Long-term outcomes of congenital cytomegalovirus infection in children early identified by extended hearing-targeted screening

被引:3
作者
Forli, Francesca [1 ]
Capobianco, Silvia [1 ]
Berrettini, Stefano [1 ]
Bruschini, Luca [1 ]
Lorenzoni, Francesca [2 ,3 ]
Fiori, Simona [4 ,5 ]
Lazzerini, Francesco [1 ]
机构
[1] Univ Pisa, Otolaryngol Audiol & Phoniatr Unit, Via Paradisa 2, I-56124 Pisa, Italy
[2] Univ Hosp Pisa, Dept Clin & Expt Med, Neonatal Intens Care Unit, Pisa, Italy
[3] Univ Hosp Pisa, Dept Clin & Expt Med, Neonatal Unit, Pisa, Italy
[4] IRCCS Stella Maris Fdn, Dept Dev Neurosci, Pisa, Italy
[5] Univ Pisa, Dept Clin & Expt Med, Pisa, Italy
关键词
Congenital cytomegalovirus; Hearing loss; Newborn hearing screening; Pregnancy; Extended-targeted early cCMV testing; CMV INFECTION; VIRAL LOAD; DISEASE; DIAGNOSIS; SEQUELAE; INFANTS; URINE; RISK; DNA;
D O I
10.1016/j.ijporl.2024.112070
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
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-rho) 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 degrees 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 subIntensive 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 rho = 0.434; p = 0.0001) and a worse hearing threshold at birth (Spearman's rho = 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 (rho = 0.582; p = 0.0001) and with other neurocognitive abnormalities (rho = 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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页数:10
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