Audiological Outcomes of Cytomegalovirus Saliva PCR-Positive Newborns in Support of Universal Screening.

Abstract

This study aims to describe the audiological outcomes of cytomegalovirus (CMV)-positive newborns detected through universal screening. Retrospective cohort. Three nurseries and a neonatal intensive care unit in Memphis, Tennessee. Data were analyzed from patients screened for congenital CMV (cCMV) by saliva polymerase chain reaction from March 2016 to May 2024. Newborns were classified based on symptoms at birth. Among 247 CMV-positive newborns (134 males, 54.2%), 77 (31.17%) were symptomatic. Among these, 16 were diagnosed with sensorineural hearing loss (SNHL): 12 bilateral SNHL (BHL), 4 with unilateral SNHL (UNHL). Three symptomatic patients developed late-onset UNHL. Four of the asymptomatic newborns developed UNHL, and one BHL, within the first year of life. Fifty-eight patients received valganciclovir. Among the patients who eventually developed SNHL, 5/10 treated experienced worsening or lack of improvement; 10/14 untreated cases showed hearing deterioration or did not improve, and 2/14 remained stable. Patients with SNHL had higher rates of microcephaly and intracranial calcifications compared to those with normal hearing but showed no differences in urine CMV viral load at birth. In the current cohort, nine patients have cochlear implants (seven bilateral, one unilateral) and four have hearing aids (three bilateral, one unilateral). Social vulnerability was associated with fewer follow-ups in patients with SNHL. This study underscores the profound impact of cCMV infection on hearing outcomes, even when asymptomatic at birth. It reinforces the importance of universal cCMV screening programs to identify infants at risk for SNHL. It also highlights the impact of social determinants of health on long-term follow-up.