PP1112 - Characterizing Newborn Hearing Screening Outcomes Utilizing HT-cCMV and Universal cCMV Screening Methods

Abstract:
Congenital cytomegalovirus (cCMV), the leading non-genetic cause of childhood hearing loss, is being considered for addition to newborn screening panels in many states. Hearing targeted screening for cCMV (HT-cCMV) is utilized in some states and hospitals. Minnesota is the first state to conduct universal screening to potentially identify all cases of cCMV regardless of the outcome of their newborn hearing screening. This investigation aims to characterize the hearing screening outcomes of individuals testing positive for cCMV utilizing targeted and universal cCMV screening methods, review hearing monitoring pathways, and prioritize quality improvement approaches for earliest identification of hearing loss and intervention.<

Summary:
Rationale:
Newborn hearing screening has been the standard of care for many years for earliest detection of hearing loss. Congenital cytomegalovirus (cCMV), the leading non-genetic cause of childhood hearing loss, is now being considered for addition to newborn screening panels in many states. For patients who have been identified with cCMV, 10% will be born with symptoms of the virus, while another 10% will develop symptoms later in life. Approximately 10-15% of newborns who are asymptomatic at birth will develop hearing loss. While it seems counterintuitive, hearing loss has not previously been considered a sequela of cCMV and is typically discussed separately from general cCMV sequelae.

Hearing targeted screening for cCMV (HT-cCMV) is utilized in some states and hospitals with varied protocols. Overall, the goal of HT-cCMV is to conduct a cCMV test on each child who has a refer result on the newborn hearing screening. HT-cCMV allows for children who did not pass the newborn hearing screening and have been identified to have cCMV to be further monitored for adverse outcomes relating to the virus.  
In February 2023, Minnesota became the first state to add cCMV blood spot testing to the newborn screening panel. This universal screening conducted on all children born in the state of Minnesota allows for the potential to identify all cases of cCMV regardless of the outcome of their newborn hearing screening. By utilizing the universal screening protocol, it is possible to identify cCMV in children even if the newborn hearing screening is missed or refused. This investigation aims to characterize the hearing screening outcomes of individuals with cCMV utilizing targeted and universal screening methods, review hearing monitoring pathways, and prioritize quality improvement approaches for earliest identification of hearing loss and intervention. 

Design:
This study was a retrospective review of newborn hearing screening outcomes from 2018 – 2023 for children born in the PostPartum unit at the Mayo Clinic in Rochester, Minnesota. Electronic records 11,283 were used to identify patients who had tested positive for cCMV utilizing HT-cCMV or universal screening techniques. The use of a custom database allowed the timeline and results of the newborn hearing screening for individuals to be confirmed. Monitoring of individuals positive for cCMV and the treatment and follow-up which they received was extracted from detailed chart reviews.  Results support the aim to monitor the identification of cCMV in newborns utilizing targeted and universal screening methods and the care that identified patients receive. Data from 2018-2022 records identified individuals diagnosed with cCMV utilizing the HT-cCMV screening method. Results from patients identified with cCMV with the universal screening method further enhance this earliest detection by providing a two-tier system of universal screening in addition to HT-cCMV approaches.   

Conclusions:  
The results of this investigation confirm the feasibility of integrated cCMV outcomes with newborn hearing screening results to enhance EHDI approaches. Moreover, a review of hearing monitoring pathways of those with cCMV demonstrates the need for improvement of more defined pathways and streamlined monitoring approaches to support the earliest identification of hearing loss and intervention.