EVALUATION OF A SYSTEMATIC CONGENITAL CYTOMEGALOVIRUS INFECTION SCREENING PROGRAM IN PREMATURE NEWBORNS

L. ESCOSA-GARCÍA, A. ALCOLEA,  C. COMÍN, F. OMEÑACA, M. ROMERO, M.J. GARCÍA DE MIGUEL, F.J. ARACIL, M.I. DE JOSÉ GÓMEZ,, F. BAQUERO-ARTIGAO.

HOSPITAL INFANTIL UNIVERSITARIO LA PAZ, MADRID (SPAIN).

BACKGROUND - AIMS

Cytomegalovirus (CMV) screening strategies may focus in diagnosing infection during pregnancy or in the newborn. In Spain, CMV screening of all mothers is not performed attending to undetected secondary infections during pregnancy and lacking therapeutic strategies. Two distinct neonatal screening programs exist in most European countries. Universal newborn hearing screening based programs, which is the current test in Spain, and CMV DNA test in neonatal blood collected on filter paper cards. The first strategy is insufficient  because most children with congenital CMV infection have normal hearing during the neonatal period. The second strategy has shown discrepant results and needs standardisation.

Up to 35% of congenital cytomegalovirus (CMV) infected infants are born prematurely and 50% are small for gestational age. We evaluated a urine screening in all premature newborns to optimize future screening strategies, according to insufficient detection of hearing screening programs.

METHODS

Preliminary prospective study of premature infants (<37 weeks) born in a tertiary care children’s hospital from December 2009 to December 2010. Congenital CMV infection screening was performed using a shell vial urine culture assay (Vircel®) during first week of life. Premature newborns were classified according to gestational age and birth weight. We considered small for gestational age those infants with birth weight below 10^th percentile for gestational age. Besides, all small for gestational age term infants were tested with the shell vial urine culture assay.

RESULTS

Screening was performed in 418 premature newborns.  Also 49 small for gestational age term newborns were tested. Premature newborns group:  53% male. Median gestational age: 32.7 weeks. Median birth weight: 1820 gs. ASYMPTOMATIC CONGENITAL CMV INFECTION PREVALENCE (by groups):  in All Prematures 0.24%, in Small for gestational age Prematures 2.2%, in Small for gestational age Newborns 3.2%.

CONCLUSIONS

Screening strategies to detect asymptomatic congenital cytomegalovirus infection focused on small for gestational age neonates (preterm and term) might be more cost-effective than universal prematures screening strategies to improve insufficient detection of newborn hearing screening.

Congenital and neonatal infections