2336. Adherence to Follow-up and CMV Testing in Infants Who Failed Newborn Hearing Screens: Evaluation of New Protocol to Ensure Follow-up and Testing

Abstract Background CMV is the most common non-hereditary cause of sensorineural hearing loss (SNHL) in children in the United States. SNHL may be the only presenting symptom in otherwise asymptomatic infants. Several states are making CMV testing mandatory for newborn infants who have a hearing deficit. Testing should be performed before 21 days of life to diagnose congenital CMV infection and provide effective therapy. However, the results of a retrospective 1 year audit of all newborn patients in the nursery of University Hospital of Brooklyn (UHB) who failed their hearing screen found that none were tested for CMV and approximately half failed to follow-up with audiology. Therefor we developed a new protocol to ensure testing and follow-up. Methods Under the new protocol, newborns who fail an initial and repeat hearing screen are tested for CMV in urine by culture and the audiology appointment is scheduled before discharge. Patients are tracked by a pediatric infectious disease fellow to ensure adherence to protocol. Results The pre-intervention audit conducted from November 1, 2017 to October 31, 2018 found 37/923 (4%) infants failed their hearing screening tests. Although 34/37 (92%) of these children had audiology appointments made before discharge, only 19 (56%) actually attended. Two (11%) children failed an otoacoustic emissions hearing test. One infant also went on to fail an auditory brainstem response test; both were lost to follow-up. None of these infants was tested for CMV. The new protocol was initiated November 1, 2018, 11/372 (3%) infants failed initial and repeat hearing screening tests. All 11 (100%) of these children had audiology appointments made before discharge, of which 9 (82%) attended. 2 (18%) of these children failed the otoacoustic emissions hearing test at that visit, 1 infant was lost to follow-up; 9 infants who failed hearing test were tested for CMV; 1 (9%) was positive. Conclusion Although it has only been in place for 5 months, the new protocol has increased adherence to audiology appointments. CMV testing has increased from 0% to 82% and 1 patient has tested positive for congenital CMV infection. The ongoing success of this protocol could facilitate timely and appropriate treatment of CMV with valgancyclovir. Disclosures All authors: No reported disclosures.

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Hearing Screening of Newborns using Distortion Product Otoacoustic Emissions

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2021.v29i2.478 ◽

2021 ◽

Vol 29 (2) ◽

pp. 189-195

Author(s):

Vybhavi MK ◽

Srinivas V

Keyword(s):

Hearing Loss ◽

Otoacoustic Emissions ◽

Screening Tool ◽

Hearing Screening ◽

Distortion Product Otoacoustic Emissions ◽

Profound Hearing Loss ◽

Distortion Product ◽

Lost To Follow Up ◽

Evoked Response Audiometry

Introduction The present study was devised to estimate the prevalence of neonatal hearing loss and document the importance of using DPOAE as a screening tool for identifying hearing loss in newborns. Materials and Methods This hospital based descriptive study was conducted from August 2018 to August 2019. A total of 928 newborn babies were included in the study. These newborn babies were subjected to hearing screening by distortion product otoacoustic emissions (DPOAE) at 24-72 hrs after birth. For pass cases, no further testing was done. For refer cases, repeat testing with DPOAE was done within 15-30 days. Newborns with refer result on repeat DPOAE testing were subjected to Brainstem evoked response audiometry (BERA) within 3 months to confirm hearing loss. Results Nine hundred and twenty eight newborn babies were screened by DPOAE. 851 newborns passed the first DPOAE hearing screening and 77 newborns gave refer result. 21 newborns were lost to follow-up. 56 newborns underwent repeat DPOAE testing and 5 newborns were referred for BERA. Amongst the 5 newborns who underwent BERA testing, one newborn was diagnosed with bilateral profound hearing loss. Hence, the prevalence of hearing loss of 1.08 per thousand newborn babies was estimated in this study. Conclusion Hearing screening of newborns using DPOAE followed by BERA in refer cases to confirm hearing loss is useful for early detection followed by timely intervention and rehabilitation.

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Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000455 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000455

Author(s):

Paulo Paixão ◽

Maria João Brito ◽

Daniel Virella ◽

Maria Teresa Neto

Keyword(s):

Primary Infection ◽

Recurrent Infection ◽

Congenital Infection ◽

High Avidity ◽

Maternal Infection ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

Missed Diagnosis ◽

Congenital Cmv

ObjectiveHuman cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood.DesignInfants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit.PatientsInfants born between 2006 and 2011 with confirmed congenital CMV infection.MethodsMaternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age.ResultsForty confirmed cases of congenital CMV infection were reported (6.6:105 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27).ConclusionThe reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

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A congenital CMV infection model for follow-up studies of neurodevelopmental disorders, neuroimaging abnormalities, and treatment

JCI Insight ◽

10.1172/jci.insight.152551 ◽

2022 ◽

Vol 7 (1) ◽

Author(s):

Yue-Peng Zhou ◽

Meng-Jie Mei ◽

Xian-Zhang Wang ◽

Sheng-Nan Huang ◽

Lin Chen ◽

...

Keyword(s):

Neurodevelopmental Disorders ◽

Infection Model ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

Follow Up Studies ◽

Congenital Cmv

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Follow-up of pregnant women with active cytomegalovirus infection

Eastern Mediterranean Health Journal ◽

10.26719/1999.5.5.949 ◽

1999 ◽

Vol 5 (5) ◽

pp. 1049-1054

Author(s):

H. Y. Al Ali ◽

S. A. Yasseen ◽

T. Y. Raof

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Pregnant Women ◽

Congenital Malformations ◽

Cmv Infection ◽

Serological Evidence ◽

Congenital Cmv Infection ◽

The Central Nervous System ◽

Congenital Cmv

Pregnant women [60]with and without serological evidence of active cytomegalovirus [CMV]infection were followed until delivery to detect the incidence and types of overt congenital CMV infection in neonates in Mosul, Iraq. Infection was diagnosed by the detection of CMV-IgM, using ELISA. CMV-IgM was detected in cord blood samples of six [10%]overtly sick infants [with different congenital malformations]born to mothers with active CMV infection. Central nervous system abnormalities were detected in all six cases [two with microcephaly and four with hydrocephaly]. Congenital CMV infection should be suspected in infants born with congenital malformations, especially those of the central nervous system. The detection of a significant number of hydrocephalus cases in our study is notable

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Comparing Newborn Hearing Test Batteries: TEOAE and A-ABR – Pilot Study

New Trends and Issues Proceedings on Advances Pure and Applied Sciences ◽

10.18844/gjapas.v0i8.2786 ◽

2017 ◽

pp. 36-41

Author(s):

Esra Dogru Huzmeli

Keyword(s):

Hearing Loss ◽

Otoacoustic Emissions ◽

Screening Programme ◽

Auditory Brainstem ◽

Hearing Screening ◽

Newborn Hearing Screening ◽

Newborn Hearing ◽

Keywords Hearing Loss ◽

Brainstem Response ◽

Hearing Test

The aim of the newborn hearing screening programme is early detection of hearing loss. Transient evoked otoacoustic emissions (TEOAE) and automised auditory brainstem response (A-ABR) are effective, objective and valuable test batteries for newborn hearing screening, and they should be used together. The purpose of this study is to determine which test battery is more accurate and can be used as the gold standard. A total of 933 newborn children were included in this study, of which 602 were girls and 331 boys. 622 of them were screened with TEOAE, while 311 with A-ABR. 31 of the newborn screened with A-ABR and 27 of those screened with TEOAE were referred in the hearing screening programme. The results showed that out of 933, 17 subjects had hearing loss. The hearing loss rate was 1.8%; 12 of the newborn screened with AABR and 5 of those screened with TEOAE had hearing loss. Keywords: Hearing loss, TEOAE, ABR, newborn hearing screening.

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OP14.09: Congenital CMV infection-a new approach to prenatal follow up

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.9393 ◽

2011 ◽

Vol 38 (S1) ◽

pp. 97-97

Author(s):

L. Levitt ◽

D. V. Valsky ◽

N. Yanai ◽

D. Hochner-Celnikier ◽

D. Wolf ◽

...

Keyword(s):

Cmv Infection ◽

New Approach ◽

Congenital Cmv Infection ◽

Congenital Cmv

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Efficacy of Valganciclovir Treatment Depends on the Severity of Hearing Dysfunction in Symptomatic Infants with Congenital Cytomegalovirus Infection

International Journal of Molecular Sciences ◽

10.3390/ijms20061388 ◽

2019 ◽

Vol 20 (6) ◽

pp. 1388 ◽

Cited By ~ 6

Author(s):

Shohei Ohyama ◽

Ichiro Morioka ◽

Sachiyo Fukushima ◽

Keiji Yamana ◽

Kosuke Nishida ◽

...

Keyword(s):

Antiviral Treatment ◽

Auditory Brainstem ◽

Severe Form ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Hearing Function ◽

Congenital Cmv Infection ◽

Brainstem Response ◽

V Wave ◽

Congenital Cmv

Although earlier studies have shown that antiviral treatment regimens using valganciclovir (VGCV) improved hearing function in some infants with congenital cytomegalovirus (CMV) infection; its efficacy on the severity of hearing dysfunction is unclear. We conducted a prospective study among 26 infants with congenital CMV infections from 2009 to 2018. Oral VGCV (32 mg/kg/day) was administered for 6 weeks (November 2009 to June 2015; n = 20) or 6 months (July 2015 to March 2018, n = 6). Hearing function was evaluated by measuring the auditory brainstem response before VGCV treatment and at 6 months. Hearing dysfunction, defined as a V-wave threshold >40 dB, was categorized into: most severe, ≥91 dB; severe, 61–90 dB; and moderate, 41–60 dB. Hearing improvement was defined as a decrease of ≥20 dB from the pretreatment V-wave threshold. Of 52 ears in 26 infants with congenital CMV infection, 29 (56%) had hearing dysfunction, and of 29 ears, 16 (55%) improved after VGCV treatment. Although, 16 (84%) of 19 ears with moderate or severe hearing dysfunction improved after treatment (p < 0.001), 10 ears with the most severe form did not. In conclusion, VGCV treatment is effective in improving moderate and severe hearing dysfunction in infants with congenital CMV infection.

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