Abstract Details
10/09/2023 | 10:30 AM - 10:55 AM | 6619
Cranial Ultrasound Comparisons in Asymptomatic and Symptomatic Infants Identified in a Universal Congenital Cytomegalovirus Screening Study in Minnesota
Abstract Summary
Background: Congenital cytomegalovirus (cCMV) is the most common infectious cause of neurodevelopmental deficits, including sensorineural hearing loss (SNHL). With the implementation of universal congenital cytomegalovirus (cCMV) screening in Minnesota in February 2023, it is imperative to define the optimal diagnostic approach for disease classification of identified cases. Cranial ultrasound (US) is a safe, non-invasive technique to examine neonatal brains, and has been advocated by an international consensus panel as a modality for cCMV disease classification. Method: Newborns were screened for cCMV at six Minnesota nurseries by PCR of dried blood spots (DBS) and saliva. Screen-positive infants had confirmatory urine PCR by day of life 21, and a diagnostic evaluation which included cranial ultrasound. Results: From February 2016-December 2022, of 23,644 screened newborns, 87 (3.7 per 1,000) had confirmed cCMV. 68 (78%) were asymptomatic (2 with delayed SNHL), 4 were asymptomatic with isolated SNHL at birth, 9 were mildly symptomatic, and 6 had moderate-to-severe symptomatic disease (2 with SNHL at birth and 2 with delayed SNHL). Cranial US exams were available for 76 infants (57 asymptomatic, 19 with cCMV disease). 53 infants had a normal US; 23 infants had an abnormal US. In infants with any clinical cCMV manifestation at birth, 14 of 19 had at least one abnormal US finding, versus 9 of 57 asymptomatic infants (p<0.0001, Fischer’s exact). Five infants with US abnormalities defined cases as symptomatic cCMV (DOI: 10.1016/S1473-3099(17)30143-3). Conclusion: PCR of newborn DBS and/or saliva revealed a prevalence of 3.7 per 1000 in a universal cCMV screening study. Among babies with cCMV, the majority had a normal cranial US, and most abnormalities were not pathognomonic for cCMV disease. Clarification is needed regarding which cranial US findings require detailed follow-up, including MRI, as universal cCMV screening programs move forward in clinical practice.
Learning Objectives
- Determine clinical manifestations of congenital cytomegalovirus in infants identified in the context of a universal screening study.
- Characterize cranial ultrasound findings observed during diagnostic evaluation of confirmed congenital cytomegalovirus cases.
- Examine relationships between viral load in saliva samples with clinical findings.
Presentation
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Presenters
Rebecca Kruc | Primary Presenter
krucx003@umn.edu;
Rebecca Kruc MD, MPH is a resident in pediatrics at the Mayo College of Medicine. Her background is in public health. She previously worked in enteric infectious diseases at the Minnesota Department of Health. She also previously worked for the Centers for Disease Control in New York City doing tuberculosis control and prevention, as well as in Arizona doing public health emergency preparedness.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Nelmary Hernandez-Alvarado | Author
hernande@umn.edu;
Ms. Hernandez-Alvarado is a molecular biology and Director of a CLIA-certified CMV diagnostic laboratory at the University of Minnesota. She has considerable expertise in detection of CMV and in the clinical manifestations of congenital and neonatal CMV infections.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Erin Osterholm | Author
oste0123@umn.edu;
Dr. Osterholm is Medical Director of the Newborn Intensive Care Unit at the University of Minnesota Medical School and a faculty member in the Division of Neonatology. She is interested in the clinical implications of CMV on neurodevelopment in both preterm and term infants.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Mark R. Schleiss | Author
schleiss@umn.edu ;
Dr. Schleiss is a Professor of Pediatrics and holds the American Legion and Auxiliary Endowed Research Chair at the University of Minnesota Medical School. His laboratory is supported by the NIH. He conducts research in small animal models testing vaccine strategies against congenital CMV infection. His laboratory is also engaged in the study of the epidemiology, pathogenesis and management of congenital and neonatal CMV infections.
ASHA DISCLOSURE
Financial - Receives Grants for Other activities from Moderna Vaccines.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - Receives support from Moderna Vaccines for Grant support, but no personal fees..