Analysis of an Expanded Targeted Early Cytomegalovirus Testing Program

Abstract

ObjectiveDetermine the detection rate from an expanded targeted early cytomegalovirus (CMV) testing program implemented from a large healthcare system (Intermountain Healthcare, IHC).Study DesignRetrospective review.SettingTertiary medical center.MethodsAn electronic system was modified to include indications for testing whenever a provider placed an order for CMV testing. A retrospective analysis of this database was performed.ResultsFrom March 1, 2021 to August 31, 2022, there were 3450 (8.8%) patients who underwent CMV testing out of 39,245 total live births within the IHC system. Since the formal implementation of this program in 2019, annual CMV testing has increased almost 10‐fold: 2668 CMV tests were performed in 2021 compared to 289 CMV tests in 2015. The most frequent indication for congenital CMV (cCMV) testing was small for gestational age (SGA) (68.2%), followed by macrocephaly (13.5%), an abnormal hearing test (5.0%), and microcephaly (4.4%). Fourteen cCMV‐infected infants were diagnosed all of them meeting the criteria for symptomatic cCMV. The most common indication resulting in a positive diagnosis was those who presented with SGA (n = 10 patients). The positivity rate would result in a prevalence of 35.7 symptomatic cCMV cases diagnosed per 100,000 live births, numbers comparable to those expected for universal cCMV screening.ConclusionAn expanded targeted early cCMV testing program may improve detection rates of symptomatic cCMV cases and should be considered as a feasible alternative approach to universal or hearing‐targeted early CMV testing.

A Cross-Sectional Survey of Pediatric Infectious Disease Physicians’ Approach to Congenital Cytomegalovirus Infection

“…Based on these criteria, they found substantial rationale and evidence to support a hearing-targeted approach to testing for congenital CMV. Recently, Suarez et al reported that an expanded targeted early cCMV testing program can significantly improve detection rates compared to a more limited hearing-targeted early CMV program [ 19 ]. Testing was carried out for any newborn found to meet any of the following criteria: maternal history of CMV infection, idiopathic elevated liver enzymes or bilirubin, failed hearing screening, abnormal central nervous system imaging findings suggestive of cCMV, being small for gestational age, microcephaly, unexplained hepatosplenomegaly or petechial rash.…”

American Academy of Audiology Position Statement on Early Identification of Cytomegalovirus in Newborns

“…Due to concerns with universal testing and the limitation of the HT-cCMV screening, expanded targeted cCMV protocols have been introduced. 27 Expanded targeted cCMV testing protocol recommends CMV testing for any newborn found to meet any of the following criteria: maternal history of CMV infection, idiopathic elevated liver enzymes or bilirubin, failed hearing screen, abnormal central nervous system imaging findings suggestive of cCMV (for example, intracranial calcifications), unexplained thrombocytopenia, history of intrauterine growth restriction, small for gestational age, macrocephaly, microcephaly, intra-abdominal calcifications, unexplained hepatomegaly or splenomegaly, or petechial rash. These expanded criteria help identify many symptomatic infants who would not be identified through the HT-cCMV screening protocols.…”

Newborn cytomegalovirus screening: is this the new standard?

“…Such programs have since implemented widely in the United States, Canada, the United Kingdom, Europe and Australia. The indications for testing later also explicitly included other signs of cCMV infection in the newborn period, such as thrombocytopenia, jaundice or microcephaly in some (“expanded”) targeted programs [32 ▪ ]. Although testing newborns with these abnormalities for cCMV could reasonably be considered to be simply an expectation of good clinical care rather than screening, it has been well documented that even newborns with symptomatic cCMV are rarely diagnosed without a formal screening program [17,33,34 ▪ ].…”

“…Targeted screening identifies a large fraction of cases of SNHL due to cCMV and for which antiviral treatment is indicated [32 ▪ ,51 ▪ ,52]. Most hearing loss due to cCMV, however, is not detected by UNHS because it develops after birth, primarily during the first year, but anytime up to at least 5 years old [19].…”