2326. “Targeted” Screening for Cytomegalovirus (CMV)-Related Hearing Loss: It’s Time for Universal CMV Screening in the NICU!
Session: Poster Abstract Session: Pediatric Virology
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • IDSAPoster2017Medoro.pdf (725.2 kB)
  • Background: Congenital CMV infection is the leading cause of non-genetic sensorineural hearing loss in infancy. Antiviral therapy has been shown to improve hearing outcomes, and thus “targeted” CMV screening for newborns who do not pass the hearing screen has been recommended. Diagnosis of congenital CMV infection requires that the infant be tested for CMV in the first 3 weeks of age. Our objective was to determine when infants in the neonatal intensive care unit (NICU) have their first hearing screen performed and thus inform the practice of targeted screening for determination of CMV-related hearing loss.

    Methods: Retrospective review of the electronic health records of all infants admitted to the Level 4 outborn NICU at Nationwide Children’s Hospital, Columbus, OH from 8/2016-5/2017. Demographic and clinical data were obtained, and the age that the first hearing screen was performed was assessed.

    Results: During the 10 month study period, 362 infants were admitted to the NICU and had a first hearing screen performed. The majority of neonates (204, 56%) had a first hearing screen performed in the first 3 weeks of age. However, 158 (44%; median birth weight [IQR], 1072 g [747-1766]; median gestational age [IQR], 28 weeks [25-32]) infants received the first hearing screen at >3 weeks of age when a positive CMV PCR or culture cannot distinguish congenital infection from intrapartum/postnatal acquisition of CMV. Of the 158 infants, 20 (13%) did not pass the first hearing screen (13, unilateral; 7, bilateral), and subsequently, 9 of them did pass a second hearing screen. However, 11 of the 20 infants did not pass a second hearing screen and had urine CMV PCR testing, and 1 (9%) was positive. This latter infant’s newborn dried blood spot CMV DNA PCR was negative so a diagnosis of congenital CMV infection was not possible.

    Conclusion: Targeted screening in the NICU for CMV-related hearing loss is problematic as a substantial number of infants do not have a hearing screen performed until after 21 days of age, thus representing a missed opportunity for diagnosis of congenital CMV infection and institution of antiviral therapy if indicated. Our findings support universal CMV screening of neonates on admission to the NICU.

    Alexandra Medoro, MD1, Prashant Malhotra, MD, FAAP2, Masako Shimamura, MD3, Gina Hounam, PhD4, Ursula Findlen, PhD4, Phillip Wozniak, BA5, Nicholas Foor, BS6, Oliver Adunka, MD, FACS2 and Pablo J. Sanchez, MD, FIDSA, FPIDS7, (1)Pediatrics, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, (2)Otolaryngology, Nationwide Children's Hospital, Columbus, OH, (3)Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, (4)Audiology, Nationwide Children's Hospital, Columbus, OH, (5)Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, (6)Neonatology, Nationwide Children's Hospital, Columbus, OH, (7)Pediatrics, Divisions of Pediatric Infectious Diseases and Neonatology, Nationwide Children's Hospital - Ohio State University College of Medicine, Columbus, OH

    Disclosures:

    A. Medoro, None

    P. Malhotra, None

    M. Shimamura, None

    G. Hounam, None

    U. Findlen, None

    P. Wozniak, None

    N. Foor, None

    O. Adunka, MED-EL Corporation: Consultant , Consulting fee , Educational grant and Research support
    Advanced Bionics: Consultant , Consulting fee and Licensing agreement or royalty
    Advanced Cochlear Diagnostics: President , Ownership interest
    AGTC Corporation: Consultant , Consulting fee

    P. J. Sanchez, None

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