Effective Strategies for Targeted Congenital CMV Screening

Importance of Early Detection of Congenital CMV

Congenital cytomegalovirus (cCMV) is recognized as the most prevalent viral infection affecting newborns, leading to significant long-term disabilities, particularly sensorineural hearing loss (Aldon et al., 2025). The early detection of cCMV is crucial as timely intervention can mitigate severe outcomes, including neurological impairments and developmental delays. Studies have demonstrated that approximately 10-15% of infants with cCMV may exhibit long-term sequelae, which emphasizes the need for screening programs that effectively identify at-risk neonates (Aldon et al., 2025; Boppana et al., 2013).

The integration of cCMV screening into existing newborn care protocols, particularly in conjunction with universal newborn hearing screenings, has been shown to enhance the identification of affected infants (Aldon et al., 2025). Targeted screening strategies can significantly increase the detection rate of cCMV, leading to earlier treatment and better outcomes. This proactive approach not only addresses the immediate health concerns of affected infants but also reduces the long-term economic burden associated with untreated cCMV-related disabilities (Aldon et al., 2025).

Overview of Targeted Screening Criteria for CMV

Targeted screening for cCMV involves specific criteria aimed at identifying infants at higher risk of infection. The screening criteria typically include:

1. Failed Hearing Screening: Infants who do not pass the initial hearing test are at increased risk for cCMV and should undergo further evaluation.
2. Small for Gestational Age (SGA): Neonates born with low birth weight or who are SGA are more likely to have cCMV.
3. Clinical Suspicion: Infants exhibiting clinical symptoms such as microcephaly, neurologic abnormalities, or signs of intrauterine infection should be screened for cCMV (Aldon et al., 2025).

From February 2022 to January 2023, a study at the National University Hospital in Singapore screened 5,277 neonates, of which 305 met the targeted screening criteria, highlighting the feasibility of implementing such protocols (Aldon et al., 2025). The findings underscored the importance of targeted screening as a practical approach to identify cCMV cases promptly.

Cost Analysis of Different CMV Screening Approaches

The economic implications of various cCMV screening strategies are significant and warrant careful consideration. A cost analysis comparing universal screening, targeted screening, and no screening revealed substantial differences:

The analysis indicates that while universal screening incurs the highest costs primarily due to its comprehensive nature, targeted screening remains cost-effective compared to no screening, especially when considering the potential costs associated with untreated cCMV-related disabilities (Aldon et al., 2025).

The targeted screening model identified 0.98% of infants with cCMV, demonstrating an effective balance between cost and detection (Aldon et al., 2025). This underscores the importance of implementing targeted screening frameworks as a means to enhance early diagnosis while managing healthcare expenditures effectively.

Clinical Outcomes of Congenital CMV Infection in Infants

The clinical outcomes for neonates diagnosed with cCMV can vary significantly. In the study by Aldon et al. (2025), three infants were confirmed to have cCMV, with one presenting with significant neurodevelopmental issues. This highlights the varied spectrum of clinical manifestations associated with cCMV, including:

• Hearing Loss: A substantial proportion of cCMV-positive infants experience hearing deficits, necessitating early intervention strategies like cochlear implants.
• Neurological Impairments: Some infants may exhibit upper motor neuron signs or developmental delays, requiring ongoing monitoring and supportive therapies (Aldon et al., 2025).
• Ophthalmological Issues: Regular eye examinations are crucial to detect potential visual impairments associated with cCMV.

By employing targeted screening, healthcare providers can initiate timely interventions, thereby improving outcomes for affected infants and reducing the long-term impact of cCMV.

Challenges in Implementing Universal CMV Screening Programs

Despite the clear benefits of screening for cCMV, several challenges hinder the widespread adoption of universal screening programs. Key challenges include:

1. Cost and Resource Allocation: Implementing universal screening can be resource-intensive, requiring significant financial investment in testing and follow-up care (Aldon et al., 2025).
2. Awareness and Training: Healthcare providers and parents must be educated about the importance of cCMV screening, which necessitates training and awareness campaigns (Aldon et al., 2025).
3. Logistical Issues: The collection and processing of samples for cCMV testing must be streamlined to ensure timely diagnosis and intervention.

These challenges must be addressed through comprehensive planning and collaboration among healthcare stakeholders to ensure the successful implementation of cCMV screening programs.

FAQ

What is congenital cytomegalovirus (cCMV)?
cCMV is a common congenital viral infection that can lead to a range of health issues in newborns, primarily sensorineural hearing loss and neurodevelopmental delays.

Why is targeted screening for cCMV important?
Targeted screening helps identify high-risk infants who may have cCMV, allowing for early intervention and treatment to improve long-term outcomes.

What are the common screening criteria for cCMV?
Screening criteria typically include failed hearing screenings, being small for gestational age, or having clinical suspicions of cCMV infection.

What are the potential costs associated with cCMV screening?
Costs can vary significantly depending on the screening strategy; targeted screening is more cost-effective than universal screening or no screening, especially when long-term impacts of untreated cCMV are considered.

What challenges exist in implementing universal cCMV screening?
Key challenges include financial implications, the need for increased awareness and training, and logistical issues related to sample collection and testing.

References

1. Aldon, M. L., Raveentheran, G., Amin, Z., Chan, S. M., Aoyama, R., Tee, N., Ng, S. Y., Lee, C. K., Ng, P. G., & Low, J. M. (2025). Congenital cytomegalovirus screening in neonates born after 35 weeks gestation—is targeted screening beneficial? Frontiers in Pediatrics, 13. doi:10.3389/fped.2025.1510612

2. Boppana, S. B., Ross, S. A., & Fowler, K. B. (2013). Congenital cytomegalovirus infection: clinical outcome. Clinical Infectious Diseases, 57(suppl 4), S178–S181. doi:10.1093/cid/cit629

3. Tan, Y. Y., Chan, K. H., Tee, C. S., & Yeo, G. S. (2023). Seroprevalence of cytomegalovirus, toxoplasma and parvovirus in pregnancy. Singapore Medical Journal, 41(4), 151–155. doi:10.1097/00006454-200301000-00012

4. Gantt, S. D., Dionne, F. K., Kozak, F. K., Goshen, O., Goldfarb, D. M., & Park, A. H. (2016). Cost-effectiveness of universal and targeted newborn screening for congenital cytomegalovirus infection. JAMA Pediatrics, 170(12), 1173. doi:10.1001/jamapediatrics.2016.2016

5. Kenneson, A., & Cannon, M. J. (2007). Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Review of Medical Virology, 17(4), 253–276. doi:10.1002/rmv.535