Congenital cytomegalovirus (cCMV) is the most common congenital infection and a leading nongenetic cause of sensorineural hearing loss. In the United States, legislative mandates for cCMV screening are expanding, but there is no consensus on the optimal screening approach. The Cleveland Clinic Ohio enterprise established a program to assess implementation outcomes and provide operational insights for initiating cCMV screening across a large hospital system.
A multidisciplinary team representing clinical and laboratory specialties developed a comprehensive screening and follow-up program. The system adopted a hybrid screening protocol: universal screening in neonatal intensive care units (NICUs) and targeted screening in newborn nurseries. The report describes integration of screening protocols into clinical workflows across the enterprise, emphasizing multidisciplinary collaboration as essential to rapid implementation.
Between 2022 and 2025 there were 50,438 live births within the Cleveland Clinic Ohio enterprise. Over that period, 7,491 infants (14.9% of live births) underwent cCMV screening. Annual testing increased substantially—from approximately 150 infants tested before implementation to more than 2,000 infants tested per year after the program was deployed. This demonstrates substantial scale-up of screening activity within the system.
Thirty-four infants who underwent screening were confirmed to have cCMV, representing 0.45% of those screened. The program’s introduction increased overall case detection by about 2.5-fold compared with prior detection rates. Detection rates differed by screening strategy and clinical setting: the targeted screening group (newborn nurseries) had a higher confirmed cCMV rate (0.74%) than the universal screening group (NICUs), which had a rate of 0.33%. This difference was statistically significant (P = .01), indicating variation in yield by screening approach and population.
Among the 34 infants with confirmed cCMV, the most common clinical findings reported were abnormal neuroimaging, observed in 32.3% of cases, and being small for gestational age, observed in 26.5% of cases. The abstract does not provide additional granular clinical details such as specific neuroimaging abnormalities, timing of symptom onset, or longer-term developmental and hearing outcomes.
While the screening protocols were rapidly integrated into hospital workflows, the authors identified limitations in post-diagnostic follow-up. Audiology follow-up—critical for monitoring hearing outcomes in infants with cCMV—was constrained by multiple factors: logistical issues, socioeconomic barriers, and educational gaps among families. These obstacles limited access to recommended audiologic and other specialty follow-up care, and thus may reduce the potential clinical impact of increased detection.
The abstract does not report specific laboratory methods, the screening assay(s) used, detailed follow-up schedules, or adherence rates to specific follow-up visits. Those operational and methodological details were not reported in the abstract.
The Cleveland Clinic’s experience indicates that a hybrid cCMV screening program is feasible across a large health care system and substantially increases case detection. Key enabling factors included multidisciplinary collaboration and systematic integration into clinical workflows. However, increasing detection alone is insufficient: improving access to audiology and other follow-up services is necessary to translate screening into improved clinical outcomes. These findings underscore that implementation planning must address not only laboratory and screening logistics but also equitable access to diagnostic and longitudinal care for affected infants.