126 - Implementation of Hearing Targeted Screening of Newborns for Congenital CMV

Poster Number: 126
Publication Number: 126.415

Julie Kessel, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Beth Smith, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Elizabeth Goetz, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background:
CMV is the most common cause of early hearing loss. When found early, CMV related hearing loss can be mitigated. Wisconsin has no mandate for CMV screening at birth. In 2020 a pilot hearing based CMV screening protocol was initiated at Meriter Hospital, the largest birthing center in WI.

Objective:
Implement CMV testing for infants with hearing loss and refer for evaluation and treatment by 28 days of life.  

Design/Methods:
CMV screening guidelines were developed for infants who fail hearing screen during birth hospitalization. An algorithm included provider notification after two failed hearing screens, salivary CMV testing and follow up hearing screen. Guidelines for CMV+ were developed for testing, follow up and referrals. Primary outcome measure was percent of infants CMV+ after failed newborn hearing screen referred to ID by 28 days of life. Process measures were percent of infants who completed hearing screen and percent of infants with failed hearing screen tested for CMV. Balancing measures were percent of false positives on CMV testing and newborn hearing screen.

Results:
In 2019, 1.3% of infants failed inpatient ABR hearing screen. Of these, 1.6% were tested for CMV, 91% had outpatient ABR screen, 4.5% had no further hearing screen, and 4.5% had hearing loss. In 2020 after CMV guidelines were implemented 1.3% failed inpatient newborn hearing screen. Of these, 29% were screened for CMV. Because COVID altered workflows only 4.5% of infants had third ABR screen and 75% of infants were referred directly to audiology for OAE testing, Importantly, 19.7% of infants had no further hearing screen. 4.5 % of infants had hearing loss. In 2021 guidelines were re-evaluated. In PDSA Cycle 1 outpatient hearing screen using ABR was reestablished. In PDSA Cycle 2 infants not tested for CMV during birth hospitalization were tested at repeat ABR hearing screen. After PDSA cycles, the percent of infants screened for CMV increased to 84% with 78% having third ABR screen and 12.5% directly referred to audiology for OAE testing. 8% had no further hearing screen  and 8% had hearing loss. 2 infants had salivary CMV+ test and both infants had negative urine CMV confirmatory testing.
Conclusion(s):
Hearing based CMV testing was successful but has not identified any CMV+ infants. The COVID pandemic interrupted normal hearing screening process and while QI measures to address this disruption have been successful in improving hearing screening process they have not returned to baseline. Future PDSA cycles will focus on increasing outpatient follow up and expanding CMV testing in the nursery to other populations.

Run Chart Hearing Based CMV Screening
Driver Diagram for Hearing Based CMV Testing