Targeted CCMV Screening Model Using a Customized EMR Dashboard

Introduction: Targeted congenital CMV (cCMV) screening in newborns has been proposed as a strategy to identify neonates who could benefit from early detection and possible antiviral treatment. Several states have passed legislation requiring targeted newborn screening. While the criteria for targeted screening are well known, the implementation of targeted screening on a large scale is highly variable and left to the discretion of the individual institutions. We propose a prospective targeted CMV screening model using an EMR dashboard in an inpatient setting.

Methods: Study

Design: Prospective

Setting: Tertiary medical center

Methods: A targeted CMV screening dashboard was generated though an Electronic Medical Record (EMR) system on a weekly basis. The dashboard screened all births in a large multi-site medical center for CMV screening criteria (Small for gestational age (SGA), Failed neonatal hearing screening, microcephaly, hepatomegaly, purpura, retinitis, seizures). The sites were then notified of eligible patients who needed urine or saliva CMV testing before discharge. For patients who tested positive for CMV as inpatients, their pediatrician was notified, and appropriate follow up appointments were scheduled (Otolaryngology, audiology, Infectious disease and Ophthalmology).

Results: From July 1, 2021 to December 31, 2022, there were 961 patients who underwent CMV testing out of 6908 total live births within the Montefiore system (201 Urine CMV PCR and 760 Saliva PCR). The criteria for testing included 298 patients with SGA, 289 patient with intrauterine growth restriction , 274 patients who failed the Otoacoustic emissions (OAEs) and 81 patients who failed the automated ABR testing , 19 patients with neonatal seizures. Thirteen patients tested positive for CMV , with 11/13 presenting with symptomatic cCMV.

Conclusions: We propose a prospective targeted CMV screening model using an EMR dashboard in an inpatient setting. This model looks promising for large scale cCMV screening