Inconsistent Provider Testing Practices for Congenital Cytomegalovirus: Missed Diagnoses and Missed Opportunities

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Newborn congenital cytomegalovirus (cCMV) screening programs enhance early diagnosis and treatment.
• North American newborn cCMV screening is not widely implemented, leading to reliance on clinical suspicion for testing.
• This reliance often results in delayed or missed diagnoses.

Purpose of the Study:

• To examine healthcare providers' cCMV testing practices in a North American quaternary children's hospital.
• To assess the frequency and indications for cCMV testing in infants.
• To compare observed cCMV diagnostic prevalence with expected rates.

Main Methods:

• Retrospective review of electronic health records for infants over a six-year period (2014-2019).
• Analysis of cCMV testing rates and diagnostic prevalence.
• Identification of common indications for cCMV testing.

Main Results:

• A total of 40,091 infants were cared for; 178 were tested for cCMV, with 10 diagnosed.
• The cCMV testing rate was 4.5 per 1000 infants, significantly lower than expected.
• Isolated small-for-gestational age was the most frequent reason for testing (53/178 infants).
• The diagnostic prevalence of 0.2 cases per 1000 infants was 15-fold lower than expected.

Conclusions:

• Current clinical suspicion-based testing for cCMV is infrequent, leading to missed diagnoses.
• Systematic cCMV screening is crucial for improving early detection and timely treatment.
• Improved screening can positively impact childhood outcomes for infants with cCMV.