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

Area of Science:

• Neonatology
• Infectious Diseases
• Public Health

Background:

• Congenital cytomegalovirus (cCMV) is a leading nongenetic cause of sensorineural hearing loss in newborns.
• Existing hearing-targeted screening (HTS) programs for cCMV exhibit variable adherence and detection rates.
• Effective screening strategies are crucial for early identification and intervention.

Purpose of the Study:

• To implement and assess a comprehensive cCMV HTS program in a newborn nursery.
• To evaluate the adherence and yield of a nurse-driven HTS algorithm for cCMV detection.
• To determine the effectiveness of saliva and urine PCR testing for cCMV screening.

Main Methods:

• Implementation of a nurse-driven HTS algorithm and follow-up process for cCMV screening in December 2018.
• cCMV screening using saliva polymerase chain reaction (PCR), with confirmatory urine PCR within 21 days of birth.
• Utilized an annotated run chart to monitor screening adherence and outcomes over time.

Main Results:

• Screening adherence increased from 0% to 100% within the first 23 quarters post-implementation.
• Of 650 newborns referred for hearing screening, 13 had positive saliva screens.
• Only one newborn was confirmed with cCMV infection; 12 cases were false positives.

Conclusions:

• The implemented HTS program achieved high adherence for cCMV screening.
• The low yield of confirmed cCMV cases suggests a need for re-evaluation of screening strategies in low-prevalence settings.
• Balancing feasibility and diagnostic yield is essential when considering alternative cCMV screening approaches.