Rochat Ryan, Goodman Elizabeth, Miller Jerry, Wang Wei, Demmler-Harrison Gail J
Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States of America.
Center for Observational and Real World Evidence, Merck & Co., Inc., Rahway, NJ, United States of America.
PLoS One. 2024 Dec 19;19(12):e0313163. doi: 10.1371/journal.pone.0313163. eCollection 2024.
Congenital cytomegalovirus disease (cCMV) can have significant sensory and neurodevelopmental sequelae throughout childhood. Many of these sequalae are consistent with special education eligibility, but the special education needs of affected children have not been systematically studied.
Retrospective chart reviews from two cohorts of cCMV children receiving care in a large tertiary care children's hospital were included in this study: a historical research cohort (N = 186, 41% symptomatic at birth) and a contemporary clinical cohort of cCMV patients (N = 112, 68% symptomatic at birth). SNOMED-CT was used to identify ICD-10 codes describing special education-qualifying health outcomes fitting the Individuals with Disabilities Education Act (IDEA) criteria. ICD-10 codes were retrospectively applied to the historical research cohort through manual chart review, whereas the ICD-10 billing codes were extracted from the electronic medical record for all encounters in the contemporary cohort.
Of the 56 unique special education-qualifying ICD-10 codes we identified as pertinent to the IDEA, at least one was noted in 39% of those asymptomatic at birth (AcCMV) as compared to 94% of the patients symptomatic at birth (ScCMV). In the contemporary clinical cohort, at least one of these codes was noted in 67% of the AcCMV patients as compared to 95% for ScCMV patients. 61% of patients in the historical and 86% in the contemporary cohort had at least one special education-qualifying ICD-10 code. Developmental, mobility, physical therapy and hearing-related health outcomes were common in both ScCMV and AcCMV patients.
Health outcomes qualifying for special educational services occur commonly in children with cCMV, including those who are classified as asymptomatic at birth. The emergence of qualifying conditions beyond the neonatal period among these children suggests that continued surveillance of this vulnerable population throughout early childhood may facilitate the timely identification of health outcomes requiring special educational services.
先天性巨细胞病毒病（cCMV）在儿童期可导致严重的感觉和神经发育后遗症。其中许多后遗症符合特殊教育资格标准，但受影响儿童的特殊教育需求尚未得到系统研究。
本研究纳入了在一家大型三级儿童医院接受治疗的两组cCMV儿童的回顾性病历审查：一个历史研究队列（N = 186，41%出生时出现症状）和一个当代cCMV患者临床队列（N = 112，68%出生时出现症状）。使用SNOMED-CT识别符合《残疾人教育法》（IDEA）标准的描述特殊教育资格健康结果的ICD-10编码。通过人工病历审查将ICD-10编码追溯应用于历史研究队列，而从当代队列所有就诊的电子病历中提取ICD-10计费编码。
在我们确定与IDEA相关的56个独特的符合特殊教育资格的ICD-10编码中，出生时无症状（AcCMV）者中有39%至少出现了其中一个编码，而出生时出现症状（ScCMV）的患者中这一比例为94%。在当代临床队列中，AcCMV患者中有67%至少出现了其中一个编码，而ScCMV患者中这一比例为95%。历史队列中的61%以及当代队列中的86%的患者至少有一个符合特殊教育资格的ICD-10编码。ScCMV和AcCMV患者中常见发育、活动能力、物理治疗及听力相关的健康结果。
符合特殊教育服务资格的健康结果在cCMV儿童中普遍存在，包括那些出生时被归类为无症状的儿童。这些儿童在新生儿期之后出现符合资格的情况表明，在幼儿期持续监测这一脆弱人群可能有助于及时识别需要特殊教育服务的健康结果。
