Shannon A Ross1, Amina Ahmed2, April L Palmer3, Marian G Michaels4, Pablo J Sánchez5, Audra Stewart6, David I Bernstein7, Kristina Feja8, Karen B Fowler9, Suresh B Boppana1. 1. Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL; Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL. 2. Department of Pediatrics, Carolinas Medical Center, Charlotte, NC. 3. Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS. 4. Department of Pediatrics, University of Pittsburgh and the Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. 5. Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH. 6. Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX. 7. Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH. 8. Saint Peter's University Hospital, New Brunswick, NJ. 9. Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL.
Abstract
OBJECTIVE: To determine the utility of dried blood spot (DBS) polymerase chain reaction (PCR) in identifying infants with cytomegalovirus (CMV) infection-associated sensorineural hearing loss (SNHL). STUDY DESIGN: Newborns at 7 US hospitals between March 2007 and March 2012 were screened for CMV by saliva rapid culture and/or PCR. Infected infants were monitored for SNHL during the first 4 years of life to determine sensitivity, specificity, and positive and negative likelihood ratios of DBS PCR for identifying CMV-associated SNHL. RESULTS: DBS at birth was positive in 11 of 26 children (42%) with SNHL at age 4 years and in 72 of 270 children (27%) with normal hearing (P = .11). The sensitivity (42.3%; 95% CI, 23.4%-63.1%) and specificity (73.3%; 95% CI, 67.6%-78.5%) was low for DBS PCR in identifying children with SNHL at age 4 years. The positive and negative likelihood ratios of DBS PCR positivity to detect CMV-associated SNHL at age 4 years were 1.6 (95% CI, 0.97-2.6) and 0.8 (95% CI, 0.6-1.1), respectively. There was no difference in DBS viral loads between children with SNHL and those without SNHL. CONCLUSIONS: DBS PCR for CMV has low sensitivity and specificity for identifying infants with CMV-associated hearing loss. These findings, together with previous reports, demonstrate that DBS PCR does not identify either the majority of CMV-infected newborns or those with CMV-associated SNHL early in life.
OBJECTIVE: To determine the utility of dried blood spot (DBS) polymerase chain reaction (PCR) in identifying infants with cytomegalovirus (CMV) infection-associated sensorineural hearing loss (SNHL). STUDY DESIGN: Newborns at 7 US hospitals between March 2007 and March 2012 were screened for CMV by saliva rapid culture and/or PCR. Infected infants were monitored for SNHL during the first 4 years of life to determine sensitivity, specificity, and positive and negative likelihood ratios of DBS PCR for identifying CMV-associated SNHL. RESULTS:DBS at birth was positive in 11 of 26 children (42%) with SNHL at age 4 years and in 72 of 270 children (27%) with normal hearing (P = .11). The sensitivity (42.3%; 95% CI, 23.4%-63.1%) and specificity (73.3%; 95% CI, 67.6%-78.5%) was low for DBS PCR in identifying children with SNHL at age 4 years. The positive and negative likelihood ratios of DBS PCR positivity to detect CMV-associated SNHL at age 4 years were 1.6 (95% CI, 0.97-2.6) and 0.8 (95% CI, 0.6-1.1), respectively. There was no difference in DBS viral loads between children with SNHL and those without SNHL. CONCLUSIONS:DBS PCR for CMV has low sensitivity and specificity for identifying infants with CMV-associated hearing loss. These findings, together with previous reports, demonstrate that DBS PCR does not identify either the majority of CMV-infected newborns or those with CMV-associated SNHL early in life.
Authors: Suresh B Boppana; Shannon A Ross; Masako Shimamura; April L Palmer; Amina Ahmed; Marian G Michaels; Pablo J Sánchez; David I Bernstein; Robert W Tolan; Zdenek Novak; Nazma Chowdhury; William J Britt; Karen B Fowler Journal: N Engl J Med Date: 2011-06-02 Impact factor: 91.245
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