title: Congenital cytomegalovirus infection as a cause of sensorineural hearing loss in a highly immune population.
abstract: BACKGROUND
  The burden of congenital cytomegalovirus (CMV)-associated sensorineural hearing loss (SNHL) in populations with CMV seroprevalence approaching 100% is unknown. The purpose of this study was to assess the rate, associated factors, and predictors of SNHL in CMV-infected infants identified by newborn screening in a highly seropositive maternal population.
  
  
  METHODS
  Newborns with positive saliva CMV-DNA that was confirmed by virus isolation in the first 2 weeks of life were enrolled in a prospective follow-up study to monitor hearing outcome.
  
  
  RESULTS
  Of 12,195 infants screened, 121 (1%) were infected with CMV and 12 (10%) had symptomatic infection at birth. Hearing function could be assessed in 102/121 children who underwent at least one auditory brainstem evoked response testing at a median age of 12 months. SNHL was observed in 10/102 (9.8%; 95% confidence interval: 5.1-16.7) children. Median age at the latest hearing evaluation was 47 months (12-84 months). Profound loss (>90 dB) was found in 4/5 children with bilateral SNHL while all 5 children with unilateral loss had moderate to severe deficit. The presence of symptomatic infection at birth (odds ratio, 38.1; 95% confidence interval: 1.6-916.7) was independently associated with SNHL after adjusting for intrauterine growth restriction, gestational age, gravidity, and maternal age. Among 10 infants with SNHL, 6 (60%) were born to mothers with nonprimary CMV infection.
  
  
  CONCLUSIONS
  Even in populations with near universal immunity to CMV, congenital CMV infection is a significant cause of SNHL demonstrating the importance of CMV as a major cause of SNHL in children worldwide. As in other populations, SNHL is more frequently observed in symptomatic CMV infection.
authors.affiliation: Faculty of Medicine of Ribeirão Preto, Department of Pediatrics, University of São Paulo, São Paulo, Brazil. yulie@fmrp.usp.br
authors.forename: Aparecida Y
authors.initials: AY
authors.lastname: Yamamoto
authors.forename: Marisa Marcia
authors.initials: MM
authors.lastname: Mussi-Pinhata
authors.forename: Myriam de Lima
authors.initials: Mde L
authors.lastname: Isaac
authors.forename: Fabiana R
authors.initials: FR
authors.lastname: Amaral
authors.forename: Cristina G
authors.initials: CG
authors.lastname: Carvalheiro
authors.forename: Davi C
authors.initials: DC
authors.lastname: Aragon
authors.forename: Alessandra K da Silva
authors.initials: AK
authors.lastname: Manfredi
authors.forename: Suresh B
authors.initials: SB
authors.lastname: Boppana
authors.forename: William J
authors.initials: WJ
authors.lastname: Britt
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital* / Q000453:epidemiology / Q000276:immunology; D016057:Evoked Potentials, Auditory, Brain Stem; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D006801:Humans; D007231:Infant, Newborn; D012463:Saliva / Q000821:virology