482 - Association of congenital cytomegalovirus infection and hearing screening in U.S. Neonatal intensive care units.

Publication Number: 3465.482

Chioma Eze-Njoku, Tufts University School of Medicine, Boston, Massachusetts, MA, United States; Joleen Dako, Mercer University School of Medicine, Macon, GA, United States; Rachel G. Greenberg, Duke Clinical Research Institute, Durham, NC, United States; Ashley Stark, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Veeral Tolia, Pediatrix, Dallas, TX, United States; Ryan Kilpatrick, Tufts University School of Medicine, Winchester, MA, United States

Background: Congenital cytomegalovirus infection (cCMV) is the leading cause of sensorineural hearing loss in infants worldwide. Targeted CMV screening in infants with referred hearing screen is commonly practiced in the U.S, with only three states practicing universal CMV screening. Hearing screening is recommended for all neonates at no later than 1 month of age. Performing hearing screening prior to discharge, especially in preterm infants with prolonged hospitalization may result in missed diagnosis of cCMV and timely intervention.

Objective: To ascertain the proportion of hospitalized neonates with CMV screening and cCMV diagnosis following referred hearing screening from 2010- 2020, and to compare diagnosis timing of cCMV between preterm and term infants.

Design/Methods: Cohort study of infants discharged from 364 NICUs managed by the Pediatrix Medical Group from 2010-2020, excluding infants transferred prior to discharge and those without hearing screening result. We defined cCMV as CMV positivity by PCR or culture within 21 days postmenstrual age (PMA). We described the proportion of infants with cCMV. We computed summary statistics (n,% for categorical variables) to describe infants by final hearing screen result. Trends over time in cCMV and referred hearing screening were evaluated graphically.

Results: 710,113 infants, with median GA of 36 (Q1, Q3: 33-38) weeks and birth weight (BW) of 2.55 kg (Q1, Q3: 1.93-3.24) were included. 14,591 (2.1%) of infants had at least one CMV test during hospitalization, with 10,918 (1.5%) having at least one test ≤21 postnatal days. 674 (0.1%) infants were evaluated for CMV following a referred hearing screen. 517 (0.07%) infants had cCMV, of which 271/517 (52%) were preterm. Among infants with cCMV, 70/271 (25.8%) of preterm and 66/246 (26.8%) of term infants had referred hearing screen. Median postnatal day of hearing screen was 20 (Q1, Q3: 10-43) for preterm and 7 days (Q1, Q3: 4-14) for term infants, p< 0.001. The median day of cCMV diagnosis was 3 (Q1, Q3: 0-6) for preterm and 2 (Q1, Q3: 0-4) days for term infants, p=0.005. Infants with referred hearing screening had initial hearing screening at later PMA, lower GA, lower BW, and were more likely to have CMV and other comorbidities (Table 1). The prevalence of cCMV appears stable 2010-2020 (Figure 1), whereas prevalence of referred hearing screening increased (Figure 2).

Conclusion(s): Preterm infants had later hearing screening compared to term infants and had later diagnosis of cCMV. The prevalence of cCMV was low compared to other population studies, highlighting that a large proportion of cCMV is likely undiagnosed.

Table 1. Characteristics of infants by hearing screen result


Figure 1. CMV Prevalence Over Time from 2010 to 2020


Figure 2. Referred hearing test over time from 2010 to 2020