Rethinking congenital cytomegalovirus: A narrative review of the clinical, public health, and ethical challenges of a preventable cause of childhood hearing loss

Abstract

Congenital cytomegalovirus (cCMV) is the most common non-genetic cause of pediatric sensorineural hearing loss, affecting approximately tens of thousands of infants annually in the United States. While cCMV may present symptomatically at birth, many infants are asymptomatic initially and later develop progressive or fluctuating hearing loss, which is often undiagnosed without early screening. Despite advances in diagnostic methods such as polymerase chain reaction (PCR) testing, the absence of a national screening policy in the U.S. results in significant variability in early detection and follow-up care. This narrative review provides an overview of the clinical manifestations, diagnostic strategies, and treatment options for cCMV, while highlighting critical gaps in public health infrastructure, policy coordination, and ethical oversight. Cost considerations remain a major factor in determining the feasibility of universal versus targeted screening approaches, with emerging data suggesting that both strategies offer cost-effective benefits depending on implementation context. Additionally, disparities in access to follow-up care and interventions raise important questions about health equity. Current efforts by some states to include cCMV in newborn screening protocols are promising, but without consistent national guidance, large portions of affected infants will continue to be missed. Addressing cCMV effectively will require a multidisciplinary, systems-based approach that combines early detection with sustainable follow-up, robust policy frameworks, and ethical consideration for families navigating diagnosis and care.