Implementing Congenital CMV Screening in a Large Hospital System.

Abstract

Congenital cytomegalovirus (cCMV) is the most common congenital infection and the leading nongenetic cause of sensorineural hearing loss. Despite expanding legislative screening requirements across the United States, there is no consensus guidance on the screening approach, resulting in wide variation in implementation. Our objective was to assess the outcomes and provide operational insights of initiating cCMV screening within a large hospital system. A multidisciplinary team representing key clinical and laboratory specialties developed a comprehensive cCMV screening and follow-up program. Infants born within the Cleveland Clinic Ohio enterprise were screened through a hybrid screening protocol (universal screening in neonatal intensive care units and targeted screening in newborn nurseries). Detection rates and implementation insights were compiled. Clinical outcomes were assessed through retrospective medical record review. Among 50 438 live births, 7491 infants (14.9%) underwent cCMV screening from 2022 to 2025, increasing annual testing from approximately 150 to over 2000 infants. Thirty-four infants (0.45%) were confirmed to have cCMV, increasing case detection approximately 2.5-fold, with higher detection rates in targeted vs universal groups (0.74% vs 0.33%; P = .01). The most common clinical findings were abnormal neuroimaging (32.3%) and small for gestational age (26.5%). Although screening protocols were rapidly integrated into workflows, audiology follow-up was limited by logistical, socioeconomic, and educational barriers of families. Hybrid cCMV screening is feasible across a large health care system and increases detection. Multidisciplinary collaboration is essential to successful implementation. Improved access to audiology and other follow-up care is needed to maximize clinical impact.