Implementing a Hearing-Targeted Congenital CMV Screening Program in a Low-Prevalence Region

Congenital cytomegalovirus (cCMV) is the most common nongenetic cause of congenital sensorineural hearing loss. Hearing-targeted screening (HTS) programs have variable adherence and performance in terms of cCMV detection. Our institution implemented a cCMV HTS program in the newborn nursery with the aim of screening all eligible newborns during the birth hospitalization.

A bundle of interventions, including a nurse-driven HTS algorithm and process for cCMV screening test follow-up, was implemented in December 2018. cCMV screening was performed by saliva polymerase chain reaction (PCR) with confirmatory urine PCR within 21 days of birth. Our primary outcome was the median percentage of eligible newborns each quarter who completed cCMV screening. Secondary outcomes included the number of patients with confirmed cCMV (saliva +, urine +) and a false-positive saliva screen (saliva +, urine -). An annotated run chart was used to measure the impact of the bundle over time.

Between December 2018 and September 2024, 650 newborns referred on hearing screening. cCMV screening increased from 0% to 94% during the first 14 quarters after implementation and increased further to 100% in the remaining 9 quarters. Thirteen newborns tested positive by saliva; all underwent confirmatory urine testing. Only 1 newborn had confirmed cCMV infection and remained asymptomatic with normal hearing. The remaining 12 were false positives.

We achieved high adherence to HTS but identified only 1 newborn with cCMV infection in 6 years. Alternative approaches to cCMV screening should be considered in regions with low cCMV prevalence that balance feasibility and yield.