Integrating congenital cytomegalovirus screening within a newborn hearing screening program: Is it worthwhile?

Area of Science:

• Public Health
• Neonatal Screening
• Infectious Disease Epidemiology

Background:

• Congenital Cytomegalovirus (cCMV) is a leading infectious cause of non-genetic sensorineural hearing loss in newborns.
• Universal Newborn Hearing Screening (UNHS) programs aim to detect hearing loss early, but may miss cases of cCMV.
• A pilot cCMV screening program was implemented to assess its integration with UNHS.

Purpose of the Study:

• To evaluate the feasibility and identify challenges of expanding a pilot cCMV screening program into a permanent, state-wide UNHS initiative.
• To analyze the outcomes of a cCMV screening pilot and stakeholder perspectives on state-wide implementation.
• To determine the potential impact of integrating cCMV screening into existing newborn screening protocols.

Main Methods:

• A retrospective review of a cCMV screening pilot program outcomes (August 2014-April 2018) at three maternity hospitals.
• Analysis of state-wide laboratory notifications for infant CMV Polymerase Chain Reaction (PCR) testing.
• Qualitative data collection through stakeholder interviews to inform program implementation.

Main Results:

• The pilot identified 4 (0.8%) infants with cCMV from 485 tested via saliva swab.
• Over 63% of infants with cCMV would have been missed by a targeted state-wide screening program due to passing UNHS or other clinical factors.
• Identified barriers included program logistics (timing, funding, communication, training) and community factors (low awareness).

Conclusions:

• Integrating cCMV screening into UNHS is achievable but requires overcoming significant programmatic and community-level barriers.
• Addressing identified challenges is essential for the successful implementation of a state-wide cCMV screening program.
• Further planning and resource allocation are necessary to ensure comprehensive cCMV detection and management.