National and Regional Trends in Congenital Cytomegalovirus Infection From 1998 to 2019

To analyze temporal changes and to assess the possible effect of newborn hearing screening (NBHS) programs on changes in congenital cytomegalovirus (cCMV) diagnostic rates in the United States.

Cross-sectional study.

National Inpatient Sample (NIS) database.

Neonates with cCMV infection were identified using discharge data from the NIS database from 1998 to 2019. Neonates with cCMV infection were identified via International Classification of Diseases codes and categorized as asymptomatic versus symptomatic and with or without hearing loss. Linear regression and interrupted time series analyses were conducted to analyze changes in diagnostic rates over time. Interrupted analyses were based on the timing of NBHS implementation in geographic regions.

Per 1,000,000 live births, the estimated total number of cCMV diagnoses increased from 109 in 1998 to 250 in 2019 (the estimated annual increase per 1,000,000 live births is 6.89 ([95% confidence interval, 5.43-8.35], P < .001). Diagnosis of cCMV with hearing loss showed a significant annual increase during this time (0.87 [0.51-1.22], P < .001), and within this group, diagnosis of both asymptomatic (0.18 [0.03-0.32], P = .02) and symptomatic (0.68 [0.37-0.99], P < .001) cases increased significantly. Compared to pre-NBHS, the rate of increase in cCMV diagnosis was significantly higher post-NBHS implementation in the Northeast (P < .001) and South (P = .008).

Implementation of state NBHS programs correlated with increasing diagnosis rates of cCMV, though cCMV education and awareness may be contributing. cCMV continues to be underdiagnosed in a large national database.