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PEDIATRICS Vol. 110 No. 4 October 2002, pp. 762-767

Predictors of Hearing Loss in Children With Symptomatic Congenital Cytomegalovirus Infection

Lisa B. Rivera, MBA, MPH*, Suresh B. Boppana, MD*,{ddagger}, Karen B. Fowler, DrPH*,§, William J. Britt, MD*,{ddagger}, Sergio Stagno, MD*,{ddagger} and Robert F. Pass, MD*,{ddagger}

* Department of Pediatrics
{ddagger} Microbiology
§ Epidemiology, University of Alabama School of Medicine, Birmingham, Alabama

--> Objective. Congenital cytomegalovirus (CMV) infection is a major cause of sensorineural hearing loss (SNHL) and neurologic impairment in children. Although the majority of children with symptomatic congenital CMV infection develop hearing loss, many symptomatic infants have normal hearing. The purpose of this study was to identify indicators present in the newborn period that have predictive value for the development of hearing loss in children with symptomatic congenital CMV infection.

Methods. Of the 190 children who had symptomatic congenital CMV infection and were born between 1966 and 1997 and enrolled in a follow-up study, hearing outcome was known for 180 children. Follow-up data were analyzed using univariate and multivariate logistic regression analyses to determine the specific demographic, newborn clinical, and laboratory findings predictive of hearing loss. The amount of infectious CMV in urine was quantified in a subset of 21 children who were born between 1994 and 1998.

Results. The presence of intrauterine growth retardation, petechiae, hepatosplenomegaly, hepatitis, thrombocytopenia, and intracerebral calcifications was associated with the development of hearing loss on univariate analysis. The presence of microcephaly and other neurologic abnormalities was not predictive of hearing loss. Logistic regression analysis revealed that only petechiae and intrauterine growth retardation independently predicted hearing loss. None of the demographic and other newborn findings predicted progressive hearing loss. The children who developed hearing loss had higher urine CMV titers during infancy than those with normal hearing.

Conclusion. In children with symptomatic congenital CMV infection, evidence of disseminated infection with or without the presence of neurologic involvement at birth was predictive of the development of hearing loss. However, it was not possible to identify factors that are independently predictive of the development of progressive hearing loss.

Key Words: cytomegalovirus • congenital infection • symptomatic congenital CMV infection • sensorineural hearing loss • predictors of outcome

Abbreviations: CMV, cytomegalovirus • SNHL, sensorineural hearing loss • CNS, central nervous system • UAB, University of Alabama at Birmingham • dB, decibel • ABR, auditory brainstem response audiometry • OR, odds ratio • CI, confidence interval • aOR, adjusted odds ratio

Received for publication Feb 27, 2002; Accepted May 14, 2002.


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