Congenital cytomegalovirus (cCMV) is the most common infectious cause of sensorineural hearing loss (SNHL). 1 It is estimated to account for up to 25% of SNHL in young children and is capricious in its presentation. 2 A substantial proportion of infants with cCMV infection will have normal hearing at birth and then present later with fluctuating or progressively worse hearing. However, not all children with cCMV infection will present with or develop late-onset SNHL; determining those at risk to develop this sequela has been an elusive goal.In this issue of JAMA Otolaryngology-Head & Neck Surgery, De Cuyper et al 3 report on the risk factors for congenital hearing loss in newborns with cCMV using a prospective multicenter registry. They identified 1033 children, 40.3% of whom were diagnosed with clinically apparent symptomatic and 59.7% with asymptomatic cCMV infection. Symptomatic disease was defined as containing clinical, neurological, or laboratory abnormalities. They included intrauterine growth retardation, petechiae, hepatosplenomegaly, thrombocytopenia, anemia, leukopenia, elevated transaminase levels, cholestasis, seizures, microcephaly, chorioretinitis, central nervous system imaging abnormalities, or SNHL. They found 3 independent risk factors for congenital SNHL in the symptomatic group: petechiae, periventricular cysts seen on brain magnetic resonance imaging (MRI), and maternal seroconversion of anti-CMV antibodies during the first trimester of pregnancy. For the asymptomatic group, they noted only 1 independent risk factor, first trimester maternal seroconversion. In addition, they found that the median viral load was markedly lower in children without congenital SNHL compared with those with hearing loss.These findings build on earlier smaller studies that just focused on symptomatic disease. [4][5][6] The association of first trimester seroconversion with SNHL, the significance of periventricular cysts on a brain MRI, and the identification of a risk factor for congenital SNHL in infants with asymptomatic cCMV infection are novel findings. 3 Another strength of this study is their use of a standardized registry created in 2007. A multidisciplinary team of pediatricians and otolaryngologists partnered with 6 centers to create a protocol for cCMV diagnosis, treatment, follow-up, and documentation. From this work, an astounding 1033 infants with cCMV infection were able to be diagnosed and evaluated for this project. As many US and Canadian institutions, some at the state or provincial level, are developing or refining their early CMV screening or testing ef-