Diagnostic Clues for Congenital Cytomegalovirus Infection: Association with Newborn Hearing Screening Tests

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.

Neonatal Hearing Screening in Neonatal Intensive Care Unit Graduate

PURPOSE: Hearing loss is one of the common birth defects in humans, with a reported prevalence of 1-3 per 1000 newborns. We investigated the incidence of hearing loss and evaluated the use of neonatal hearing screening test in neonatal intensive care unit (NICU) graduates who are at greater risk for hearing loss than normal newborns. METHODS: The neonates admitted to the NICU of Asan Medical Center from 1 March, 2003 to 30 March, 2008 who were available for follow-up were included. Those who failed the first auditory brainstem response prior to discharge were retested with the stapedial reflex test, auditory brainstem response and tympanometry in the Otolaryngology department. RESULTS: Of 2,137 neonates, 2,000 (93.5%) neonates were tested prior to discharge. Sixty-seven neonates (3.4%) failed the first newborn hearing screening test. Of 67 infants, 52 infants were retested for a second hearing test. Excluding 10 infants (19.2%) who were lost during follow-up, 16 infants were confirmed to have hearing impairment of which 12 and 4 infants had unilateral and bilateral hearing loss, respectively. Of 16 infants, 5 did not meet the criteria set by the Korean National Health Insurance Corporation. CONCLUSION: The prevalence of hearing impairment in NICU graduates is about 0.8%, excluding those who were lost for follow up, necessitating a systemic and effective hearing assessment program among these high risk infants and more generous national insurance coverage.

Analysis of newborn hearing screening using automated auditory brainstem response / 소아과

PURPOSE: As hearing ability affects language and cognitive development, early detection and intervention of congenital hearing defects is very important. We analyzed the result of newborn hearing screening using automated auditory brainstem response and estimated the incidence of congenital hearing defects in newborn infants in Korea. METHODS: Hearing screening tests were done on 7,218 newborn infants who were delivered at Cheil General Hospital from July 1, 2004 to June 30, 2005. The first screening test was done on the second day of life with automated auditory brainstem response(AABR) using ALGO(3) Newborn hearing screener(Natus(R) Medical Incorporated, San Carlos, USA) with 35 dB sound level. The newborn infants who did not pass the initial screening test took the second screening AABR test before discharge from the nursery. Infants who did not pass these screenings at the nursery were followed up at the Department of Otorhinolaryngology, Samsung Seoul Hospital. RESULTS: Total 7,218 infants(83.3 percent of total 8,664 live births of the Cheil General Hospital) were screened in the nursery, and 55 of them failed to pass the newborn screening. Among 55 infants who were referred, six were lost during follow-up, and 14 were confirmed as hearing impaired. Six of them(42.8 percent) do not have any risk factors for hearing impairment. We can estimate that the incidence of hearing defects is about 1.9-2.8 per 1,000 live births. CONCLUSION: Automated auditory brainstem response is an effective tool to screen the hearing of newborn infants. Congenital hearing loss is more frequent than metabolic diseases on which screening tests are available in the newborn period. About 40 percent of infants who have hearing defects do not have any risk factors for hearing impairment. Therefore, universal newborn hearing screening must be recommended to all neonates.

Investigation of Automated Neonatal Hearing Screening for Early Detection of Childhood Hearing Impairment / 소아과

PURPOSE: Early diagnosis of congenital hearing loss through the neonatal hearing screening test minimizes language defect. This research intends to identify frequency of congenital hearing loss in infants through neonatal hearing screening test with the aim of communicating the importance of hearing test for infants. METHODS: From May 20, 2003 to May 19, 2004, infants were subjected to Automated Auditory Brainstem Response test during one month of birth to conduct the test with 35 dB sound. Infants who passed the 1st round of hearing test, were classified into 'pass' group whereas those who did not were classified into 'refer' group. Infants who did not 'pass' in the hearing test conducted within one month of birth were subjected to re-test one month later, and if classified as 'refer' during the re-test, they were subjected to the diagnosis for validation of hearing loss by requesting test to the hearing loss clinic. RESULTS: There was no difference among the 'pass' and 'refer' group in terms of form of childbirth, weight at birth and gestational age. In the 1st test, total of 45 infants were classified into 'refer' group. Six among 35 who were subjected to re-test (17%) did not pass the re-test, and all were diagnosed with congenital hearing loss. This corresponds to 0.35% (3.5 per 1, 000) among total number of 1, 718 subjects. CONCLUSION: In our study the congenital hearing loss tends to be considerably more frequently than congenital metabolic disorder. Accordingly, newly born infants are strongly recommended to undergo neonatal hearing screening test.

Newborn Hearing Screening: 3 Years of Experience

PURPOSE: Hearing loss is one of the most common major abnormalities present at birth, which has an incidence of 1 to 3 per 1,000 newborn infants in the well-baby nursery population, and 2 to 4 per 1,000 infants in the intensive care unit population each year. If early undetected, will impede speech and language. The purpose of this study was to confirm in prevalence of neonatal hearing loss and to establish a common screening method adjusted to our country and to emphasize the importance of early detection. MATERIALS AND METHODS: TEOAE (transient evoked otoacoustic emission) were performed in 5,512 newborn infants in the well-baby nursery. The tests were performed daily until the infant had passed. Failed infants were followed at the outpatient clinic for re-tests. ABRs were performed for the confirmation of hearing loss those who had failed 3 TEOAE tests. RESULTS: The average test durations for right and left TEOAE were 67+/-50 sec and 72+/-56 sec respectively. There was no difference in test durations of the first TEOAE between before 24 hours and after 24 hours of life. 89% of tested infants passed during admission and the rest were followed at the outpatient clinic for the further studies. Eight infants were diagnosed with hearing loss on ABR. Overall time spent for the diagnosis of hearing loss was less than 3 months. CONCLUSION: TEOAE is a simple and useful screening method for the identification of hearing loss in infants. TEOAE must be necessary to universal screening of all infants.

TEOAE as a Newborn Hearing Screening / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing impairment is a common congenital disability of the newborn, which has an incidence of 1.5 to 3 per 1,000 infants each year. The identification of this problem is difficult and many of these children are not identified until 2-3 years of age if not screened at birth. The purpose of this study is to establish a common screening method adjusted to our country and to emphasize the importance of early diagnosis of neonatal hearing loss. MATERIALS AND METHODS: TEOAE were performed in 1,459 infants from March to December, 1998 at Ajou university hospital. The tests were performed daily until discharge if the infant had failed the first test, and were followed at the outpatient clinic. Hearing loss was confirmed by ABR. RESULTS: The average test time of TEOAE was 102.6 seconds. Test time after 24 hours of birth was shorter than before 24 hours, and was shorter in female compared to male infants. Pass rate after 24 hours was higher than before 24 hours and 86% of tested infants passed during admission. Thirty-one out of 213 infants failed to follow-up at the outpatient clinic. Two were diagnosed with unilateral hearing loss on ABR. CONCLUSION: TEOAE is a simple and useful screening method for the identification of hearing loss in infants.