The cCMV Screening Guidelines, published in November 2022, are available to view and download on https://floridanewbornscreening.com/

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

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.

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.

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.

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

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).

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.

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.

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.

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.

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.