Do the hospitals in which you provide well newborn care include congenital cytomegalovirus testing in their newborn screening programs? If they do not, should they? This month’s early release of Pediatrics Ethics Rounds (10.1542/peds.2021-055368) considers arguments for and against such screening programs.
About 1 in every 200 infants in the US are congenitally infected with cytomegalovirus. While most of these infants (90%) are asymptomatic, some will nonetheless develop long-term sequelae including sensorineural hearing loss (10-15%) and vestibular/balance disorders (35-50%). Many of the symptomatic infants, however, are also undiagnosed. While testing only those who fail their newborn hearing screen (hearing targeted screening) reduces the percentage of infants who will not develop sequalae, many infants who later develop hearing loss pass their newborn hearing screens. Testing on different types of samples has different benefits and detriments. There is limited data regarding the efficacy of antiviral treatment. Other potential inventions for those identified by universal screening (testing all newborns) include hearing monitoring. Some worry about vulnerable child syndrome, while others argue parents find information valuable.
Three commentators, a developmental and behavioral pediatrician and patient of a child with a congenital cytomegalovirus infection, an ethicist and pediatrician, and a primary care pediatrician, draw different conclusions based on the relevant information. The first commentator emphasizes physical examination’s low sensitivity for diagnosing congenital cytomegalovirus infections and the availability of interventions in addition to antivirals. The second, in contrast, emphasizes the variable sensitivity of PCR testing on dried blood spots and the structural barriers to incorporating other types of samples into newborn screening program. The third argues that, rather than trying to protect families, we should develop innovative ways to incorporate screening information into family centered care.
Do you think that including a form of congenital cytomegalovirus screening in state newborn screening programs is justified? If it is not, should you offer screening to parents as part of shared decision-making? Link to this month’s Ethics Rounds and see if your opinion on this issue changes.