Congenital Cytomegalovirus Among Newborns in Neonatal Intensive Care Units, United States, 2010-2020

Little is known about routine testing practices and diagnosis of congenital cytomegalovirus (cCMV) infection in newborns admitted to neonatal intensive care units (NICUs) across the United States. We assessed demographics and clinical signs associated with cCMV testing and diagnosis in newborns admitted to US NICUs.

We analyzed Pediatrix Clinical Data Warehouse data, comprising 840,988 newborns admitted to 389 NICUs in 35 states during 2010-2020. We defined cCMV testing as culture or PCR performed on urine, saliva, blood, or cerebrospinal fluid collected within 21 days of life, and a positive result (except in saliva) as cCMV infection diagnosis. Logistic regression models examined associations between clinical signs and cCMV testing and diagnosis separately, adjusting for region, birth year, and prematurity.

Among 10,033 (1.2%) newborns tested (67.7% by culture; 79.8% using urine), 559 (5.6%) were diagnosed with cCMV infection. During 2010-2020, among those tested, the proportion with ≤ 1 clinical sign increased from 12.9% to 32.0%. Hepatosplenomegaly, petechiae, microcephaly, hepatitis, thrombocytopenia, chorioretinitis, and intracranial calcifications were associated with increased odds of both cCMV testing and diagnosis, with varying specificity.

Despite low CMV testing rates in the NICU, a shift toward testing newborns with fewer clinical signs occurred over time.