Vestibular and balance dysfunction in children with congenital CMV: a systematic review

Annalie Shears; Georgina Yan; Harriet Mortimer; Elizabeth Cross; Shari Sapuan; Seilesh Kadambari; Suzanne Luck; Paul T Heath; Simone Walter; Katy J Fidler

doi:10.1136/archdischild-2021-323380

Vestibular and balance dysfunction in children with congenital CMV: a systematic review

Arch Dis Child Fetal Neonatal Ed. 2022 May 11;107(6):630-636. doi: 10.1136/archdischild-2021-323380. Online ahead of print.

Authors

Annalie Shears^#^{1

2}, Georgina Yan^#^{3

4}, Harriet Mortimer⁵, Elizabeth Cross^{6

7}, Shari Sapuan⁸, Seilesh Kadambari^{9

10}, Suzanne Luck¹¹, Paul T Heath⁸, Simone Walter¹², Katy J Fidler^{2

7}

Affiliations

¹ Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK.
² Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK.
³ Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK g.yan@ucl.ac.uk.
⁴ Department of Neonatology, University College London EGA Institute for Women's Health, London, UK.
⁵ Medicine, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁶ Department of Infectious Diseases, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
⁷ Brighton and Sussex Medical School, Brighton, UK.
⁸ Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
⁹ Department of Paediatrics, University of Oxford Oxford Vaccine Group, Oxford, Oxfordshire, UK.
¹⁰ NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.
¹¹ Jersey General Hospital, Saint Helier, Jersey.
¹² Department of Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK.

^# Contributed equally.

Abstract

Objective: This systematic review evaluates vestibular and balance dysfunction in children with congenital cytomegalovirus (cCMV), makes recommendations for clinical practice and informs future research priorities.

Design: MEDLINE, Embase, EMCARE, BMJ Best Practice, Cochrane Library, DynaMed Plus and UpToDate were searched from inception to 20 March 2021 and graded according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.

Patients: Children with cCMV diagnosed within 3 weeks of life from either blood, saliva and/or urine (using either PCR or culture).

Intervention: Studies of vestibular function and/or balance assessments.

Main outcome measures: Vestibular function and balance.

Results: 1371 studies were identified, and subsequently 16 observational studies were eligible for analysis, leading to an overall cohort of 600 children with cCMV. All studies were of low/moderate quality. In 12/16 studies, vestibular function tests were performed. 10/12 reported vestibular dysfunction in ≥40% of children with cCMV. Three studies compared outcomes for children with symptomatic or asymptomatic cCMV at birth; vestibular dysfunction was more frequently reported in children with symptomatic (22%-60%), than asymptomatic cCMV (0%-12.5%). Two studies found that vestibular function deteriorated over time: one in children (mean age 7.2 months) over 10 months and the other (mean age 34.7 months) over 26 months.

Conclusions: Vestibular dysfunction is found in children with symptomatic and asymptomatic cCMV and in those with and without hearing loss. Audiovestibular assessments should be performed as part of neurodevelopmental follow-up in children with cCMV. Case-controlled longitudinal studies are required to more precisely characterise vestibular dysfunction and help determine the efficacy of early supportive interventions.

Prospero registration: CRD42019131656.

Keywords: Child Health; Deafness; Epidemiology; Neonatology; Virology.