P2.P302: Testing for Congenital CMV for Newborn with a Failed Hearing Screening

Purpose/Objectives: Cytomegalovirus (CMV) is the most common congenital infection. Although some infants (~10%) present with microcephaly, rash, or jaundice at birth, most infected infants are asymptomatic. In addition, infants with congenital CMV can develop sensorineural hearing loss that progresses through childhood and/or adolescence. Therefore, identification of congenital CMV in a neonate allows for earlier evaluation by pediatric infectious disease specialists, and consideration of treatment with antiviral medications. In addition, with earlier detection of hearing loss, services such as speech-language therapy can be initiated to aid the infant to develop their full language potential. There is currently no universal protocol for early identification of neonates with congenital CMV. The aim is to identify neonates with potential congenital CMV infection by screening all those newborns who failed a routine newborn hearing screen in the initial hospital stay.

Design/Methods: Starting in June 2023, all newborns who failed Auditory Brainstem Response (ABR) screen in one or both ears qualified to be screened for CMV. A CMV PCR buccal swab was performed and a referral to outpatient audiology was placed. Any positive CMV PCR result was referred to pediatric infectious disease specialist for further care.

Results: Of the 1246 neonates screened from 06/2023-2/2024, 36 neonates failed the ABR screen. Out of these 36 neonates, 33 were tested for congenital CMV via PCR buccal swab. One CMV test (2.8%) has been positive thus far, and it was referred to pediatric infectious disease specialist. The 3 patients who were not screened were early in the PI process and were due to not realizing a screen was necessary, lack of EMR order, and test by CMV urine culture instead of PCR.

Conclusion/Discussion: Congenital CMV can potentially lead to hearing loss in newborns. During the initial implementation and PDSA cycles, we were able to improve CMV testing to 100% of all failed ABR screens. There has been one positive CMV result thus far. We will continue to provide education to staff and parents regarding the importance of screening and continue to evaluate the success of this new guideline.