1. Screening for seemingly healthy newborns with congenital cytomegalovirus infection by quantitative real-time polymerase chain reaction using newborn urine: an observational study
- Author
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Jutaro Fujita, Takashi Arai, Hidetoshi Fujita, Jiro Matsumoto, Akira Yamaguchi, Tsutomu Oh-ishi, Tadashi Uesato, Hideaki Sakata, Hirofumi Kimoto, Nodoka Adachi, Ken Shirato, Takako Kizaki, Hideki Ohno, Satoshi Asanuma, and Eiji Oguma
- Subjects
Central Nervous System ,Male ,Pediatrics ,medicine.medical_specialty ,Hearing loss ,Urinary system ,Hearing Loss, Sensorineural ,Congenital cytomegalovirus infection ,Cytomegalovirus ,Urine ,universal screening ,Real-Time Polymerase Chain Reaction ,Asymptomatic ,Congenital Abnormalities ,congenital cytomegalovirus infection ,03 medical and health sciences ,0302 clinical medicine ,Neonatal Screening ,Hearing ,Japan ,medicine ,otorhinolaryngologic diseases ,Evoked Potentials, Auditory, Brain Stem ,Humans ,030212 general & internal medicine ,quantitative real-time PCR ,Diagnostics ,hearing loss ,business.industry ,Incidence (epidemiology) ,Research ,Incidence ,Infant, Newborn ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,White Matter ,Immunology ,Cytomegalovirus Infections ,DNA, Viral ,Sensorineural hearing loss ,Observational study ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Objective Approximately 8–10% of newborns with asymptomatic congenital cytomegalovirus (cCMV) infection develop sensorineural hearing loss (SNHL). However, the relationship between CMV load, SNHL and central nervous system (CNS) damage in cCMV infection remains unclear. This study aimed to examine the relationship between urinary CMV load, SNHL and CNS damage in newborns with cCMV infection. Study design The study included 23 368 newborns from two maternity hospitals in Saitama Prefecture, Japan. Urine screening for cCMV infection (quantitative real-time PCR) and newborn hearing screening (automated auditory brainstem response (AABR) testing) were conducted within 5 days of birth to examine the incidence of cCMV infection and SNHL, respectively. CNS damage was assessed by MRI of cCMV-infected newborns. Results The incidence of cCMV infection was 60/23 368 (0.257%; 95% CI 0.192% to 0.322%). The geometric mean urinary CMV DNA copy number in newborns with cCMV was 1.79×106 copies/mL (95% CI 7.97×105 to 4.02×106). AABR testing revealed abnormalities in 171 of the 22 229 (0.769%) newborns whose parents approved hearing screening. Of these 171 newborns, 22 had SNHL (12.9%), and 5 of these 22 were infected with cCMV (22.7%). Newborns with both cCMV and SNHL had a higher urinary CMV DNA copy number than newborns with cCMV without SNHL (p=0.036). MRI revealed CNS damage, including white matter abnormalities, in 83.0% of newborns with cCMV. Moreover, newborns with CNS damage had a significantly greater urinary CMV load than newborns without CNS damage (p=0.013). Conclusions We determined the incidence of cCMV infection and urinary CMV DNA copy number in seemingly healthy newborns from two hospitals in Saitama Prefecture. SNHL and CNS damage were associated with urinary CMV DNA copy number. Quantification of urinary CMV load may effectively predict the incidence of late-onset SNHL and neurodevelopmental disorders.
- Published
- 2017