Hearing-Targeted Congenital Cytomegalovirus Screening: An 11-Year Experience.

Abstract

Congenital cytomegalovirus (cCMV) is a leading cause of hearing loss, but many cases are missed at birth. In 2016, Connecticut mandated cCMV testing for all newborns who fail their hearing screening. We evaluated this mandate's impact on diagnosis rates and characterized the long-term outcomes of the identified cohort. We conducted an interrupted time series study (2013-2023) within a health system serving approximately 60% of Connecticut's population. The cohort included all confirmed and probable cCMV cases. Confirmed infection was defined as CMV detection by polymerase chain reaction or culture from urine, blood, or cerebrospinal fluid at 21 days or less of life. Probable cases were those with compatible clinical findings but only presumptive laboratory evidence of infection (eg, testing at 22-42 days or saliva without urine or blood confirmation). Annual diagnosis rates were modeled before and after mandate implementation. Long-term audiologic and neurodevelopmental outcomes were tracked through June 2025. Among 197 177 births, 49 met criteria for confirmed or probable cCMV. The mandate increased annual diagnoses by 4.32-fold (95% CI, 1.09-17.01). Before the mandate, no cases were asymptomatic. Afterward, 28% were asymptomatic or had isolated sensorineural hearing loss (SNHL), of which 75% later developed neurodevelopmental sequelae. Among those with SNHL at birth, hearing worsened in 81%. Only 21% of children with follow-up remained without sequelae. Hearing-targeted screening increased detection of cCMV disease in infants who would otherwise have been missed. However, many infections likely remain undetected, underscoring both the value and limitations of hearing-targeted screening and the need to consider universal screening.