title: Feasibility and acceptability of targeted screening for congenital CMV-related hearing loss.
abstract: BACKGROUND
  Congenital cytomegalovirus (cCMV) is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. Ganciclovir has been shown to prevent the continued deterioration in hearing of children with symptomatic cCMV, but some children with cCMV-related SNHL are unidentified in the neonatal treatment period. Neonatal cCMV screening provides an opportunity to identify infants with cCMV-related SNHL who might benefit from early treatment.
  
  
  OBJECTIVE
  To assess the feasibility (ability to take samples before 3 weeks of age and clinical assessment by 30 days of age) and acceptability (maternal anxiety) of targeted CMV testing of infants who are 'referred' for further audiological testing after routine newborn hearing screening programme (NHSP).
  
  
  METHODS
  Parents of infants who have 'no clear responses' on routine NHSP before 22 days of life in London and North East England were approached. Salivary and urine samples were tested by CMV PCR. At recruitment and 3 months, the short form Spielberger State-Trait Anxiety Inventory measured maternal anxiety.
  
  
  RESULTS
  411 infants were recruited. 99% (407/411) returned a sample; 98% (404/411) successfully yielded a CMV result, 6 had cCMV, all diagnosed on salivary samples taken <22 days of age (1.5%; 95% CI 0.6% to 3.2%). Only 50% returned urine samples compared with 99% returning salivary samples (p<0.001). Using saliva swabs 98% were successfully screened for CMV within 3 weeks. All positive screening CMV results were known by day 23, and 5/6 infants with cCMV were assessed within 31 days. Anxiety was not increased in mothers of infants screened for cCMV.
  
  
  CONCLUSIONS
  Targeted salivary screening for cCMV within the NHSP is feasible, acceptable and detects infants with cCMV-related SNHL who could benefit from early treatment.
authors.affiliation: Department of Paediatric Immunology and Infectious Diseases, Great North Childrens Hospital, Royal Victoria Hospital, , Newcastle-upon-Tyne, UK.
authors.forename: Eleri J
authors.initials: EJ
authors.lastname: Williams
authors.forename: Seilesh
authors.initials: S
authors.lastname: Kadambari
authors.forename: Janet E
authors.initials: JE
authors.lastname: Berrington
authors.forename: Suzanne
authors.initials: S
authors.lastname: Luck
authors.forename: Claire
authors.initials: C
authors.lastname: Atkinson
authors.forename: Simone
authors.initials: S
authors.lastname: Walter
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Embleton
authors.forename: Peter
authors.initials: P
authors.lastname: James
authors.forename: Paul
authors.initials: P
authors.lastname: Griffiths
authors.forename: Adrian
authors.initials: A
authors.lastname: Davis
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Julia E
authors.initials: JE
authors.lastname: Clark
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis; D003586:Cytomegalovirus Infections / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy; D004739:England; D005240:Feasibility Studies; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006319:Hearing Loss, Sensorineural / Q000151:congenital* / Q000175:diagnosis; D006320:Hearing Tests / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology; D015997:Neonatal Screening / Q000379:methods*; D016133:Polymerase Chain Reaction; D012463:Saliva / Q000821:virology*; D018709:Statistics, Nonparametric; D013997:Time Factors; D014556:Urine / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
keywords: CMV; Congenital cytomegalovirus; deafness; screening; sensorineural hearing loss