Congenital cytomegalovirus (cCMV) is the most

common congenital infection, affecting 0.5–0.7% of

children in developed, including the US, and 1–2% in
developing countries. CCMV accounts for 21% of
cases of hearing loss (HL) at birth and 25% by age
4. In children with bilateral moderate to profound
HL, 15–35% has been attributed to cCMV. CMV is
most reliably diagnosed through urine samples
collected within three weeks of birth. Targeted
screening involves cCMV testing of all newborns that
fail the in-hospital newborn hearing screen (NBHS)
and/or fail a second screen post discharge. Williams
found that newborn screening and treatment per
case of cCMV-related HL in the UK to be cost-
saving. Duration of dried blood spot storage varies
by state, and test referral rates are extremely low.
Six states have passed legislation mandating
targeted screening. However, widespread adoption
of targeted screening has been impeded in part by
cost concerns and the small number of children
affected. Studies examine the costs associated with
targeted testing have limitations. Reports Medicaid
savings were overestimated as they were based on
cost per child with HL for all children. Gantt et al.
However, the analysis assumed no LTF prior to the
second community evaluation, estimated as high as
38 and the no-screening branch of the model was
mis specified.
Congenital cytomegalovirus (CMV) is a common viral
infection that affects newborns in the United States,
and can cause hearing loss, developmental delays,
and other disabilities. Recently, targeted screening
for CMV in newborns has been proposed as a more
cost-effective strategy than clinical diagnosis. This
essay aims to evaluate the cost-effectiveness of
targeted screening for congenital cytomegalovirus in
newborns compared to clinical diagnosis in the
United States, by examining the benefits and
limitations of each strategy. EI services for children
identified with HL at birth consisted of: a speech
evaluation, therapy twice a week from two months to
age 1 year. 50% of children with bilateral profound
HL are assumed to receive cochlear implant (CI) as
given families are not interested in implants and
may face financial barriers. Children who are cCMV+
and have a negative auditory brainstem response
are assumed to undergo hearing tests every six
months until age 4 years.
Targeted screening for congenital cytomegalovirus in
newborns involves testing only those infants who are
at high risk for the infection. This includes infants
born to mothers who have tested positive for the virus
during pregnancy, as well as infants who display
symptoms of CMV infection at birth. One advantage of
this strategy is that it targets those infants who are
most likely to have the infection, thereby reducing the
number of unnecessary tests and treatments. In
addition, targeted screening can identify infants with
CMV infection before symptoms develop, allowing for
earlier intervention and treatment. Early detection and
treatment of CMV can reduce the risk of long-term
complications, such as hearing loss and
developmental delays, thereby improving the quality
of life for affected children and their families.
However, targeted screening may miss some cases of
CMV infection in newborns, particularly those born to
mothers who did not test positive for the virus during
pregnancy. In addition, targeted screening may be
expensive, as it requires multiple tests and follow-up
visits for those infants who test positive for the
infection.
Clinical diagnosis of congenital cytomegalovirus
infection typically involves testing all newborns for
the virus, regardless of risk factors or symptoms. This
approach ensures that all infants with CMV infection
are identified, regardless of their risk status or
symptoms. However, this strategy can be expensive,
as it requires testing all newborns, including those
who are at low risk for the infection. Furthermore,
clinical diagnosis may result in overdiagnosis and
overtreatment of infants who do not have CMV
infection, leading to unnecessary medical
interventions and costs. This approach may also lead
to delays in diagnosing and treating infants with CMV
infection, as it may take longer to identify those who
are at higher risk for the infection.

The most common cause of environmental hearing

loss is CCMV, and early detection and treatment of
affected infants is beneficial. Our model suggests that
targeted cCMV newborn screening after two failed
NBHS, with follow-up to age 5 years, may prevent or
slow the progression of HL, detect HL at an earlier
age, and identify more cases of cCMV+ at a low cost.
Adoption of newborn targeted screening as standard
of care should be considered because it has the
potential to prevent disability and save money when
educational costs and productivity losses are factored
in.