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Review
. 2014 Sep;24(5):291-307.
doi: 10.1002/rmv.1790. Epub 2014 Apr 24.

Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit?

Affiliations
Review

Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit?

Michael J Cannon et al. Rev Med Virol. 2014 Sep.

Abstract

Congenital CMV infection is a leading cause of childhood disability. Many children born with congenital CMV infection are asymptomatic or have nonspecific symptoms and therefore are typically not diagnosed. A strategy of newborn CMV screening could allow for early detection and intervention to improve clinical outcomes. Interventions might include antiviral drugs or nonpharmaceutical therapies such as speech-language therapy or cochlear implants. Using published data from developed countries, we analyzed existing evidence of potential benefit that could result from newborn CMV screening. We first estimated the numbers of children with the most important CMV-related disabilities (i.e. hearing loss, cognitive deficit, and vision impairment), including the age at which the disabilities occur. Then, for each of the disabilities, we examined the existing evidence for the effectiveness of various interventions. We concluded that there is good evidence of potential benefit from nonpharmaceutical interventions for children with delayed hearing loss that occurs by 9 months of age. Similarly, we concluded that there is fair evidence of potential benefit from antiviral therapy for children with hearing loss at birth and from nonpharmaceutical interventions for children with delayed hearing loss occurring between 9 and 24 months of age and for children with CMV-related cognitive deficits. We found poor evidence of potential benefit for children with delayed hearing loss occurring after 24 months of age and for children with vision impairment. Overall, we estimated that in the United States, several thousand children with congenital CMV could benefit each year from newborn CMV screening, early detection, and interventions.

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Figures

Figure 1
Figure 1
Estimates of USA annual congenital CMV-related hearing loss, including numbers of children with hearing loss who would potentially benefit from newborn CMV screening. Boxes denoting children who would potentially benefit are shaded from lighter to darker according to a subjective rating of the increasing strength of evidence. For some, the benefit would be due to pharmaceutical treatment (i.e. those with hearing loss at birth); whereas, for the others the benefit would be due to nonpharmaceutical interventions. Because children can experience multiple disabilities, the number of children in Figures 1–3 who would potentially benefit from screening cannot necessarily be added together
Figure 2
Figure 2
Estimates of US annual congenital CMV-related cognitive deficit, including numbers of children with cognitive deficit who would potentially benefit from newborn CMV screening. Boxes denoting children who would potentially benefit are shaded from lighter to darker according to a subjective rating of the increasing strength of evidence. Because children can experience multiple disabilities, the number of children in Figures 1–3 who would potentially benefit from screening cannot necessarily be added together
Figure 3
Figure 3
Estimates of US annual congenital CMV-related vision impairment, including numbers of children with vision impairment who would potentially benefit from newborn CMV screening. Boxes denoting children who would potentially benefit are shaded from lighter to darker according to a subjective rating of the increasing strength of evidence. Because children can experience multiple disabilities, the number of children in Figures 1–3 who would potentially benefit from screening cannot necessarily be added together
Figure 4
Figure 4
Annual cases for conditions that make up the core US newborn screening panel [30], along with estimates of annual US cases of congenital CMV-related disabilities. There is some overlap among the children with hearing loss and the children with congenital CMV-related disabilities. However, children in these two groups may not be strictly comparable because newborn hearing screening typically uses >40 dB as a cutoff for hearing loss, whereas the congenital CMV literature sometimes uses a cutoff as low as >20 dB

References

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