Table 2 cCMV diagnostic evaluation for infants with positive newborn screen.

From: Beyond hearing loss: exploring neurological and neurodevelopmental sequelae in asymptomatic congenital cytomegalovirus infection

Minnesota Department of Health (MDH) Recommendations for Clinical Evaluations of Infants with CMV Detected by Newborn Screeninga,b

Clinical Assessment

History and physical examination with particular attention to the following

• Maternal history of primary CMV infection, prenatal ultrasonography abnormalities.

• Assess if infant was born small for gestational age or has microcephaly.

• Palpation for hepatomegaly, splenomegaly, or both.

• Skin exam for jaundice, petechiae, purpura, blueberry muffin rash.

• Neurologic assessment of muscle tone, abnormal reflexes, or other neurologic findings.

Laboratory and Imaging Assessment

• Confirmation of cCMV by urine CMV PCR prior to 21 days of age.

• Collection of complete blood count (CBC) with differential leukocyte count and platelet count.

• Hepatic function tests (transaminase, serum bilirubin).

• Cranial ultrasound. A brain MRI may be recommended in some settings (see text for details).

Additional Assessments

• Audiology evaluation. Initial audiologic examination including auditory brainstem response (ABR) studies irrespective of results of newborn hearing screening examination, followed by regularly scheduled audiology to monitor for delayed onset/progressive hearing loss.

• Ophthalmology examination for baseline visual assessment for eye findings (e.g., chorioretinitis) associated with cCMV.

  1. aModified from MDH cCMV newborn screening program clinical practice guideline published at: https://www.health.state.mn.us/people/newbornscreening/program/cmv/followup.html.
  2. bNewborn screening is performed on infant dried blood spot PCR testing for CMV DNA; all positive cases should have a confirmatory urine sample for CMV PCR obtained to confirm diagnosis of cCMV prior to engaging in additional diagnostic evaluation.90
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