# Targeted congenital cytomegalovirus screening as part of the newborn hearing screening programme in Northeast England

## TL;DR

A targeted screening approach for congenital CMV in newborns with hearing loss can identify cases early, but some high-risk infants are missed due to delayed referrals.

## Contribution

A regional pathway within the UK Newborn Hearing Screening Programme successfully identifies cCMV in 'otherwise well' neonates within a critical treatment window.

## Key findings

- Approximately 10% of 'otherwise well' neonates with hearing loss had cCMV identified through the screening pathway.
- A subgroup of medically complex infants was often referred too late for timely cCMV testing.
- Early referral pathways need optimization to ensure all at-risk neonates receive timely cCMV testing.

## Abstract

Neonates with congenital CMV (cCMV) with hearing loss at birth have improved hearing and developmental outcomes when treatment is started within the first 4 weeks of life. This report retrospectively evaluates the performance of a targeted diagnostic pathway for ‘otherwise well’ neonates who fail their newborn hearing screen. Approximately 10% of ‘otherwise well’ neonates who failed their newborn hearing screen and were subsequently diagnosed with sensorineural hearing loss were identified as having cCMV, highlighting the pathway’s diagnostic utility. Our findings do, however, identify a missed subgroup—infants with complex medical needs requiring prolonged neonatal hospital stays—who are often referred for audiology assessment too late for timely cCMV testing. These findings support the need to optimise early referral pathways to ensure that all at-risk neonates are offered diagnostic cCMV testing within the recommended time frame.

What is Known:

• Treatment of symptomatic cCMV infection in neonates started timely before 4 weeks of life, improves hearing and developmental outcomes.

• cCMV screening for all neonates is not available in all countries.

What is New:

• This report demonstrates the diagnostic utility of a regional pathway embedded within the UK Newborn Hearing Screening Programme for identifying ‘otherwise well’ neonates with cCMV-associated hearing loss timely, allowing start of treatment within the first 4 weeks of life.

• Alternative strategies are required for premature and unwell hospitalised neonates.