiologic investigation of prelingual hearing loss among children <2 years of age in the era of universal newborn hearing screening (UNHS). DATA SOURCES PubMed, Embase, PsycInfo, CINAHL, and Cochrane Library databases. REVIEW METHODS We searched for articles published from January 1, 1998, to February 19, 2020. We reviewed studies that (1) included children identified with either congenital or delayed-onset hearing loss before 2 years of age among cohorts who had undergone UNHS and (2) investigated ≥1 etiologies of hearing loss. We defined hearing loss as congenital when confirmed after UNHS failure and as delayed onset when diagnosed after ≥1 assessments with normal hearing. RESULTS Among 2069 unique citations, 115 studies met criteria for full-text assessment, and 20 met our inclusion criteria. Six studies tested children diagnosed with hearing loss for genetic etiology, 9 for congenital cytomegalovirus (CMV) infection, and 5 for both. Among 1787 children with congenital hearing loss and etiologic investigation, 933 (52.2%) were tested for genetic mutations and 1021 (57.1%) for congenital CMV infection. The proportion of congenital hearing loss cases attributable to genetic etiology ranged between 7.7% and 83.3% and to congenital CMV infection between 0.0% and 32.0%. CONCLUSION Data are lacking on the identification and etiology of delayed-onset hearing loss in children <2 years of age in the UNHS era. The proportion of congenital hearing loss cases attributable to genetic etiologies and congenital CMV infection appears to vary widely.
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Affiliation(s)
| | - Ayesha Umrigar
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Tatiana M. Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Thorpe RK, Smith RJH. Future directions for screening and treatment in congenital hearing loss. PRECISION CLINICAL MEDICINE 2020; 3:175-186. [PMID: 33209510 PMCID: PMC7653508 DOI: 10.1093/pcmedi/pbaa025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
Hearing loss is the most common neurosensory deficit. It results from a variety of heritable and acquired causes and is linked to multiple deleterious effects on a child's development that can be ameliorated by prompt identification and individualized therapies. Diagnosing hearing loss in newborns is challenging, especially in mild or progressive cases, and its management requires a multidisciplinary team of healthcare providers comprising audiologists, pediatricians, otolaryngologists, and genetic counselors. While physiologic newborn hearing screening has resulted in earlier diagnosis of hearing loss than ever before, a growing body of knowledge supports the concurrent implementation of genetic and cytomegalovirus testing to offset the limitations inherent to a singular screening modality. In this review, we discuss the contemporary role of screening for hearing loss in newborns as well as future directions in its diagnosis and treatment.
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Affiliation(s)
- Ryan K Thorpe
- Molecular Otolaryngology and Renal Research Laboratories, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242, USA
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Richard J H Smith
- Molecular Otolaryngology and Renal Research Laboratories, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242, USA
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
- The Interdisciplinary Graduate Program in Genetics, University of Iowa, 375 Newton Rd, Iowa City, IA 52242, USA
- Iowa Institute of Human Genetics, University of Iowa, 375 Newton Rd, Iowa City, IA 52242, USA
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Brain Magnetic Resonance Imaging in Congenital Cytomegalovirus With Failed Newborn Hearing Screen. Pediatr Neurol 2020; 110:55-58. [PMID: 32713673 PMCID: PMC8856767 DOI: 10.1016/j.pediatrneurol.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/30/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2013, Utah enacted legislation requiring that infants failing newborn hearing screening be tested for cytomegalovirus infection. As a result, cytomegalovirus-infected infants are being identified because of hearing deficits. The neuroimaging findings in this population have not been characterized. METHODS Retrospective medical record review was used to identify patients seen at the University of Utah and Primary Children's Hospitals in Salt Lake City, Utah, who failed newborn hearing screening. A cohort of patients with congenital cytomegalovirus infection, brain magnetic resonance imaging (MRI), and sedated auditory brainstem response testing was studied. RESULTS Seventeen patients were identified; 11 (65%) were female. Confirmatory auditory brainstem response testing, performed at a median age 29 days, showed profound hearing loss in 8 (47%) subjects, severe loss in two (12%), moderate loss in two (12%), and mild loss in three (18%); two (12%) subjects had normal hearing. The diagnosis of cytomegalovirus infection was made at a median age 23 days. Brain imaging was performed at a median age 65 days. Ten (59%) subjects had one or more neuroimaging abnormality. White matter lesions were found in eight (47%) subjects, cysts in three (18%), and stroke in two (12%). Polymicrogyria was identified in two (12%) subjects. Seven (41%) subjects had normal brain MRIs. CONCLUSIONS These results indicate that most infants whose cytomegalovirus infections were identified after failing newborn hearing screening had abnormal brain MRIs. Our results suggest that brain MRIs should be considered in infants with congenital cytomegalovirus infections who are identified through hearing screening programs.
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Aaron KA, Kim GS, Cheng AG. Advances in Inner Ear Therapeutics for Hearing Loss in Children. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020; 8:285-294. [DOI: 10.1007/s40136-020-00300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gievers LL, Holmes AV, Loyal J, Larson IA, Oliveira CR, Waldman EH, Khaki S. Ethical and Public Health Implications of Targeted Screening for Congenital Cytomegalovirus. Pediatrics 2020; 146:peds.2020-0617. [PMID: 32591436 PMCID: PMC8171256 DOI: 10.1542/peds.2020-0617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 11/24/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) is the most common congenital infection and is associated with sensorineural hearing loss, developmental delays, and visual impairment. The clinical presentation of cCMV is variable, and the majority (80%-90%) of newborns will never manifest any clinical symptoms. Given the clinical heterogeneity of cCMV infection, it is challenging to identify which newborns may benefit from testing. Recently, certain states have implemented a targeted screening program in which newborns who fail the newborn hearing screen are tested for cCMV. Clinicians and legislative bodies have been propelled into debates about the ethical and moral permissibility of a targeted cCMV screening approach. Those who oppose this screening approach describe undue burden on patients, families, and the health care system because the majority of newborns who fail the newborn hearing screen and have cCMV will not go on to have any sequelae related to cCMV, including hearing loss. However, those who support this screening approach cite the importance of early detection and ongoing surveillance for hearing loss and developmental delays in this high-risk group of newborns. This debate will be considered by experts in the field.
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Affiliation(s)
- Ladawna L. Gievers
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Alison Volpe Holmes
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College and Children’s Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Jaspreet Loyal
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ilse A. Larson
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University, New Haven, Connecticut,Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Erik H. Waldman
- Head and Neck Surgery, Section of Otolaryngology, Yale University, New Haven, Connecticut
| | - Sheevaun Khaki
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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