315 - Implementation of Targeted CMV Testing for Failed Newborn Hearing Screening

Poster Number: 315
Publication Number: 315.124

Molly Pont, University of Texas at Austin Dell Medical School, Austin, TX, United States; Kristy Herrman, Univ. of TX Dell Children's Medical School, Austin, TX, United States; Jianzhong Ji, University of Texas at Austin Dell Medical School, Cedar park, TX, United States; Stephanie M. Glover, University of Texas at Austin Dell Medical School, Austin, TX, United States; aman Odeh, Mednax, Austin, TX, United States; Jennifer Gareau, Mednax, Dripping Springs, TX, United States; Marisol Fernandez, Dell Children's Medical Center of Central Texas, Austin, TX, United States

Background:
CMV is the most common congenital infection as well as the most common cause of nongenetic sensorineural hearing loss in children with a prevalence rate of 0.6 to 0.7% live births. Most infants with congenital CMV (cCMV) are asymptomatic. Some will present with isolated hearing loss at birth, but many are not identified until later in life when the window to potentially intervene to impact outcome has passed. 

Objective: To implement a screening program for congenital CMV for infants who fail their newborn hearing screen in one or both ears in the Ascension Texas hospital system in Central Texas. 

Design/Methods:
Newborns cared for in Ascension Texas mother baby units receive newborn hearing screening via automated auditory brainstem response (aABR). If the first hearing screen is failed in one or both ears, a second aABR is performed prior to discharge. Those who failed their second hearing screen during their birth hospitalization were tested for congenital CMV either by a saliva PCR obtained 2 or more hours after breastfeeding, a urine PCR or both obtained prior to discharge. Implementation occurred 8/1/2019 for the largest delivery center (Ascension Seton Medical Center) and 1/10/2020 for the three smaller sites (Ascension Seton Northwest, Ascension Seton Hays, and Ascension Seton Williamson). Data collection extends through 7/31/2021. 

Results: A total of 13,864 infants were born during the implementation time frame through 7/31/2021. Two hundred and thirty-seven infants failed their hearing screen in one or both ears during their birth hospitalization (1.7%). CMV testing was performed via saliva PCR only in 134 infants (56.6%), urine PCR only in 6 infants (2.5%), both saliva and urine PCR in 96 infants (40.5%). One infant was not tested according to guidelines. A total of four infants had a positive PCR (two infants with a positive urine PCR and negative saliva PCR, one infant with a positive saliva PCR and no urine sample, and one infant with a positive saliva PCR but a negative urine PCR). The infant with the positive saliva PCR and a negative urine PCR was determined to not have cCMV. Thus, 1.3% of infants with a failed hearing screen and 0.02 % of infants born during the implementation time frame tested positive with cCMV. Conclusion(s): Targeted testing for congenital CMV in infants who fail their newborn hearing screen during their birth hospitalization results in a low yield of diagnosis of cCMV. Higher yield methods to detect congenital CMV and to refer newborns for evaluation for extent of cCMV disease, hearing loss, and potential antiviral treatment are needed.
Results for Infants who failed their newborn hearing screens.On the first newborn hearing screen, 35% of infants failed bilaterally, 40.9% failed their left ear only, and 24.1% failed their right ear only. On the second newborn hearing screen, 21.9% failed bilaterally in both ears, 44.7% failed their left ear only, and 30.4% failed their right ear only. Three percent of infants did not have a second newborn hearing screen during their birth hospitalization.
Type of test performed for cytomegalovirus in newborns who failed their newborn hearing screen.Out of the two hundred and thirty seven infants who failed their newborn hearing scree, 40.5% were tested by both urine and saliva PCR, while 2.5% were tested via urine PCR only, and 56.6% were tested with saliva PCR only. One infant (0.4%) was not tested.