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The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. The mortality of symptomatic congenital CMV infection is about 30%.

Background and aimsCongenital cytomegalovirus (cCMV) is the most common congenital infection with a birth prevalence of 0.3%–0.7% in developing countries. It is the leading cause of non-genetic sensorineural hearing loss (SNHL) and an important cause of neurodisability. At birth, 10%–15% of infants are symptomatic and a further 10%–15% develop symptoms, mostly SNHL, by age 5 years. Despite this, there is limited awareness of cCMV, therefore meaning many infected infants are undiagnosed.We aimed to determine the number of infants presenting to our University Hospital with cCMV over a 10 year period and to describe the diagnosis, treatment and outcome of these infants in order to refine our clinical pathways.MethodsElectronic patient databases were searched to identify patients diagnosed with cCMV between 01/09/2007 and 30/08/2017. A standardised data capture tool was designed and utilised to describe the clinical features and management of these children.ResultsForty infants were initially identified of which 4 were subsequently determined to have postnatal acquisition of CMV. Of the 36 infants with cCMV, 22 (61%) were symptomatic in the neonatal period and 6 (17%) developed sequelae beyond the neonatal period. The mean age of diagnosis was 4 months 10 days. The majority of infants were diagnosed using PCR of a urine sample. Eighteen (50%) of infants were treated with either ganciclovir or valganciclovir for either 6 weeks or 6 months. In total, 28 (78%) infants experienced long term adverse outcomes associated with CMV.ConclusionCongenital CMV is a relatively rare condition, however it is associated with a significant health burden for infants, their families and the NHS. Increased awareness and education of pregnant women and healthcare professionals is essential to improve early diagnosis of cCMV and therefore increase the number of infants who might benefit from anti-viral treatment. Follow-up of both symptomatic and asymptomatic infants is essential for early diagnosis of SNHL and therefore early intervention for these infants.

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