Importance of congenital cytomegalovirus in the neonatal hearing screening program.

INTRODUCTION: In newborns, hearing loss secondary to congenital Cytomegalovirus (CMVc) infection, despite its low prevalence, can cause a serious problem in the personal development and social integration of patients. Therefore, it is important to include the determination of CMV DNA as a neonatal screening tool. MATERIALS AND METHODS: We have carried out a 5-year retrospective study, by describing the CMVc in the Autonomous Community of the Basque Country in newborns who did not pass the hearing screening in the early hearing loss detection program. The times of detection, confirmation (incidence) and intervention (treatment) are described. RESULTS: Of 18,782 subjects studied, 58 (three per thousand live births) presented hearing loss. Of these, CMVc is guaranteed in four patients (one woman and three men). The mean time to hearing screening was 6.5 days (SD: ±3.69) and to detect CMV by polymerase chain reaction (PCR) in urine and saliva was 4.2 days (SD: ± 3.94). Time to confirm hearing loss by BAEP and audiological intervention 2.2 (SD: ±0.957) and 5 months (SD: ±3.741), respectively. Four hearing aid adaptations and one cochlear implant were performed. DISCUSSION AND CONCLUSION: Neonatal hearing screening has established itself as a good public health program. The determination of viral DNA allows an early, specific and interdisciplinary diagnosis and treatment, in which otorhinolaryngology plays a fundamental role. Our study highlights the importance of including CMV PCR as a universal screening tool.

Ultrasound of pneumothorax in neonates: Diagnostic value of the anterior transverse plane and of mirrored ribs.

INTRODUCTION: Point-of-care lung ultrasound is increasingly used to diagnose pneumothorax efficiently and safely in neonates. OBJECTIVES: This study aimed to evaluate the usefulness of the central and anterior transverse thoracic plane in the ultrasound diagnosis of pneumothorax, analyze the diagnostic value of the "mirrored ribs" sign, and evaluate the predictive value of the lung point location for the need of pleural drainage. METHODS: Retrospective cohort study of all newborns admitted to the neonatal intensive care unit of the Basurto University Hospital (Bilbao, Spain) due to respiratory distress and with ultrasound, with or without pneumothorax, between January 2014 and December 2020. RESULTS: The presence of A-lines behind the sternum in the anterior transverse plane in newborns with pneumothorax (N = 311) and controls (N = 195) was compared. A-lines were present in 98.9% of newborns with pneumothorax compared to none in the controls (p < .0001). Diagnosis of pneumothorax with the anterior transverse plane presented high interobserver reproducibility (κ = 0.92, 95% confidence interval: 0.84-1.00). In contrast, the "mirrored ribs" sign in the anterior longitudinal plane was observed in 35.6% of patients with pneumothorax and in 36.9% of controls (p = .1505). A significant association was observed between lung point location and the need for pleural drainage (p < .0001). CONCLUSIONS: A-lines in the anterior transverse plane is a simple ultrasound sign which presents high sensitivity, specificity, and reproducibility for the diagnosis of pneumothorax. The mirrored ribs sign showed low diagnostic utility. Patients with severe pneumothorax in lung ultrasound are most likely to require thoracic drainage.