A Targeted Approach for Optimizing Congenital Cytomegalovirus (cCMV) Testing: A Quality Improvement Initiative

Background: Cytomegalovirus (CMV) is one of the most common congenital infections identified in the neonatal period; however, testing remains inconsistent and can lead to increased health care costs and low diagnostic yield. Purpose: To optimize resource utilization and reduce overtesting in a level III neonatal intensive care unit (NICU) and general care nursery (GCN) among neonates classified as small for gestational age (SGA) or with intrauterine growth restriction (IUGR). Methods: An interprofessional team implemented a standardized congenital CMV testing guideline supported by an electronic medical record–based best practice advisory (BPA) in the NICU and GCN. Education was provided to advanced practice providers and physicians, and the guideline was accessible through the hospital intranet. Weekly audits were conducted over a 12-week period (November 18, 2024-February 7, 2025) to evaluate BPA-identified neonates. Measures included IUGR and SGA classification, presence of physical signs or additional risk factors, CMV testing and positivity rates, and guideline adherence. Results: Forty-one neonates triggered the BPA for testing consideration. Nine infants (21%) exhibited a physical sign, exclusively head circumference less than the 10th percentile. Fifteen infants (36%) were tested for isolated IUGR and/or SGA without physical signs or additional risk factors. Twenty-four neonates (59%) underwent urine CMV polymerase chain reaction testing, with zero positive results. Guideline adherence was 90% (n = 37). Implications for Practice and Research: A standardized, risk-based congenital cytomegalovirus testing guideline improved testing consistency and reflected evidence of low diagnostic yield in asymptomatic infants. Future evaluation is needed to assess sustainability and refine testing criteria.