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Newborn Hearing Screening Referrals: The Importance of Congenital Cytomegalovirus Follow-Up
Abstract Summary
Background: Congenital cytomegalovirus (cCMV) is the most common infectious cause of sensorineural hearing loss (SNHL). Although controversial (doi: 10.1542/peds.2020-0617), one approach for identification of cCMV is “targeted screening”, whereby infants who “refer” on the newborn hearing screen (NHS) are tested before hospital discharge. Objective: In this quality improvement assessment, we examined compliance with cCMV screening recommendations, prevalence of cCMV identified by targeted screening, and cCMV disease classification and hearing outcomes. Design/Methods: A standing order set was implemented for urine PCR assay prior to hospital discharge for all infants who “referred” on the NHS for seven nurseries in Minnesota. Referrals were tabulated by the Newborn Hearing Screening program at M Health Fairview Hospitals. Results: Approximately 55,000 deliveries occurred during the study (1/1/18 through 12/31/22). 993 newborns (1.8%) were “refer” status on NHS; 592 (60%) had urine CMV PCR testing. Thirteen infants (2.2%) were confirmed to have cCMV. Clinical evaluation (doi: 10.1016/S1473-3099(17)30143-3) indicated 4 had moderate-to-severe disease, 1 mildly symptomatic disease, 5 were asymptomatic with isolated SNHL, and 3 asymptomatic. Two had cranial ultrasounds that defined the infant as symptomatic. Audiology demonstrated 10 of 13 infants (77%) had SNHL (7 unilateral and 3 bilateral). Viral loads ranged from <137 IU/mL to >9,100,000 IU/mL. Challenges included difficulty obtaining urine specimens, parental refusal, and declination of testing at the hospitalist’s discretion. Conclusions: Among newborns who refer on NHS, order set compliance was suboptimal; only 60% of infants were tested for cCMV. Of infants in the NHS refer group, 2.2% had cCMV infection. Most had proven SNHL, allowing for early diagnosis and commencement of antivirals. Interestingly, some infants that “referred” on NHS had normal follow-up audiological evaluation but did have cCMV infection. Since Minnesota implemented universal cCMV screening in February 2023, the utility of continuing targeted cCMV screening for NHS referrals requires further study.
Learning Objectives
- Analyze the completion of congenital cytomegalovirus screenings during the 4 year study period
- Illustrate the importance of congenital cytomegalovirus screenings when a newborn refers on the newborn hearing screening
- Summarize the findings of audiologic follow-up for the newborns who referred on the newborn hearing screening
Presentation
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Presenters
Rebecca Kruc | Primary Presenter
krucx003@umn.edu;
Rebecca Kruc MD, MPH is a resident in pediatrics at the Mayo College of Medicine. Her background is in public health. She previously worked in enteric infectious diseases at the Minnesota Department of Health. She also previously worked for the Centers for Disease Control in New York City doing tuberculosis control and prevention, as well as in Arizona doing public health emergency preparedness.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Jordan G Marmet | Author
marme001@umn.edu ;
Dr. Marmet grew up in Los Angeles, California. He studied medicine at Tel Aviv University in Israel, experiencing their system of universal health care. Following Pediatrics residency and being chief resident at the University of Minnesota, Dr. Marmet joined South Lake Pediatrics, where he enjoyed being a primary care Pediatrician for six years. He worked on many quality and process improvement projects, most notably on anaphylaxis and on nutrition and healthy lifestyles. In 2010, Dr. Marmet returned to the University of Minnesota as a Pediatric Hospitalist. He went on to lead the Division of Pediatric Hospital Medicine, which cares for pediatric patients at three Twin Cities hospitals, in medical and behavioral units, newborn areas, as well as providing chronic pain and palliative care. Dr. Marmet has interests in quality improvement, patient safety, and education, and has leadership roles in organizational care for children admitted to the hospital.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Emily Graupmann | Author
graup052@umn.edu;
Emily is a Clinical Research Coordinator in the Pediatrics Department at the University of Minnesota. In 2014, she graduated from Washington University in St. Louis with her BA in biology. After graduation, she started in clinical research at the University of Minnesota, mainly coordinating pediatric infectious disease studies. Recently she has had the opportunity to explore other specialties and help with new projects.
ASHA DISCLOSURE
Financial -
Nonfinancial -
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Jeanne Gallmeier | Author
jeanne.gallmeier@pediatrix.com ;
Jeanne Gallmeier is the site supervisor at the M Health Fairview Hospitals Newborn Screening Program.
ASHA DISCLOSURE
Financial - No relevant financial relationship exists.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - No relevant financial relationship exists.
Mark R. Schleiss | Author
schleiss@umn.edu ;
Dr. Schleiss is a Professor of Pediatrics and holds the American Legion and Auxiliary Endowed Research Chair at the University of Minnesota Medical School. His laboratory is supported by the NIH. He conducts research in small animal models testing vaccine strategies against congenital CMV infection. His laboratory is also engaged in the study of the epidemiology, pathogenesis and management of congenital and neonatal CMV infections.
ASHA DISCLOSURE
Financial - Receives Grants for Other activities from Moderna Vaccines.
Nonfinancial - No relevant nonfinancial relationship exists.
AAA DISCLOSURE
Financial - Receives support from Moderna Vaccines for Grant support, but no personal fees..