Background and aims: Children with congenital cytomegalovirus (cCMV) can develop late-onset sensorineural hearing loss (LO-SNHL). In this study, we aim to assess the characteristics and predictors of LO-SNHL in infants with cCMV having normal hearing at the first neonatal assessment. Methods: A retrospective study within the European Registry of Children with cCMV (www.ccmvnet.org) was performed. Included children had cCMV and a normal first audiological assessment by Auditory Brainstem Response (ABR). Late-onset hearing loss (LO-SNHL) is defined as the presence of sensorineural hearing loss after an initial normal hearing test. Hearing evaluation was performed at birth, at 6 months of age, and at least annually up to 6 years of age. Results: Seven hundred twenty-one children with normal audiological tests at birth were included, and 47/721 (6.5%) developed LO-SNHL. LO-SNHL was diagnosed at a range of 4-65 months of age [median (IQR) age: 34.3 (15.1-48.7) months]. Children with LO-SNHL had a higher proportion of abnormalities on physical examination at birth (45.7% vs. 20.8%; P < 0.001): petechiae (17.4% vs. 6.0%; P = 0.008), splenomegaly (8.7% vs. 2.3%; P = 0.031), hepatomegaly (13% vs. 2.9%; P = 0.001), microcephaly (15.2% vs. 4.5%; P = 0.005) and small for gestational age (21.7% vs. 8.3% P = 0.005). Children with LO-SNHL showed lower platelet count at birth [177500.0 (88750.0-261250.0)/μL vs. 243500.0 (173000.0-304000.0)/μL; P = 0.012], and higher blood viral load at birth [3.7 log (3.3-4.4) vs. 3.4 log (2.7-3.9) IU/mL; P = 0.013] and had more frequent white matter involvement (27.7% vs. 14.7%; P = 0.03) and ventriculomegaly (20.7% vs. 4.6%; P = 0.001) on birth magnetic resonance imaging. Overall, symptomatic children at birth showed a higher risk of developing LO-SNHL than asymptomatic children (32/317, 10.1%, vs. 15/404, 3.7%; P < 0.0001). Among asymptomatic children, only 0.3% developed severe or profound LO-SNHL in the best ear. In multivariate logistic regression analysis, ventriculomegaly [odds ratio (OR): 7.503 (1.78-27.9)], white matter abnormalities [OR: 3.19 (1.010-9.01)], and splenomegaly [OR: 3.679 (1.56-8.506)] at birth were associated with the development of LO-SNHL (Fig. 1). Conclusions: Among this large cohort of children with cCMV and a first normal audiological assessment, the risk of LO-SNHL was 6.5%. Asymptomatic children developed LO-SNHL in 3.7% of the cases versus 10.1% in symptomatic cases. In multivariate logistic regression analysis, ventriculomegaly, white matter abnormality, and splenomegaly at birth were associated with LO-SNHL.
Prognostic Factors of Late-onset Hearing Loss in Infants With Congenital Cytomegalovirus and Normal Audiologic Assessment at Birth / D. Buonsenso, R. Pedrero-Tome, F. Raimondi, S. Salome, V. Papaevangelou, G. Syridou, M. Rios-Barnes, C. Fortuny, S. Villaverde, J. De Vergas, F. Baquero-Artigao, P. Rodriguez-Molino, M.A. Frick, B. Alvarez-Vallejo, J. Saavedra-Lozano, Y. Fougere, R. Del Valle, F. Ara-Montojo, I. Foulon, S. Mignogna, O. Muga Zuriarrain, H. Lyall, I. Vives-Onos, E. Colino, O. Tsiatsiou, E. Moliner, F. Garofoli, I. Cuadrado, D. Blazquez-Gamero, X. Bringue Espuny, P. Sanchez Pintos, E.M.M. Isidro, M.J. Garcia Garcia, A. Corredera Sanchez, M. Illan, A. Cunarro, A.F. Medina Claros, E. Moliner Calderon, B. Carazo Gallego, E. Nunez Cuadros, L. Ferreras Antolin, R. Porta, I. Sota Busselo, P. Galan Del Rio, F. Pronzato Cuello, M. Dapena, L. Castells Vilella, B. Soto, I. Cuadrado Perez, E. Rincon Lopez, E. Duenas, J. Saavedra, M. Del Mar Santos, A.M. Grande Tejada, E. Del Castillo Navio, A. Navas, B. Agundez Reigosa, A. Tagarro Garcia, L. Perez Cid, M. De La Serna Martinez, A. Belen Jimenez, O. Calavia Garsaball, E. Martin Lopez, J. Carrasco, F. Baquero, L. Escosa, T. Del Rosal, A. Montesdeoca Melian, A. Vidal Moreso, R. Diez Martin, R. Pinillos, J. Barja Tur, A. Perez Garcia, A. Alvarez De Blas, F. Garrido Martinez-Salazar, L. Munoz Saa, J. Antonio Couceiro, R. Martinez Lorenzo, J. Beceiro, F. Ara, M.B. Encinas Pardilla, M.F. Sanchez Mateos, A. Alonso Ojembrana, C.F. Gutierrez Del Alamo, J.M. Rumbao Aguirre, F. Alvarez Breciano, A. Noguera Julian, C. Fortuny Guasch, I. Olabarrieta, A. Filgueira Posse, S. Herrero Perez, M. Llorente, I. Llana Martin, O. Alfonso Rodriguez, P. Soler Palacin, P. Terol Barrero, M. Montero Martin, C. Rodrigo, C. Carreras Abad, M. Nicolas Lopez, W. Coroleu Lletget, E. Garrote Llanos, H. Uriarte Gutierrez, J.I. Rementeria Radigales, A.I. Mensalvas Ruiz, E. Cervantes, B. Croche Santander, M. Fenoy, V. Bonil Martinez, M. Garcia Reymundo, V. Vaquerizo Vaquerizo, B. Reyes Millan, D. Araceli Hernandez, D. Romero Ramirez, I. Marin Cruz, L. Falcon, B. Guach, L. Sole, J. Cantero Garcia, M. Rico Pajares, C. Guillamo, K. Badillo Navarro, L. Sanz Rueda, A. Oliver, M. Malumbres, M.N. Gonzalez Bravo, A. Hawkins, A. Gonce, D. Salvia, D. Navarri, M. Ruiz Garcia, S. Costa Lima, R. Martin, E.H. Hassan Hassan, D. Pajkrt, E. Alexander, R. Motha, V. Selimaj, V. Kennedy, F.P. Oana Gabriela, A. Hilali, M. Haras, I. Kopsidas, A. Sophie Schaper, C. Fieterna-Sperling, R. Kruger, V. Stefansson, B. Freyne, W. Ferguson, M. Buttcher, H. Karaoglu Asrak, A. Rack-Hock, F. Thomas, I. Shah, J. Kenny, J. Cohen, T. Shah, D. Husada, A. Micol, G. Lombardi, E. Williams, A. Bamford, C. Elvegaard, J. Penner, K. Bhagwandas, R. Crane, S. Kadambari, S. Mendis, W. Pagarkar, X. Li, E. Gowin, E. Vergadi, M. Lopo Tuna, A. Abu Bakar, A. Reis Melo, B. Borgstein, I. Goniotakis, W. Jan, C. Lampada, E. Roilides, K. Charisi, C. Ohomoto De Morais, A. Guri, K. Mazur-Melewska, S. Bandi, A. Vossen, S. Kottapalli, E. Gardiner, L. Capozzi, A. Fitzgerald, P. Mcmaster, S. Holland, F. Waltson, L. Pocock, M. Jasmine, S. Scott, S. Wills, B. Lindsey, C. Douglas, E. David, E. Lees, K. Dominic, L. Pollard, D. Glikman, A. Sulik, D. Lewandowski, K. Toczylowski, A. Buciak, E. Majda-Stanislawska, P. Kaiser-Labusch, L. Jones, K. Fidler, S. Christie, C. Doherty, C. Spyridakou, F. Shackley, S. Armoush, P. Heath, N. Tan, S. Ibrahim, S. Tizzard, S. Storey, S. Drysdale, S. Walter, S. Janarthan, C. Kachramanoglou, H. Payne, A. Smyrnaios, C. Marisco, M. Grazia Capretti, G. Hector, P. Palasanthiran, R. Vernall, M. Meir, I. Mildred, K. Dhond, K. Mccarthy, M. Almarzooqi, J. Evans, J. Muller, J. Pitcher, J. Tomlinson, J. Amaryl, A. Shears, P. Frattaroli, S. Sobowiec, V. Richmond, K. Ralph, K. Lindsey, C. Lanaghan, J. Langlands, K. O'Brien, R. Crawley, A. Manian, K. Alison, C. Smith, M. Hayman, F. Diaz, J. Parratt, N. Vanner, B. Jones, J. Kane, R. Chadwick, A. Keymeulen, P. Painoi, S. Sivakumaran, V. Parsonson, C. Sen, C. Kortsalioudaki, E. Nastouli, J. Martin, L. Wellings, S. Amor, S. Eisen, A. Tzaki, A. Mavridi, C. Loizou, S. Karagiannidou, H. Buxmann, L. Hafez, M. Alexe, T. Vogel, D. Smiskova, J. Bolchova, U. Schulze-Sturm, A. Ansary, V. Giacomet, S. Vila Bedmar, S. Villaverde Gonzalez, L. Prieto, E. Fernandez Cooke, J.T. Ramos Amador, C. Epalza, C. Moraleda, A. Shan, J. Soler, P. Rojo. - In: THE PEDIATRIC INFECTIOUS DISEASE JOURNAL. - ISSN 0891-3668. - 45:1(2026), pp. 1-10. [10.1097/inf.0000000000004960]
Prognostic Factors of Late-onset Hearing Loss in Infants With Congenital Cytomegalovirus and Normal Audiologic Assessment at Birth
V. Giacomet;
2026
Abstract
Background and aims: Children with congenital cytomegalovirus (cCMV) can develop late-onset sensorineural hearing loss (LO-SNHL). In this study, we aim to assess the characteristics and predictors of LO-SNHL in infants with cCMV having normal hearing at the first neonatal assessment. Methods: A retrospective study within the European Registry of Children with cCMV (www.ccmvnet.org) was performed. Included children had cCMV and a normal first audiological assessment by Auditory Brainstem Response (ABR). Late-onset hearing loss (LO-SNHL) is defined as the presence of sensorineural hearing loss after an initial normal hearing test. Hearing evaluation was performed at birth, at 6 months of age, and at least annually up to 6 years of age. Results: Seven hundred twenty-one children with normal audiological tests at birth were included, and 47/721 (6.5%) developed LO-SNHL. LO-SNHL was diagnosed at a range of 4-65 months of age [median (IQR) age: 34.3 (15.1-48.7) months]. Children with LO-SNHL had a higher proportion of abnormalities on physical examination at birth (45.7% vs. 20.8%; P < 0.001): petechiae (17.4% vs. 6.0%; P = 0.008), splenomegaly (8.7% vs. 2.3%; P = 0.031), hepatomegaly (13% vs. 2.9%; P = 0.001), microcephaly (15.2% vs. 4.5%; P = 0.005) and small for gestational age (21.7% vs. 8.3% P = 0.005). Children with LO-SNHL showed lower platelet count at birth [177500.0 (88750.0-261250.0)/μL vs. 243500.0 (173000.0-304000.0)/μL; P = 0.012], and higher blood viral load at birth [3.7 log (3.3-4.4) vs. 3.4 log (2.7-3.9) IU/mL; P = 0.013] and had more frequent white matter involvement (27.7% vs. 14.7%; P = 0.03) and ventriculomegaly (20.7% vs. 4.6%; P = 0.001) on birth magnetic resonance imaging. Overall, symptomatic children at birth showed a higher risk of developing LO-SNHL than asymptomatic children (32/317, 10.1%, vs. 15/404, 3.7%; P < 0.0001). Among asymptomatic children, only 0.3% developed severe or profound LO-SNHL in the best ear. In multivariate logistic regression analysis, ventriculomegaly [odds ratio (OR): 7.503 (1.78-27.9)], white matter abnormalities [OR: 3.19 (1.010-9.01)], and splenomegaly [OR: 3.679 (1.56-8.506)] at birth were associated with the development of LO-SNHL (Fig. 1). Conclusions: Among this large cohort of children with cCMV and a first normal audiological assessment, the risk of LO-SNHL was 6.5%. Asymptomatic children developed LO-SNHL in 3.7% of the cases versus 10.1% in symptomatic cases. In multivariate logistic regression analysis, ventriculomegaly, white matter abnormality, and splenomegaly at birth were associated with LO-SNHL.
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