Congenital Cytomegalovirus (cCMV)



Florida began in January a targeted cCMV screening program for newborns who do not pass their hearing test. cCMV is the most common viral infection and the leading non-genetic cause of hearing loss in infants born in the United States. cCMV infection is harmless to most people. However, when contracted during pregnancy, cCMV can cause symptoms in infants including hearing loss and developmental disabilities. This new screening is intended to identify infants with cCMV and connect families with appropriate medical treatments and therapies.

Please review the information below to learn more about cCMV and how Florida plans to provide targeted screening, family follow-up, and early intervention to infants with cCMV.

Where can I find the newly published cCMV guidelines?

The cCMV Screening Guidelines, published in November 2022, are available to view and download on

Are the hearing screen and the cCMV screen state-mandated just like the newborn screen?

Hearing and cCMV screening are required by law per section 383.145, Florida Statutes.

Should a facility screen a child for cCMV after failure of the first (initial) hearing screen or the second (repeat) hearing screen?

Each facility is responsible for creating a protocol for cCMV screening after failed hearing screen(s), including which inpatient hearing screen will trigger cCMV screening. Examples of screening flows have been provided in the cCMV Guidelines. Page 6 of the Guidelines is a screening flow designed for facilities who choose to use the initial inpatient screen as the trigger for a cCMV screen. Page 7 of the guidelines is a screening flow designed for facilities who choose to use the repeat inpatient screen as the trigger for a cCMV screen. If a facility’s protocol is to collect a specimen after the initial hearing screen, the results of the cCMV screen must be reported even when a repeat hearing screen is a pass.

Is there a standardized period when hearing screening should be performed?

According to the Florida Newborn Hearing Screening Guidelines and the Joint Committee on Infant Hearing 2019 Position Statement, a hearing screen should be completed as close to hospital discharge as possible while allowing enough time for a single repeat screen if the infant does not pass the first screen.

For some infants in the neonatal intensive care unit (NICU) (e.g., infants on ventilators) it may not be reasonable to complete a hearing screening prior to 21 days of age. Facilities should establish a hearing and cCMV screening procedure that contemplates infants with prolonged NICU stays.

Are non-birthing hospitals (i.e., pediatric hospitals) following a two-screen process or are they going straight to a diagnostic ABR after the first failed hearing screening? If the latter, when in the cCMV test completed?

The legislation does not contemplate this circumstance. This decision is up to individual facilities. It is recommended for newborns with prolonged NICU stays to receive diagnostic testing.

Should a baby remain inpatient until the results of the cCMV testing are confirmed?

Delaying discharge solely to wait for the receipt of cCMV screening results is not recommended.

Since hearing and cCMV testing are required, are there repercussions for parent refusal?

Section 383.145(3)(c), Florida Statutes allows the parent or legal guardian of the newborn to opt out of the hearing screening. Per Florida Guidelines for Newborn Hearing Screening, a parent who chooses to opt out of the hearing screen should be provided with educational materials regarding hearing loss and potential delays in speech and oral language milestones. Additionally, the parent must sign a document that confirms this choice, which is to be included in the child’s medical record. Finally, the hearing screen should be reported as a refusal to Florida Newborn Hearing Screening (NBHS) and Early Hearing Detection and Intervention Program (EHDI).

Should cCMV screening be offered if the parents opt out of the hearing screen?

Legislation does not require hospitals to screen for cCMV if a parent opts out of the hearing screen on behalf of their baby. However, each facility should develop procedures to address this circumstance. Some hospitals make an outpatient appointment for a hearing screen and experience a high rate of parental follow-through. If an infant fails the outpatient hearing screen, the primary care physician (PCP) is responsible for referring the infant for cCMV screening.

What are the next steps if a child tests positive for cCMV but is asymptomatic?

While 85% – 90% of children who screen positive for cCMV are asymptomatic, the cCMV Screening Guidelines recommends infants who test positive for cCMV receive diagnostic testing for cCMV, consultation with an infectious disease specialist for recommendations for medical management, diagnostic testing for other related conditions, and ongoing follow-up with appropriate specialists.

What is the recommendation for repeat hearing screenings for monitoring a child’s hearing level after a positive cCMV screen?

There is not universal consensus on the timing and frequency of monitoring children’s hearing levels. The Joint Committee on Infant Hearing 2019 Position Statement recommends newborns diagnosed with cCMV receive a diagnostic follow-up no later than three months of age and every 12 months to age three or at shorter intervals based on parent concerns. Other entities recommend children with cCMV receive a full audiological diagnostic evaluation in the first six weeks of life, ongoing evaluations every six months until the child is four years of age, and an annual audiological assessment until six years of age. Audiological monitoring every three months is recommended when hearing levels change.

There is a long wait to get an appointment with a pediatric infectious disease physician. Who will guide parents when their child screens positive for cCMV?

As with accessing pediatric audiologists, PCPs will take the lead in ensuring infants are connected with pediatric infectious disease physicians. PCPs can search for pediatric infectious disease physicians in their area by using the Department of Health’s Practitioner Profile Search.

How will cCMV screening results be reported to the Florida Department of Health, Newborn Hearing Screening Program?

All cCMV screening results, whether negative or positive, must be submitted through the electronic reporting portal, eReports™. eReports account requests can be made by completing the eReports™ Online Registration Form. cCMV screening results must be reported to the NBHS Program within seven days of receiving the results.