Congenital Cytomegalovirus Detected Through Universal Newborn Screening: A Narrative Review of What Universal Testing Finds That Targeted Testing Misses
DOI:
https://doi.org/10.5281/zenodo.22237624Keywords:
Newborn Screening, Congenital Cytomegalovirus, Sensorineural Hearing Loss, Valganciclovir, Targeted ScreeningAbstract
Congenital cytomegalovirus is the commonest non-genetic cause of childhood hearing loss and is usually silent at birth. Targeted
testing of babies who fail their hearing screen is cheap and logical, and it finds under half of the affected infants.
Objectives: To review the published evidence on universal newborn screening for congenital cytomegalovirus: what universal
testing detects that targeted testing does not, how many of those additional cases matter clinically, what treatment achieves, and
what universal screening costs in return.
Material and Methods: Narrative review of universal and targeted screening programmes, randomised antiviral trials, cohort
studies of hearing outcome and society guidance indexed in PubMed and the major paediatric, infectious disease and audiology
journals. No new patient data were generated; every estimate quoted is one published by the original investigators.
Results: In a universal screening programme covering 48,556 infants (94.7 per cent of live births), congenital infection was
identified in 176 newborns, a birth prevalence of 3.6 per 1000 (95% CI 3.1 to 4.2). One hundred of those 176 cases (57 per cent)
would have been missed by expanded-targeted screening; of these, 8 per cent were moderately to severely symptomatic, 3 per
cent were asymptomatic with sensorineural hearing loss, and 11 per cent received valganciclovir. Fifty-three per cent of cases
with maternal infection type available were born to mothers with non-primary infection.
Conclusion: Universal screening roughly doubles case detection, and the additional cases include a minority who are clinically
significant and treatable immediately. The majority are asymptomatic infants with normal hearing, for whom the benefit is
surveillance and the cost is years of parental anxiety about a child who may never be affected.
Abbreviations: ABR – Auditory Brainstem Response, cCMV – Congenital Cytomegalovirus, CI – Confidence Interval, PCR –
Polymerase Chain Reaction, SNHL – Sensorineural Hearing Loss, UNHS – Universal Newborn Hearing Screening.
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