Representatives from the Connecticut Department of Public Health's Early Hearing Detection and Intervention (EHDI) program on May 23 briefed the Midwifery Working Group on newborn hearing screening, congenital cytomegalovirus (cCMV) testing and resources for families and providers.

The EHDI presenters said the program follows a "1-3-6-9" model: screening by 1 month, diagnostic audiology by 3 months for babies who fail screening, enrollment in early intervention by 6 months for infants with identified hearing loss and family-based supports by 9 months. "Hearing 1 month of age, all Connecticut born infant receive new receive their newborn hearing screening," EHDI staff said.

The presentation also described a change in state practice scheduled for July 1, 2025: universal cCMV testing for newborns. John Lamb, supervisor of the EHDI program, said that beginning July 1 "testing will be seamlessas it will be done as part of already required blood spot card submission to the DPH lab." Under the current practice described in the meeting, cCMV testing is required for infants who fail a newborn hearing screen and is recommended to be performed before day 21 to help determine whether CMV infection is congenital or acquired.

Why it matters: EHDI staff said early identification matters because most infants with hearing loss show no outward signs and early language development begins immediately after birth. "Most infants with hearing loss show no sign. So early learning starts from day 1," the presenter said. EHDI staff also noted state data indicating approximately 2.45 babies per 1,000 screened in Connecticut are identified with hearing loss.

Program details and resources: EHDI provides newborn-screening oversight, case tracking, outreach and education, and family navigation. The program contracts with the American School for the Deaf to provide family-to-family support and navigation for children ages 0 to 3. EHDI staff said brochures titled "Can Your Baby Hear?" and "Your baby needs a CMV test and a hearing test" are available in English and Spanish and are distributed to birth facilities; the presenters said they print roughly 35,000copies per year for providers and families.

Testing types and availability: Presenters explained common screening methods: otoacoustic emissions (OAE) and automated auditory brainstem response (AABR or ABR). EHDI staff described a practical shift they have observed: many birth facilities increasingly use ABR at birth, while OAE equipment is less common and harder for the program to supply to community providers. "Getting equipment purchased is a very difficult process for us," John Lamb said, noting past work supplying equipment under contract and the administrative and funding hurdles that accompany any equipment procurement and distribution.

Midwives raised access barriers for families who choose home birth. Several midwives described cases where pediatric audiology centers would not accept a referral from a midwife unless an MD, APRN or PA submitted it, or where satellite clinics directed families to go to a hospital for their first screen. One midwife described a client who abandoned follow-up because the administrative steps were too burdensome.

EHDI staff acknowledged those access issues and said they will raise referral-policy concerns on the state's EHDI task force and will contact specific centers to clarify which sites accept referrals from home-birth midwives. "I will talk to her and see if we can get that cleared up," John Lamb said about a Waterford satellite reported by midwives.

Treatment and specialist availability: EHDI presenters said treatment options for cCMV are limited and should be discussed with a child's health-care provider and an infectious-disease specialist. They identified two Connecticut hospitals with relevant infectious-disease expertise cited in the presentation: Yale New Haven Hospital and Connecticut Children's Hospital.

What was decided or directed: The program offered to share printed materials and QR-code resources for midwives to distribute to families, and staff said they will attempt to develop a short guidance document for home-birth midwives about what families can expect at an audiology appointment (appointment scheduling, baby sleep/feeding guidance and testing steps). EHDI staff also said they will raise referral restrictions and the Waterford example at the EHDI task force and may contact the audiology centers represented there.

No formal votes were taken on program policy during the meeting.

Ending: EHDI staff encouraged midwives to email specific examples of access barriers so the agency can raise them with the task force and named audiology centers. They also said the program will continue to supply brochures and outreach materials and to provide technical assistance to reduce barriers for families choosing home birth.