P4.056: Implementation of Hearing-Targeted CMV Testing in the Newborn Nursery

Background: About 1 of 200 infants in the United States are born with congenital cytomegalovirus infection (cCMV). Most babies with cCMV are asymptomatic at birth. Early screening promotes timely diagnosis of cCMV and potentially intervention with antiviral medication to prevent hearing loss. Universal screening for cCMV, such as with a dried blood spot, is currently not technologically feasible. Targeted screening of infants with risk factors, including all those with suspected congenital hearing loss, has been shown to improve the rate of detection of cCMV. In 2023 the state of Texas passed House Bill 2478 mandating that all newborn infants failing the hearing screen be tested for CMV. Our institution developed a hearing-targeted cCMV testing program to comply with the state law.

Methods: Hearing-targeted screening for cCMV was initiated in May 2024. A flow diagram was created to identify and test affected infants. Standardized orders for CMV testing were added to the newborn order set. The nursing staff was educated on this change in practice. Urine was sent for CMV PCR on infants with a failed hearing screen and they were referred for outpatient audiology testing. If the PCR for CMV was positive, the infant's pediatrician was notified by telephone call and letter. The pediatrician was responsible for making a referral to the pediatric infectious disease specialist.

Results: Of the 4646 infants delivered from May 2024 through February 2025, there were 120 (2.6%) failed hearing screens. Urine cCMV PCR was resulted on 62 infants. Testing was not sent on the other 58 infants for the following reasons: parental refusal (34), insufficient sample (9), test not ordered by provider (12), and canceled order (3). No infant was positive for cCMV.

Conclusion: The rate of cCMV detection using hearing-targeted cCMV testing was expected to be around 1.5% based on a recent study comparing universal screening, hearing-targeted screening, and delayed blood spot testing. We were surprised that no baby so far has tested positive. This could be due to the low rate of infants with failed hearing screens that had resulted CMV tests (52%). Early in the initiation of the testing, we noticed that the lab cancelled samples. We discovered that the ointment for circumcisions was interfering with the PCR testing. We did not expect the high number of parents refusing testing (28%). The reasons for parental refusal: did not want to wait for urine collection or did not want the testing. We have also identified an opportunity to re-educate the physicians about the need for testing. We will also explore changing the test to buccal swab PCR. In the future we will examine if testing increases length of stay and results of outpatient follow-up hearing screens.