Role of the primary-care provider
Although the urine test is not adequate for cCMV testing in later childhood due to the virus’s permanent presence after initial infection, any infant who failed the hearing screen at birth or has developed other concerning symptoms that may be indicative of cCMV can still be tested by the primary-care provider within the first 3 weeks of life.
However, if the child develops symptoms after the first 3 weeks of life, and there is clinical suspicion for cCMV, the child’s dried blood spots (DBS) can be tested for CMV by means of PCR as the virus is stable on DBS cards for up to 18 years.6Drawbacks of this method of testing include the fact that the length of time the cards are kept varies by state, but most important, if viral replication at birth is low or absent, the test may render a false-negative result.6
The primary-care provider must promptly make all necessary referrals to clinicians specializing in pediatric infectious disease, hearing, vision, and neurology; and to physical therapy, speech therapy, and occupational therapy services. This will facilitate early intervention for the diagnosed infant as well as for infants with other developmental delays or medical conditions.3Many insurance plans, specifically state Medicaid plans, require the child’s primary-care provider to order these referrals, which makes it even more important for these practitioners to be knowledgeable about cCMV and vigilant about clinical presentation.
Audiology assessments should be conducted a minimum of every 6 months in infected children, even if asymptomatic, for the first 3 years of life, and then routinely at the audiologist’s discretion.3
If at any time the primary-care provider has clinical suspicion of undiagnosed maternal or congenital CMV infection but is not comfortable performing the testing, he or she should refer the case to a perinatologist and/or a pediatric-infectious-disease specialist as soon as possible.