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Evaluating the feasibility of integrating salivary testing for congenital CMV into the Newborn Hearing Screening Programme in the UK

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Abstract

Congenital cytomegalovirus (cCMV) accounts for 20 % of all childhood sensorineural hearing loss (SNHL) but is not routinely tested for at birth. Valganciclovir has been shown to prevent hearing deterioration and improve neurocognitive outcomes if started in the first month of life. This study aimed to assess the feasibility of integrating testing for cCMV using salivary swabs into the Newborn Hearing Screening Programme (NHSP). Parents of newborns <22 days old in South West London, who were referred after their initial newborn hearing screen for further audiological testing, were approached by hearing screeners to obtain a saliva sample for CMV DNA polymerase chain reaction (PCR). Eighty percent (203/255) of newborns who were eligible had a saliva swab taken by the hearing screener. Over 99 % of results were delivered within the first month of life. Two newborns were identified with cCMV and both seen on day 10 of life by the paediatric specialist. All saliva samples tested delivered a result using real-time PCR.

Conclusion: It is feasible for hearing screeners to obtain saliva swabs to test for CMV DNA using real-time PCR in newborns referred after their initial hearing screen. Rapid diagnostic testing for cCMV needs a more detailed clinical and cost-effectiveness analysis.

What is Known:

• Congenital CMV (cCMV) is the most common congenital infection in the developed world but is not routinely screened for at birth.

• Treatment with oral valganciclovir has been shown to prevent hearing deterioration and improve neurodevelopmental outcomes if started in the first month of life.

What is New:

• This study shows that it is feasible for hearing screeners to obtain saliva swabs to test for CMV DNA using real-time PCR in newborns.

• Salivary samples testing for cCMV integrated into the Newborn Hearing Screening Programme enable timely diagnosis and treatment of this condition.

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Fig. 1

Abbreviations

AABR:

Automated auditory brainstem response

AOAE:

Automated otoacoustic emission

cCMV:

Congenital cytomegalovirus

CNS:

Central nervous system

NHSP:

Newborn Hearing Screening Programme

PIS:

Participant information sheet

SNHL:

Sensorineural hearing loss

PCR:

Polymerase chain reaction

RCT:

Randomised Controlled trial

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Acknowledgments

The authors would like to thank the Newborn Hearing Screeners in south west London, the diagnostic staff at Virology department at the Royal Free Hospital London and CMV Action for all their support.

Conflict of interest

The authors have no conflicts of interest to disclose

Funding

This project has received funding from Sparks, the Children’s Medical Research Charity under grant agreement No. 09NGH01.

Authors Contributions

S.K, S.L and M.S concieved the study. S.K, S.L, A.D, S.W, J.B, E.W, P.G and M.S designed thestudy. S.W, C.A, C.A, L.S were involved in data collection. S.K performed the data analysis. S.K produced thefirst draft of the mansucript and all authors critically apprasied the final verison.

Author information

Authors and Affiliations

  1. Paediatric Infectious Diseases Research Group, St George’s University of London, Cramer Terrace, London, SW17 0RE, UK

    Seilesh Kadambari, Suzanne Luck, Laura Stimson & Mike Sharland

  2. Director Population Health Science, Public Health England, London, UK

    Adrian Davis

  3. St Helier Hospital, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK

    Simone Walter

  4. Croydon University Hospital, 530 London Rd, Thornton Heath, Surrey, CR7 7YE, UK

    Charlotte Agrup

  5. Department of Virology, Royal Free Hospital, Pond St, London, NW3 2QG, UK

    Claire Atkinson & Paul Griffiths

  6. Royal Victoria Infirmary, Queen Victoria Rd, Newcastle Upon Tyne, Tyne and Wear, NE1 4LP, UK

    Eleri Williams & Janet Berrington

  7. Kingston NHS Trust, Galsworthy Road, Kingston Upon Thames, Surrey, KT2 7QB, UK

    Suzanne Luck

Authors
  1. Seilesh Kadambari
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  2. Suzanne Luck
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  3. Adrian Davis
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  4. Simone Walter
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  5. Charlotte Agrup
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  6. Claire Atkinson
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  7. Laura Stimson
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  8. Eleri Williams
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  9. Janet Berrington
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  10. Paul Griffiths
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  11. Mike Sharland
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Corresponding author

Correspondence to Seilesh Kadambari.

Additional information

Communicated by David Nadal

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Kadambari, S., Luck, S., Davis, A. et al. Evaluating the feasibility of integrating salivary testing for congenital CMV into the Newborn Hearing Screening Programme in the UK. Eur J Pediatr 174, 1117–1121 (2015). https://doi.org/10.1007/s00431-015-2506-8

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  • DOI: https://doi.org/10.1007/s00431-015-2506-8

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