Delays in diagnosis and treatment initiation for congenital cytomegalovirus infection - why we need universal screening
File(s)
Published version
Author(s)
Alifieraki, Styliani
Payne, Helen
Hathaway, Chantal
Wei Ying Tan, Rachel
Lyall, Hermione
Type
Journal Article
Abstract
Introduction: Congenital cytomegalovirus (cCMV) is the leading cause of neurodevelopmental and hearing impairment from in-utero infection. Late diagnosis results in limited treatment options and may compromise long-term outcome.
Methods: A retrospective audit of infants with cCMV referred to a Tertiary Paediatric Infectious Diseases centre from 2012-2021. Data collected included timing of diagnostics, treatment initiation and reasons for delays.
Results: 90 infants with confirmed cCMV were included, 46/90 (51%) were symptomatic at birth. Most common reasons for diagnostics in asymptomatic infants were failed newborn hearing screening (17/44, 39%) and antenatal risk-factors (14/44, 32%). Median age at cCMV diagnosis was 3 (range 0-68) and 7 (0-515) days, with median referral age 10 (1-120) and 22 (2-760) days for symptomatic and asymptomatic infants respectively. There was a significant risk of delay in diagnosis (>21 days) for asymptomatic infants [RR 2.93 (1.15-7.45); p=0.02]. Of asymptomatic infants who received treatment, 13/24 (54%) commenced it within 28 days of life, a significant delay in treatment compared to 30/36 (83%) symptomatic infants [RR 2.75 (1.18-6.43); p=0.02]. The commonest reason for delayed treatment initiation was delayed first diagnostic test for both symptomatic 4/6 (67%) and asymptomatic infants 9/11 (82%).
Conclusions: Delays in diagnosis and treatment for cCMV are unacceptably frequent and significantly higher in asymptomatic infants. Our study highlights the need for increased awareness among healthcare professionals, reconsideration of age-targets for Newborn Hearing Screening, and research that addresses the barriers to implementation of universal screening, which would ultimately facilitate prompt diagnosis and management of all infants with cCMV.
Methods: A retrospective audit of infants with cCMV referred to a Tertiary Paediatric Infectious Diseases centre from 2012-2021. Data collected included timing of diagnostics, treatment initiation and reasons for delays.
Results: 90 infants with confirmed cCMV were included, 46/90 (51%) were symptomatic at birth. Most common reasons for diagnostics in asymptomatic infants were failed newborn hearing screening (17/44, 39%) and antenatal risk-factors (14/44, 32%). Median age at cCMV diagnosis was 3 (range 0-68) and 7 (0-515) days, with median referral age 10 (1-120) and 22 (2-760) days for symptomatic and asymptomatic infants respectively. There was a significant risk of delay in diagnosis (>21 days) for asymptomatic infants [RR 2.93 (1.15-7.45); p=0.02]. Of asymptomatic infants who received treatment, 13/24 (54%) commenced it within 28 days of life, a significant delay in treatment compared to 30/36 (83%) symptomatic infants [RR 2.75 (1.18-6.43); p=0.02]. The commonest reason for delayed treatment initiation was delayed first diagnostic test for both symptomatic 4/6 (67%) and asymptomatic infants 9/11 (82%).
Conclusions: Delays in diagnosis and treatment for cCMV are unacceptably frequent and significantly higher in asymptomatic infants. Our study highlights the need for increased awareness among healthcare professionals, reconsideration of age-targets for Newborn Hearing Screening, and research that addresses the barriers to implementation of universal screening, which would ultimately facilitate prompt diagnosis and management of all infants with cCMV.
Date Issued
2022-09-14
Date Acceptance
2022-08-16
Citation
Frontiers in Pediatrics, 2022, 10
ISSN
2296-2360
Publisher
Frontiers Media
Journal / Book Title
Frontiers in Pediatrics
Volume
10
Copyright Statement
© 2022 Alifieraki, Payne, Hathaway, Tan and Lyall. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Subjects
Science & Technology
Life Sciences & Biomedicine
Pediatrics
congenital cytomegalovirus
infants
neurodevelopmental impairment
hearing loss
delays
universal screening
DRIED BLOOD SPOTS
HEARING-LOSS
CMV INFECTION
SEQUELAE
CHILDREN
VALGANCICLOVIR
PREVALENCE
MANAGEMENT
THERAPY
DISEASE
congenital cytomegalovirus
delays
hearing loss
infants
neurodevelopmental impairment
universal screening
1114 Paediatrics and Reproductive Medicine
1199 Other Medical and Health Sciences
Publication Status
Published
Article Number
ARTN 988039