Clinical Features Associated with Timing of Identification of Congenital Cytomegalovirus

The objective was to study perinatal and clinical factors associated with early vs delayed diagnosis of congenital cytomegalovirus (cCMV). We conducted a cross-sectional caregiver-reported survey of children with cCMV aged 12 months to <11 years. The timing of diagnosis was categorized as early (<31 days of life) or delayed (≥31 d). Prenatal and perinatal features, neonatal signs, and clinical indications prompting cCMV testing were compared by timing of diagnosis using descriptive and bivariate analyses. Among 181 children, 133 (73.5%) were diagnosed before 31 days and 48 (26.5%) later. Early diagnosis was associated with suspected prenatal CMV infection (38.3% vs 8.3%), neonatal intensive care unit (NICU) admission or prolonged hospitalization (50.4% vs 8.3%), and abnormal brain imaging at birth (58.6% vs 18.8%) (all P  < .001). Early testing was more commonly prompted by abnormal prenatal ultrasound (33.8% vs 8.3%), NICU admission or severe illness (33.8% vs 0%), and abnormal newborn examination (48.9% vs 22.9%). Delayed diagnosis was more commonly prompted by late-onset hearing loss (29.2% vs 0.8%) and developmental concerns (33.3% vs 5.3%) (all P ≤ .002). Failed hearing screening did not differ between groups (39.6% vs 39.8%; P  = .97). Timing of cCMV diagnosis reflects differences in clinical recognition and testing pathways rather than absence of signs.