Congenital Cytomegalovirus and Timely Newborn Hearing Screens in the NICU

Congenital cytomegalovirus (cCMV) is a prevalent infection that can have devastating adverse effects, such as hearing loss, vision loss, and neurologic deficit. Identifying an infant with cCMV can be difficult, as only 10% of infants are symptomatic and not every infant is screened. The purpose of this project is to evaluate the feasibility of conducting newborn hearing screens (NHS) within the first three weeks of life for infants in a level III newborn intensive care unit (NICU) at a large urban medical center in Salt Lake City, Utah in order to improve detection of cCMV. A failed NHS is a known symptom of cCMV. If an infant in the NICU fails his or her NHS and is subsequently tested for CMV, the test must be done within the first three weeks of life in order to establish whether it is a congenital or a postnatal infection. The adverse effects of a cCMV infection are long term and more severe than that of a postnatally acquired CMV infection. Most infants in the NICU have their NHS completed just prior to discharge, but not necessarily before 21 days of age. A previous clinical trial has been conducted with NHS performed on infants as young as 32 weeks gestation, with success. An interprofessional team of Audiology and Neonatology collaborated to create a list of criteria for infants in the NICU to be eligible for NHS before 21 days of age. A chart review was conducted to evaluate potential clinical impact. The criteria were used to conduct NHS on eligible infants. Descriptive data including: gestational age and weight at birth, gestational age and weight at 14 days of age, were they discharged with their NHS completed before 21 days of age, occipital frontal circumference (OFC) at 14 days of age, degree of respiratory support, current medications, any craniofacial anomalies, date of NHS, and passing rate was gathered. A manuscript of the project and its findings will be submitted to the Neonatal Network: The Journal of Neonatal Nursing as well as share the findings with neonatal healthcare providers in the region via a professional forum. The chart review and project revealed a majority of the NICU infants have their NHS completed and are discharged before 21 days of age. Of infants who remained in the NICU longer, more than 88% were eligible for a timely NHS. Of 112 infants included in the retrospective chart review or prospective clinical trial, only three infants had an oxygen need that precluded completion of a NHS. Of the seven infants identified prospectively that were screened using the new criteria, all passed their NHS successfully. Timely NHS in a NICU setting is an effective way to screen for infants with cCMV. It has the potential to increase the detection of infants with cCMV, which will improve clinical outcomes. Treatment with anti-viral therapy, speech-language and audiological therapy, and occupational therapy may be started earlier, thus improving infants' quality of life.