Follow-up of infants with congenital cytomegalovirus and normal fetal imaging

Amir, Jacob; Atias, Joseph; Linder, Nechama; Pardo, Joseph

doi:10.1136/archdischild-2015-308357

Cited by 31 publications

(23 citation statements)

References 29 publications

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“…A recent retrospective study showed a relationship between the severity of neonatal neuroimaging and neurodevelopment in 36 infants with cCMV (26 symptomatic) [8]. All 5 patients with a normal US had a normal outcome, which is consistent with our and other studies [24], and 1 of 16 infants with mild US abnormalities (germinolysis and LSV) had polimicrogyria on MRI and a poor outcome. …”

Section: Discussionsupporting

confidence: 80%

“…The age at neurodevelopmental assessment was variable and sequelae could have been underestimated in patients with shorter periods of follow-up who were more likely to have modern-day neonatal neuroimaging. However, the age at follow-up was higher than in previous studies [2,3,4,5,6,8,19,20,21,22,23,24], the youngest patient being 19 months. At this age disabilities other than behavioral/emotional disorders are likely recognizable by our comprehensive, systematic and standardized protocol.…”

Section: Discussioncontrasting

confidence: 49%

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A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

et al. 2016

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Background: Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT). Objective: The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV. Methods: Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders. Results: Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT. Conclusions: A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 49%

A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

et al. 2016

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“…In a minority of treated infants, underreporting of CMV-associated conditions or treatment of asymptomatic infants with hearing loss only are possible. There has been limited clinical experience of use of antivirals in infants with asymptomatic congenital CMV infection with isolated hearing loss 27–29 . However, this has not been systematically evaluated in a randomized controlled trial or study, thus, there is no evidence to support treatment of infants with asymptomatic congenital CMV infection.…”

Section: Discussionmentioning

confidence: 99%

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009–2015

Leung

Dollard

Grosse

et al. 2018

Clinical Therapeutics

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Purpose To assess clinical characteristics and trends in valganciclovir use among infants diagnosed with congenital cytomegalovirus (CMV) disease in the United States. Methods We analyzed 2009–2015 medical claims from Truven Health MarketScan® Commercial Claims and Encounters and Medicaid databases. We identified infants with a live birth code in the first claim who were enrolled for at least 45 days. Among infants diagnosed with congenital CMV disease, identified by an ICD-9-CM or ICD-10-CM code of congenital CMV infection or CMV disease within 45 days of birth, we assessed codes for CMV-associated clinical condition within the same period, and hearing loss and valganciclovir claims within the first 180 days. Findings In the commercial and Medicaid databases, we identified 257 (2.5/10,000) and 445 (3.3/10,000) infants diagnosed with congenital CMV disease, respectively, among whom 135 (53%) and 282 (63%) had ≥1 CMV-associated condition, 30 (12%) and 32 (7%) had hearing loss, and 41 (16%) and 78 (18%) had valganciclovir claims. Among infants with congenital CMV disease who had valganciclovir claims, 37 (90%) among commercially-insured infants and 68 (87%) among Medicaid-insured infants had ≥1 CMV-associated condition and/or hearing loss. From 2009 to 2015, the proportion with valganciclovir claims increased from 0% to 29% among commercially-insured infants and from 4% to 37% among Medicaid-insured infants (p<0.0001). Implications During 2009–2015, there was a strong upward trend in valganciclovir claims among insured infants who were diagnosed with congenital CMV disease, the majority of whom had CMV-associated conditions and/or hearing loss.

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“…However, the clinical significance of isolated or subtle abnormalities on postnatal imaging is not well established . It is well established that when a dedicated fetal ultrasound (US) exam in a CMV infected fetus is normal, the neurodevelopmental outcome will be normal in the vast majority of cases . When subtle findings are detected on prenatal imaging (MRI and/or US), the clinical significance still remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

et al. 2020

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Objective To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy. Methods This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment. Results For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy‐four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false‐positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient. Conclusion Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false‐positive rate.

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Follow-up of infants with congenital cytomegalovirus and normal fetal imaging

Abstract: Congenital CMV infection acquired from primary maternal infection with normal fetal imaging is associated with a high rate of subtle signs and symptoms after birth. Overall, intermediate-term outcome is good with a low rate of sequelae.

Cited by 31 publications

References 29 publications

A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009–2015

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

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