582 - Targeted Urine Screening for Congenital Cytomegalovirus Infection in High-Risk Neonates

Publication Number: 582.6709

Midori Hijikata, Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan; Nobuhiko Nagano, Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan; Hidetoshi Go, Nihon University School of Medicine, Itabashi, Tokyo, Japan; Kazumasa Fuwa, Nihon University, Nerima-ku, Tokyo, Japan; Aya Okahashi, Nihon university school of medicine, Itabashi-ku, Tokyo, Japan; Ichiro Morioka, Nihon University School of Medicine, Itabashi, Tokyo, Japan

Background: Congenital cytomegalovirus (cCMV) is the most prevalent perinatal infection. Given the critical time constraints for diagnosis and treatment initiation, accurate identification of neonates with congenital infection at birth has become increasingly important.

Objective: This study aimed to elucidate the incidence of cCMV infection in high-risk neonates, specifically focusing on those born small for gestational age (SGA) and those who did not pass newborn hearing screening (NHS) using auto-auditory brainstem response (aABR) testing.

Design/Methods: The study was performed at a single medical institution between 2019 and 2023. We evaluated the SGA neonates well as those with reference results from aABR testing. SGA was defined as birth weight below the 10th percentile of the gestational age. Urine samples were collected from these neonates within the first 21 days of life and tested for CMV nucleic acids to detect cCMV infection. Neonates that tested positive for CMV were further evaluated to determine whether they exhibited symptomatic or asymptomatic infections. The comprehensive diagnostic evaluations included brain imaging, ophthalmological examinations, and regular precision ABR testing.

Results: The neonatal characteristics are presented in Table 1. Urine samples from 352 SGA neonates were screened during the study. The median gestational age was 37 weeks (range: 27–41 weeks), and the median birth weight was 2,060 g (range: 546–2,830 g). Seven neonates (2.0%) tested positive for CMV; of these, four (57%) were diagnosed with asymptomatic infection, while the remaining three (43%) were diagnosed with symptomatic infection. Among the 112 neonates who did not pass the aABR testing, the median gestational age was 38 weeks (range: 31–41 weeks) and the median birth weight was 2,976 g (range: 1,953–3,848 g). Two neonates (1.8%) were CMV-positive, and both cases (100%) were symptomatic. For the 22 neonates who underwent SGA and failed NHS, the median gestational age was 38 weeks (range: 25–41 weeks) and the median birth weight was 2,264 g (range: 356–2,520 g). Three neonates (13.6%) tested positive for cCMV and all (100%) exhibited symptomatic infection(Figure 1).

Conclusion(s): SGA neonates and those with reference results for aABR represent a high-risk for cCMV infection. The combination of both SGA and failed aABR significantly amplified the risk, resulting in a sevenfold increase in cCMV detection rates compared to either risk factor alone. These findings underscore the necessity of targeted CMV screening in high-risk groups, particularly in those demonstrating both risk factors.

Table1
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Figure1
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