Newborn Screening for Congenital Cytomegalovirus (cCMV) Infection: Universal, Targeted, Expanded-Targeted, or None-of-the-Above?

Abstract

Congenital cytomegalovirus (cCMV) infection is the most common cause of neurodevelopmental sequelae in the United States (US). The most common long-term disability associated with cCMV is sensorineural hearing loss (SNHL). Among children with cCMV-associated SNHL, over 40% will pass their newborn hearing screen (NHS). Therefore, to maximize the identification of infants at risk for SNHL, there is a strong rationale for universal cCMV screening. Early identification of cCMV also allows for the timely commencement of antiviral therapies for some infants, which in turn can improve clinical outcomes. Congenital infection must be diagnosed in the newborn infant in the first 21 days of life since demonstration of CMV infection beyond this time point commonly reflects postnatal acquisition, typically from breastfeeding. Although many advocates are enthusiastic about universal cCMV screening (1-3), other experts express hesitancy in embracing such a policy recommendation until there is more evidence of cost-effectiveness. Moreover, since most infants with cCMV are asymptomatic and have a good prognosis for normal neurodevelopmental outcomes, there is concern that universal screening may raise undue anxiety for parents of infants with asymptomatic cCMV infection (4). This review considers the pros and cons of different cCMV screening approaches, emphasizing enhancing awareness of new and emerging approaches for neonatologists in clinical practice.

Keywords: Congenital CMV; TORCH infection; antiviral therapy; newborn screening.

Figure 1.

Map of states in the US that currently either conduct targeted or universal cCMV screening, states that have legislation pending or under consideration, and states where there is stakeholder interest in legislation. Three states have universal cCMV screening: Minnesota, which commenced screening through legislation (the Vivian Act) in 2023; New York, which currently conducts universal cCMV screening through a NICHD-sponsored program, with a plan to incorporate screening permanently into the newborn screening program; and Connecticut, which passed legislation in 2023 (HB8821) to commence universal screening in 2025. All three states base the universal cCMV screen on DBS PCR analysis. (adapted from https://www.nationalcmv.org/about-us/advocacy)