Newborn Screening for Congenital Cytomegalovirus

Abstract

What Is the Issue? Congenital cytomegalovirus (cCMV) is estimated to affect between 0.2% and 2.4% of newborns worldwide, and may cause long-term effects, including hearing loss and neurodevelopmental disability. Newborn screening for cCMV can identify affected neonates and provide an opportunity for early treatment, which may reduce any long-term effects from infection. We wanted to know if universal newborn screening is a clinically effective and cost-effective intervention for identifying and managing cCMV. What Did We Do? We identified and summarized published literature comparing the clinical effectiveness and cost-effectiveness of universal newborn screening with either targeted newborn screening or no screening for congenital cytomegalovirus in neonates. We also identified and summarized published, evidence-based guidelines that make recommendations concerning the use of newborn screening for congenital cytomegalovirus to help inform decisions considering the use of this intervention. An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2014, and March 19, 2024. The search was limited to English-language documents. One reviewer screened articles for eligibility based on predefined criteria, critically appraised the included studies, and narratively summarized the findings. What Did We Find? Evidence from 1 prospective cohort study in the US found that, compared to universal newborn screening for cCMV, targeted newborn screening failed to identify a significant proportion of neonates who developed hearing loss associated with infection. Three cost-effectiveness evaluations concluded that universal newborn screening for cCMV was cost-effective when compared to targeted newborn screening or no screening. None of these analyses were specific to the Canadian context. While 1 of 3 evidence-based guidelines identified by this review makes a recommendation favouring universal newborn screening for cCMV, 2 evidence-based guidelines recommend against the implementation of universal newborn screening for cCMV (including 1 from the Canadian context), generally citing a lack of sufficient clinical evidence. What Does This Mean? The included cost-effectiveness studies and evidence-based guidelines in this report emphasize that limited clinical evidence is currently available to inform decision-making concerning newborn screening for cCMV. Jurisdictions where universal newborn screening for cCMV has been implemented provide an opportunity for clinical research to support and inform future decision-making. The current limitation of available clinical data describing newborn screening for cCMV will require decision-makers to draw from a broader set of inputs and sources than those available from empirical studies.