481 - Missed Opportunities for Congenital CMV Testing After Failed Newborn Hearing Screens

Publication Number: 3464.481

Julia Katz, Boston Children's Hospital, Brookline, MA, United States; Arielle Spellun, Boston University School of Medicine, Boston, MA, United States; Evette Ronner, Boston University School of Medicine, Boston, MA, United States; Megan Thompson, Boston University School of Medicine, Boston, MA, United States; Elizabeth D. Barnett, Boston Medical Center, Boston, MA, United States; mark Vecchiotti, Boston University School of Medicine, BOSTON, MA, United States; Alison Packer, Boston Medical Center, Boston, MA, United States

Background: Congenital cytomegalovirus (cCMV) is the leading cause of non-genetic sensorineural hearing loss in children. Testing should occur within 21 days of life, as later detection may reflect postnatal acquisition. Early diagnosis enables timely intervention to improve speech, language, and neurodevelopmental outcomes. Currently, there is no universal cCMV screening. Many hospitals, including Boston Medical Center (BMC), use targeted cCMV testing for infants with risk factors such as small for gestational age (SGA), microcephaly, or failed newborn hearing screen (NHS). Whether failed NHS consistently triggers cCMV testing remains unclear.

Objective: To determine cCMV screening rates among infants who failed NHS at BMC and identify factors associated with missed or delayed testing.

Design/Methods: We conducted a retrospective chart review of infants born at BMC between January 1 and July 15, 2025, who failed NHS. Timely testing was defined as cCMV testing ≤21 days of life; infants who were never tested or tested >21 days were classified as missed/delayed. Analyses used Fisher's exact, Mann-Whitney U, and multivariable logistic regression (SPSS v31).

Results: Of 1,418 infants, 204 (14.4%) had failed NHS. Among these, 21 (10.3%) did not receive timely cCMV testing (3 tested >21 days, 18 never tested). Missed/delayed infants were more likely to be admitted to the NICU (33.3% vs 6.6%, p=0.001), have NHS > 21 days (19.0% vs 1.1%, p=0.001), be premature (28.6% vs 11.5%, p=0.04), or have NHS on day of discharge (61% vs 36%, p=0.04). Of infants who failed NHS, those with microcephaly were more likely to receive timely testing (19.3% vs 0%, p=0.02); SGA showed a nonsignificant trend (24.7% vs 9.5%, p=0.09). No differences were seen for race, ethnicity, language, or social determinants of health (Table 1). In multivariable analysis, NICU admission (aOR 5.79, 95% CI 1.25-26.81, p=0.025) and NHS on day of discharge (aOR 4.75, 95% CI 1.52-14.88, p=0.007) independently predicted missed/delayed testing.

Conclusion(s): One in ten infants who failed NHS did not receive timely cCMV testing. Missed opportunities disproportionately occurred in the NICU and in infants who had NHS on day of discharge. Despite being an indication for targeted cCMV testing, failed NHS did not consistently prompt testing in practice. Workflow-related factors, such as NHS timing and inpatient testing logistics, appear to drive delays and misses. Future quality improvement efforts will implement standardized workflows, such as reflex cCMV testing after failed NHS, to enhance timely identification and promote equitable detection across clinical settings.

Table 1: Clinical and demographic characteristics of infants who failed the newborn hearing screen, stratified by timeliness of cCMV testing