431 - Clinical findings in infants with congenital CMV identified by targeted screening

Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss in the US. Targeted cCMV screening is an approach that involves testing newborns who meet high risk criteria for cCMV .

Objective: This retrospective study determined the characteristics of newborns with congenital CMV identified by targeted screening at a single institution.

Design/Methods:

Chart review included asymptomatic newborns admitted to the newborn nursery at UF Health Shands between November 2019 and November 2022. Inclusion criteria consisted of the newborn meeting one or more of the following criteria: failed hearing screen, high-risk perinatal HIV exposure, microcephaly, small for gestational age (SGA), or other prenatal concerns. Exclusion criteria consisted of the newborn having symptomatic cCMV at birth.

Results:

A total of 219 newborns were included. 208 were screened for cCMV with a saliva swab. The most common reason for screening was a failed newborn hearing screen (n=201). 7 of the 208 newborns were positive for cCMV. Confirmatory testing was performed in 5 of the 7 newborns and positive in all 5. Of the 5 newborns with confirmed cCMV, 3 passed their follow up auditory brainstem response (ABR) hearing test and 2 failed. Workup consisted of a CBC with differential (n=5), CMP (n=5), head imaging (n=5), abdominal ultrasound (n=5), and ophthalmologic examination (n=2). This workup revealed elevated AST in 1 patient, neutropenia in 3 patients, and abnormal head imaging in 2 patients. Both of the newborns who failed their repeat hearing test also had abnormal head imaging consisting of periventricular calcifications as well as cystic changes in the bilateral caudothalamic grooves. Only 1 patient was started on valganciclovir which was later discontinued due to severe neutropenia.

Conclusion(s):

This study emphasizes the importance of targeted screening in detecting cCMV in newborns. 7 of the 208 newborns screened with a saliva swab were positive for cCMV, with confirmation of cCMV infection in the 5 patients who were tested. Further workup of the 5 newborns with confirmed cCMV revealed AST elevations, neutropenia, abnormal head imaging, and hearing loss. The two patients who failed their repeat hearing test also had abnormal head imaging characterized by periventricular calcifications and cystic changes in the caudothalamic grooves bilaterally. Only 1 patient received treatment with valganciclovir, which was discontinued due to severe neutropenia. These findings underscore the significance of targeted CMV screening programs to allow for early identification and intervention.