P0117 - A Large Health System Wide Approach to Early Identification of Congenital CMV

Background:
CMV causes at least 10% of congenital hearing loss but there is no standard newborn screening protocol. Consequently, many babies who are otherwise asymptomatic are at risk of not being diagnosed, and consequently not receiving early interventions. At least 40,000 babies are born annually at Northwell’s 10 birth hospitals, which constitute about 1% of nationwide births.
Methodology:
We have developed a term-newborn pre-discharge targeted CMV testing program. Prior to our program, testing was inconsistent and driven by known maternal infection or symptomatic congenital CMV syndrome.
In late 2016 we began a CMV awareness campaign in our hospitals across the health system.
In early 2017 we met with audiologists, newborn unit nurses, neonatologists and pediatricians and proposed enhanced targeted testing of the following groups: all babies who fail their state-mandated hearing screen, babies with even mild symptoms, and babies born to mothers with suspicion of infection.
Champion teams that included physicians and nurses were composed at all hospitals. Initially, we relied on nurses to prompt pediatricians to order PCR on urine for newborns who failed their hearing test. After we reviewed the efficacy of PCR on saliva, we implemented a "CMV by PCR, Saliva" order in the system EMR, which went live in February of 2018. The order is available for activation by nurses for failed hearing test, circumventing the need for a physician order. Saliva testing in newborns also prevents delay in the discharge process, when comparing collection time for saliva swab vs urine. All saliva positives are confirmed by urine PCR as outpatient after the newborn is discharge.

Discussion:
We are presenting data for 7 hospitals, limited to the hearing failure targeted screening. Among 54,046 births (includes NICU babies) in the pre-implementation period January 2016 to January 2018, 852 (1.6%) failed their hearing screen; of these, 154 (18%) had CMV tests performed; 10 were positive. Among 58,777 births (excludes NICU babies) in the post-implementation period February 2018 to February 2020, 993 (1.7%) failed their hearing screen; of these 766 (77%) had saliva CMV PCR performed; 5 were positive. One had symptomatic congenital CMV.
Well after our program began, New York State mandated CMV testing of all newborns with hearing impairment.

Conclusion:
Testing is now done at all birth hospitals in our health system and compliance touched 100% in February 2020. We present a model for enhanced targeted CMV testing that can be adapted to other settings.