TOP 63 - Diagnostic Yield of TORCH Screening in Symmetrical Small for Gestational Age Neonates in a Level III Inner City NICU

Publication Number: 4767.TOP 63

Dharana Lama, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Sukhvinder Ranu, Kings County Hospital, Brooklyn, NY, NY, United States

Background: TORCH infections are estimated to account for 5 to 15% of cases of small-for-gestational-age (SGA) infants, particularly those with symmetric SGA. Historically, routine TORCH screening was done for all symmetric SGA newborns in many centers, but studies have shown that TORCH infections account for only a small fraction of SGA cases and that the cost-effectiveness of universal screening is low. The AAP also recommends screening only when clinical findings suggest infection. Nevertheless, routine TORCH screening continues to be performed in many centers for neonates born with symmetric SGA.

Objective: Our objectives are to determine the prevalence of positive TORCH infections among symmetric SGA neonates admitted to an inner-city Level III NICU and to determine whether routine screening for TORCH infection is warranted for this population. We hypothesize that the prevalence of TORCH infections among symmetric SGA neonates is low and does not require routine screening.

Design/Methods: This is an IRB approved (#2332401) retrospective study in which infants with birth weight and head circumference < 10th percentile for gestational age born during the period of 1/1/2020 to 12/31/2024 are studied. Data include demographics, TORCH work-up details, imaging results, ophthalmologic evaluations, and diagnostic outcomes. Descriptive and comparative statistics will be applied to determine testing yield and resource utilization.
Out of the cohort of symmetric SGA infants, 20 cases have been reviewed. 14 infants (70%) underwent some form of TORCH testing, yielding 1 positive result (7.1%), a confirmed case of congenital CMV infection. 9 infants (45%) had head ultrasounds, and 5 (25%) received formal ophthalmologic evaluation. Data analysis is ongoing, and final results, including diagnostic yield and practice patterns, will be completed by December 2025.
Preliminary findings indicate a low diagnostic yield of routine TORCH screening among symmetric SGA neonates, with an additional observation of variation seen in clinical practice among providers. Although not the primary objective, the observation that some infants received a full TORCH work-up while others did not, because of identification of alternative etiologies for growth restriction, may have important implications for standardizing care. These findings reinforce prior studies and current AAP recommendations that discourage routine TORCH screening in the absence of other clinical signs of infection. Completion of data analysis will provide more definitive evidence to confirm these findings and determine whether our hypothesis holds true.