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Congenital Cytomegalovirus Targeted Screening Implementation and Outcomes: A Retrospective Chart Review
Evette A Ronner1, Cheryl K Glovsky2, Barbara S Herrmann2
1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Insights
Targeted cytomegalovirus (CMV) screening for infants failing newborn hearing screening significantly increased testing rates and led to earlier diagnosis. This effective protocol identifies CMV+ infants early, improving outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Cytomegalovirus (CMV) is a common congenital infection that can lead to significant long-term health issues, including hearing loss.
- Newborn hearing screening (NHS) identifies infants with hearing impairment, but early identification of CMV as a cause is crucial for timely intervention.
Purpose of the Study:
- To evaluate the effectiveness of a targeted cytomegalovirus (CMV) testing protocol in infants who did not pass newborn hearing screening (NHS).
- To assess the impact of the protocol on CMV testing rates and patient outcomes.
Main Methods:
- Retrospective chart review of infants who did not pass NHS between 2013 and 2020 at a tertiary care institution.
- Comparison of CMV testing rates and outcomes before and after the implementation of a targeted CMV screening protocol.
Main Results:
- The rate of CMV testing in infants failing NHS increased from 14% to 88% after protocol implementation (P < .001).
- Eight infants tested positive for CMV (1.5%), with 6 demonstrating hearing loss requiring treatment.
- Infants in the targeted screening group were referred to infectious disease specialists at a significantly younger age (P < .001).
Conclusions:
- A targeted CMV screening protocol is a feasible and effective strategy for early identification of CMV in at-risk infants.
- Implementation of this protocol significantly enhances CMV testing rates and facilitates earlier medical intervention.
Objective:
To assess the effectiveness and outcomes of a targeted cytomegalovirus (CMV) testing protocol.
Study Design:
Retrospective chart review.
Setting:
Tertiary care institution.
Methods:
Targeted screening for CMV in children who did not pass the newborn hearing screening (NHS) was introduced in July 2015 for the level 2 and 3 nurseries at our hospital. In January 2016, this policy was extended to include all nurseries. Retrospective chart review was performed for all newborns who did not pass their NHS between 2013 and 2020. CMV testing rates and related outcomes were compared before and after rollout.
Results:
A total of 891 charts were reviewed for infants who did not pass their NHS: 530 (60%) had CMV testing, of which 8 (1.5%) tested positive. Three cases were detected prior to and 5 occurred after initiation of targeted screening. Six CMV+ infants demonstrated hearing loss on confirmatory auditory brainstem response, all of whom began treatment with oral valganciclovir. Hearing remained stable in 3 patients, progressed in 2, and improved in 1. The rate of CMV testing in children who did not pass their NHS increased from 14% to 88% after full implementation of targeted screening (P < .001). The average age at initial infectious disease consultation was significantly younger for infants born after targeted screening (P < .001).
Conclusion:
Targeted screening is a feasible and effective method to identify CMV+ infants early in life. Implementation of a targeted screening program for CMV in children who do not pass the NHS resulted in significantly higher rates of CMV testing and earlier referral to infectious disease.