Cytomegalovirus is the most common congenital infection, affecting
about one in 150 children or 30,000 newborns in the United States each year. In
Utah that equates to roughly one baby born per day.
An infant born with the infection often shows no symptoms or signs;
most of those infants do not experience any long-term effects. But the
virus can potentially damage the brain, eyes and inner ear. It is
estimated that 6% to 30% of hearing loss in children may
be due to congenital CMV, making it the leading non-genetic cause of
hearing loss in the United States.
‘How implementation of a state-wide screening can pick up hearing loss in infants due to congenital cytomegalovirus has been elaborated in a new study.’
A Utah law has led to increased early identification of infants with
hearing loss due to a congenital infection, according to a new study by
University of Utah and Utah Department of Health researchers.
The study, published in Pediatrics
, is the first to
assess how implementation of a state-wide screening can pick up hearing
loss in infants due to congenital cytomegalovirus (CMV). Utah, which has
the nation's highest birth rate, was the first state to mandate CMV
screening for infants who fail newborn hearing tests. The Utah law is
proving a model for other states.
"Our study demonstrates that policy changes such as the one in Utah
that required CMV testing after failed newborn hearing screening can
improve the identification of infants with hearing loss, even those
without congenital CMV," said Marissa Diener, lead author and associate
professor at the University of Utah's Department of Family and Consumer
"This is important because timely identification of hearing
loss can enable earlier intervention, which is linked to better language
outcomes for children."
The Utah legislation also provided funds for educational campaigns
surrounding congenital CMV, which is important given its prevalence,
"Although congenital Zika infection is less prevalent in the United States
than CMV, many people have heard of the Zika virus but fewer are
familiar with cytomegalovirus," Diener said.
In 2013, Utah became the first state to enact a public health
initiative requiring CMV education and testing. The Utah Department of
Health was tasked with creating a program about birth defects associated
with and ways to prevent congenital CMV.
"CMV is transmitted through body fluids. Washing your hands often,
especially after wiping a young child's nose, mouth or tears or changing
diapers is important, said Stephanie Browning McVicar, co-author and
director of the Cytomegalovirus Public Health Initiative at the Utah
Department of Health. "What is also essential, though, is not sharing
food, drink or utensils, particularly with young children, while
The bill also requires all infants who fail two hearing screens to
be tested for CMV within three weeks of birth unless a parent declines
By using that time frame, health providers are able to distinguish
between congenital CMV and CMV acquired after birth, which is rarely
associated with health problems. The screening parameters also are
designed to identify infants who do not have any symptoms but are most
at risk for hearing loss.
The researchers used Utah Department of Health and Vital Records
data to assess whether 509 asymptomatic infants who failed hearing tests
between July 1, 2013 and June 30, 2015 underwent CMV screening and the
results of that screening.
They found that 62% of these infants were tested for CMV and
three-quarters were screened within the three-week time frame. Fourteen
of those infants were CMV positive and six had hearing loss. Of the
infants who were tested more than 21 days after birth, seven were CMV
positive and three had hearing loss.
The researchers conclude that because these infants had no signs of
infection, it is "highly likely" they would not have been diagnosed
later as having congenitally acquired CMV. Identification of
CMV-positive infants increased opportunities to watch their health more
closely and intervene, when needed, more quickly. They also found more
infants received timely diagnostic hearing tests after the law took
"This result has major implications for all children who fail their
newborn hearing screening since speech and language outcomes depend upon
early hearing loss diagnosis," said Albert Park, co-author and chief of
the U's pediatric otolaryngology division. "CMV infected infants with
hearing loss may benefit from antiviral therapy. This question will
hopefully be addressed in an upcoming NIH funded clinical trial that our
group will be conducting to compare hearing, speech and language
outcomes in CMV infected infants."
The researchers suggest, based on
their analysis of the data, that screening compliance could be increased
by focusing educational and outreach efforts on certain groups who were
less likely to get their infants screened for congenital CMV: less
educated mothers, babies not born in a hospital and infants who received
hearing tests later than 14 days after birth.