在大型医院系统中实施先天性巨细胞病毒筛查

文献信息

中文摘要

背景与目标： 先天性巨细胞病毒（cCMV）是最常见的先天性感染，也是非遗传性感音神经性听力损失的主要原因。尽管美国各地不断扩大的立法筛查要求，但对于筛查方法尚无共识性指南，导致实施差异很大。我们的目标是评估在大型医院系统内启动cCMV筛查的结果，并提供运营方面的见解。
方法： 一个代表关键临床和实验室专业的多学科团队制定了一项全面的cCMV筛查和随访计划。在克利夫兰诊所俄亥俄企业内出生的婴儿通过混合筛查方案（新生儿重症监护病房普遍筛查，新生儿 nursery 针对性筛查）进行筛查。汇总了检出率和实施见解。通过回顾性病历审查评估临床结局。
结果： 在50 438例活产中，2022年至2025年期间有7491名婴儿（14.9%）接受了cCMV筛查，年度检测量从约150名婴儿增加到超过2000名婴儿。34名婴儿（0.45%）被确诊为cCMV，病例检出率增加约2.5倍，针对性筛查组的检出率高于普遍筛查组（0.74% vs 0.33%；P = .01）。最常见的临床发现是神经影像学异常（32.3%）和小于胎龄儿（26.5%）。尽管筛查方案迅速整合到工作流程中，但听力随访受到家庭后勤、社会经济和教育障碍的限制。
结论： 混合cCMV筛查在大型医疗保健系统中是可行的，并能提高检出率。多学科合作对于成功实施至关重要。需要改善听力及其他随访护理的可及性，以最大化临床影响。

英文摘要

BACKGROUND AND OBJECTIVES: Congenital cytomegalovirus (cCMV) is the most common congenital infection and the leading nongenetic cause of sensorineural hearing loss. Despite expanding legislative screening requirements across the United States, there is no consensus guidance on the screening approach, resulting in wide variation in implementation. Our objective was to assess the outcomes and provide operational insights of initiating cCMV screening within a large hospital system.
METHODS: A multidisciplinary team representing key clinical and laboratory specialties developed a comprehensive cCMV screening and follow-up program. Infants born within the Cleveland Clinic Ohio enterprise were screened through a hybrid screening protocol (universal screening in neonatal intensive care units and targeted screening in newborn nurseries). Detection rates and implementation insights were compiled. Clinical outcomes were assessed through retrospective medical record review.
RESULTS: Among 50 438 live births, 7491 infants (14.9%) underwent cCMV screening from 2022 to 2025, increasing annual testing from approximately 150 to over 2000 infants. Thirty-four infants (0.45%) were confirmed to have cCMV, increasing case detection approximately 2.5-fold, with higher detection rates in targeted vs universal groups (0.74% vs 0.33%; P = .01). The most common clinical findings were abnormal neuroimaging (32.3%) and small for gestational age (26.5%). Although screening protocols were rapidly integrated into workflows, audiology follow-up was limited by logistical, socioeconomic, and educational barriers of families.
CONCLUSIONS: Hybrid cCMV screening is feasible across a large health care system and increases detection. Multidisciplinary collaboration is essential to successful implementation. Improved access to audiology and other follow-up care is needed to maximize clinical impact.