321 - Universal Screening in the Neonatal Intensive Care Unit (NICU) for Congenital Cytomegalovirus (cCMV) Infection: It's Time!

Poster Number: 321
Publication Number: 321.124

Rafael Lemus, Nationwide Children's Hospital, Columbus, OH, United States; Alexandra K. Medoro, Nationwide Children's Hospital, Columbus, OH, United States; Randy R. Miller, Pediatrix Medical Group, Columbus, OH, United States; Anthony Theile, Central Ohio Newborn Medicine, Columbus, OH, United States; Traci Pifer, Nationwide Children's Hospital, Columbus, OH, United States; Manish Rijal, Nationwide Children's Hospital, Columbus, OH, United States; Prashant S. Malhotra, Nationwide Children's Hospital, Columbus, OH, United States; Oliver Adunka, The Ohio State University, Columbus, OH, United States; Ursula Findlen, Nationwide Children's Hospital, Columbus, OH, United States; Gina M. Hounam, Program Manager, Columbus, OH, United States; Asuncion Mejias, Nationwide Children's Hospital, Columbus, OH, United States; Masako Shimamura, Nationwide Children's Hospital, Columbus, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Background: cCMV infection is a major cause of sensorineural hearing loss and neurocognitive impairment in childhood. In the NICU, as many as 36% of infants are not screened for hearing loss until >3 weeks of age when a diagnosis of cCMV infection is difficult to ascertain, resulting in a missed opportunity for antiviral therapy if indicated. Since 2018, all infants admitted to the 7 NICUs of Nationwide Children’s Hospital (NCH) Neonatal Network have saliva and/or urine tested for CMV by PCR. Infants who have a positive CMV PCR test are referred to the NCH Neonatal Infectious Diseases Program for management.

Objective: To report the performance of the CMV screening program implemented at the NCH NICUs and describe the characteristics of screen-positive infants

Design/Methods: During 2019-2020, all infants admitted to NCH NICUs were screened for CMV by saliva PCR except in the early months of the COVID-19 pandemic when urine PCR was performed due to swab/viral transport shortages. Some infants had CMV testing performed for clinical indications by the attending neonatologist. Positive saliva specimens were confirmed by urine PCR; 2 positive CMV tests were required to confirm congenital infection. Infants diagnosed with cCMV infection underwent clinical, laboratory, ophthalmologic, auditory, and neuroimaging evaluation. Clinical/laboratory data were obtained from all infants in whom CMV was detected.

Results: From 2019-2020, 79 (1%) of 7307 infants admitted to 7 NCH NICUs (42,152 live births) had CMV detected in saliva/urine. Of the 79 infants, 47 (59%) had cCMV infection, while 14 (18%) had postnatally acquired CMV, 7 (9%) had indeterminate infection timing, and 13 (16%) had only 1 positive CMV saliva/urine result (“false positive”). 24% (19/79) of infants had birth weight < 1500 g. Of the 79 infants, 40 (50%) were tested due to clinical signs of cCMV infection, 12 (15%; 3 false positive tests) were tested due to referral on newborn hearing screen, and 27 (34%; 10 false positive tests; 4, acquired) were identified by NICU admission screening. Of the 27, 7 (54%) had signs of CMV infection (5, IUGR/SGA; 2, abnormal neuroimaging; 2, thrombocytopenia) and 2 received valganciclovir treatment. The evaluation was normal in 6 infants.Conclusion(s): Universal saliva/urine screening detected CMV in 1% of all NICU admissions. The false-positive rate of 16% highlights the need to confirm congenital infection with ≥2 positive CMV tests. Universal screening increased the identification of cCMV in the NICU by 35%, and 54% of these infants had an abnormal evaluation that in some cases, prompted antiviral therapy to improve outcomes.
CVCV 2021.pdf