Pediatric Resident The Children's Regional Hospital at Cooper Camden, New Jersey, United States
Background: Cytomegalovirus (CMV) is one of the most common congenital infections. Although some infants (~10%) present with microcephaly, rash, or jaundice at birth, the majority of infected infants are asymptomatic. In addition, infants with congenital CMV can develop sensorineural hearing loss that progresses through childhood and/or adolescence. The hearing loss can range from mild to severe early in life, during the critical period of language development. Therefore, identification of congenital CMV in a neonate allows for earlier evaluation by pediatric infectious disease specialists, and consideration of treatment with antiviral medications. In addition, with earlier detection of hearing loss, services such as speech-language therapy can be initiated to aid the infant to develop their full language potential. Objective: Lack of universal protocol for early identification of neonates with congenital CMV. The aim is to identify neonates with potential congenital CMV infection by screening all those newborns who failed a routine newborn hearing screen in the initial hospital stay. Design/Methods: A new hospital guideline was implemented that involved hearing screeners, nurses, residents, and physicians caring for patients in Mother Infant Unit (MIU), Neonatal Intensive Care Unit (NICU), and Pediatric Infectious Disease practice. Starting in June 2023, all newborns who failed Auditory Brainstem Response (ABR) screen in one or both ears qualified to be screened for CMV. A CMV PCR buccal swab was performed and a referral to outpatient audiology was placed. Any positive CMV PCR result was referred to pediatric infectious disease specialist for further care. Results: Of the 644 neonates screened from 6/2023-10/2023, 21 neonates failed the ABR screen. Out of these 21 neonates, 18 were tested for congenital CMV via PCR buccal swab. All CMV tests have been negative. The 3 patients who were not screened have been due to team not realizing a screen was necessary, lack of EMR order, and test by CMV urine culture instead of PCR. There has been a 100% CMV test rate of all failed screens in the last 2 months.
Conclusion(s): Congenital CMV can potentially lead to hearing loss in newborns. During the initial implementation and PDSA cycles, we were able to improve CMV testing to 100% of all failed ABR screens. So far, none of the CMV tests yielded a positive result. We will continue to provide education to staff and parents regarding the importance of screening and continue to evaluate the success of this new guideline.
