Korean J Pediatr.  2018 Apr;61(4):114-120. 10.3345/kjp.2018.61.4.114.

TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus) screening of small for gestational age and intrauterine growth restricted neonates: efficacy study in a single institute in Korea

• Chung MH
• Shin CO
• Lee J

• KMID: 2409831
• DOI: http://doi.org/10.3345/kjp.2018.61.4.114

Abstract

PURPOSE
Routine screening for toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes simplex virus (TORCH) in intrauterine growth restriction (IUGR) and small for gestational age (SGA) neonates has become a common practice. However, the incidence of TORCH varies across countries, and the cost of TORCH testing may be disadvantageous compared to disease-specific screening. To evaluate the efficacy of TORCH screening, the medical charts of IUGR or SGA neonates born in a single institution in Bucheon, Korea from 2011 to 2015 were reviewed.
METHODS
The clinical data of the 126 IUGR or SGA neonates were gathered, including gestational age, Apgar scores, neonatal sonographic findings, chromosome study, morbidities, developmental follow-up, and growth catch-up. Maternal factors including underlying maternal disease and fetal sonography were collected, and placental findings were recorded when available. TORCH screening was done using serum IgM, CMV urine culture, quantification of CMV DNA with real-time polymerase chain reaction, and rapid plasma reagin qualitative test for syphilis. Tests were repeated only for those with positive results.
RESULTS
Of the 119 TORCH screenings, only one was positive for toxoplasmosis IgM. This result was deemed false positive due to negative IgM on repeated testing and the absence of clinical symptoms.
CONCLUSION
Considering the incidence and risk of TORCH in Korea, the financial burden of TORCH screening, and the single positive TORCH finding in our study, we suggest disease-specific screening based on maternal history and the clinical symptoms of the neonate. Regarding CMV, which may present asymptomatically, universal screening may be appropriate upon cost-benefit analysis.

Keyword

Small for gestational age; Intrauterine growth retardation; TORCH

MeSH Terms

Cost-Benefit Analysis
Cytomegalovirus*
DNA
Fetal Growth Retardation
Follow-Up Studies
Gestational Age*
Gyeonggi-do
Herpes Simplex*
Humans
Immunoglobulin M
Incidence
Infant, Newborn*
Korea*
Mass Screening*
Plasma
Real-Time Polymerase Chain Reaction
Rubella*
Simplexvirus
Syphilis
Toxoplasmosis
Ultrasonography
DNA
Immunoglobulin M