Assessing Impact of cCMV Infection on Development and Language in Infants Identified by a Universal Screening Program

Lifelong disabilities are caused by congenital cytomegalovirus (cCMV) infection; thus, there is a need to develop data-driven, rational newborn screening and intervention policies. The practice of targeted screening for cCMV – based on signs and symptoms of disease (included a failed newborn hearing screen) at birth – has been advocated by many groups. However, many cases of cCMV-associated sensorineural hearing loss (SNHL) become clinically and audiologically evident only beyond the neonatal period, and
hence would be missed by targeted screening. Thus, universal screening for cCMV has been advocated by many, toward the goals of identifying infants at risk for SNHL (who might otherwise be missed) and offering early intervention to prevent the attendant speech, language and academic achievement deficits.

Our overarching hypothesis is that cCMV causes unrecognized disability in the context of SNHL that goes undetected, and unrecognized, subtle but important cognitive impairment in infants that has heretofore been considered ‘asymptomatic’. We will take advantage of a unique universal cCMV screening project currently ongoing in Minnesota to address these unmet needs and generate new knowledge about the scope of the impact of cCMV infection on SNHL and development. We will examine the impact of increased early identification and intervention on the language and developmental outcomes of children with cCMV infection and SNHL in our universal screening cohort.

A surveillance system will be established that will track the impact of cCMV-associated hearing loss in children for 3 years. This will provide information regarding hearing loss remediation method, prevalence on delayed-onset and progressive hearing loss in children, and long-term academic and educational outcomes. This work will be done in collaboration with the Minnesota Department of Health Early Hearing Detection and Intervention surveillance program.

We will also assess neurodevelopmental consequences of cCMV infection in partnership with the Center for Neurobehavioral Development at the UMN. Electrophysiologic and behavioral data will be obtained, as well as determination of Bayley Scales of Infant Development. Metrics will include developmental and language outcomes (IQ score, receptive and expressive language scores, reading score, documentation of academic achievements and impact of early childhood intervention).