Is it not time for international guidelines to combat congenital cytomegalovirus infection? A review of central nervous system manifestations

Gaur, Pritika; ffrench-Constant, Sara; Kachramanoglou, Carolina; Lyall, Hermione; Jan, Wajanat

doi:10.1016/j.crad.2020.02.009

Cited by 14 publications

(14 citation statements)

References 74 publications

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“…While the neonatal outcomes are currently reassuring, the long-term effects on newborns exposed in utero or early in the postnatal life is still unknown and poorly addressed. The natural history of congenital infections taught us that even asymptomatic newborns can develop significant long-term effects in terms of audiologic, visual, and neuropsychiatric problems [ 8 , 33 , 34 ]. The recent evidence that maternal SARS-CoV-2 infection induces a robust placental inflammation [ 14 ] further reinforces this hypothesis, and for these reasons we decided, in our center, to offer a long-term multidisciplinary follow-up to all infants exposed in utero or within the first hours of life.…”

Section: Discussionmentioning

confidence: 99%

Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings

et al. 2022

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The long-term outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are still unknown. We performed a single-center, prospective, observational study of newborns born from mothers with microbiologically confirmed SARS-CoV-2 infection in pregnancy or at time of delivery. Infants were offered a multidisciplinary follow-up consisting of nasopharyngeal Polymerase Chain Reaction test at birth and at 48–72 h of life, auxological growth and neurological development, serologic testing, and audiological and ophthalmological assessments. One-hundred ninety-eight mothers and 199 newborns were enrolled. Of the 199 newborns, 171 underwent nasopharyngeal swab, four (2.3%) and two (1.15%) children tested positive at birth and 48–72 h of life, respectively. None had SARS-CoV-2 related symptoms. Auxologic and neurologic development were normal in all children during follow-up. Nine out of 59 infants had SARS-CoV-2 IgG at 3 months of life, which was associated with a positive nasopharyngeal swab at birth ( P = 0.04). Twenty seven out of 143 (18.8%) newborns had pathologic transitory evoked otoacoustic emissions at birth, although 14/27 repeated after 1 month were normal. Audiological evaluation was completed with Auditory Brainstem Response between the third and sixth month of life in 34 children, showing in all normal hearing threshold. The ophthalmological evaluation found retinal vascular anomalies in 3/20 (15%) children, immature visual acuity in 5/20 (25%) children, and reduced distance attention in 6/20 cases (30%). Conclusions : Our study showed that the neonatal and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are mostly positive, with the exception of ophthalmologic findings which, in a preliminary cohort, were abnormal in about 15% of cases. Further prospective, longitudinal studies are needed to better understand the clinical outcomes of children exposed to SARS-CoV-2 in utero and in the early postnatal life. What is Known: • In utero mother-to-child transmission of SARS-CoV-2 has been documented by several independent studies. • Neonatal COVID-19 is a systemic disease that can be severe, although rarely. What is New: • Newborns exposed in utero to SARS-CoV-2 have mostly a normal auxological, audiological, and neurological development during the first months of life. • Fundus fluorescein angiography revealed that up to 5% of newborns exposed in utero to SARS-CoV2 can show retinal and choroidal abnormalities, including peripheral hypofluorescence of the choroid and increased vascular tortuosity. Supplementary Info...

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Section: Discussionmentioning

confidence: 99%

Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings

et al. 2022

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“…La ecografía cerebral sigue siendo el estudio diagnóstico de primera línea para RN con CMVc, por ser de fácil acceso y alta sensibilidad para detectar quistes germinolíticos (26%), calcificaciones periventriculares (23%) y ventriculomegalia (6,5%), tríada que está presente en casi un tercio de estos pacientes 144 . Otras alteraciones menos frecuentes son hidrocefalia, adhesiones ventriculares y quistes subependimarios o caudotalámicos.…”

Section: Ecografía Cerebralunclassified

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

Izquierdo¹,

Sandoval²,

Abarzúa-Camus³

et al. 2024

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infección por citomegalovirus (CMV) en la mujer embarazada y el recién nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por CMV en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.

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“…Due to more frequent serology testing and better prenatal ultrasound screening, the prenatal diagnosis of cCMV infection increased. Serology screening is recommended before 15 weeks of GA because a maternal infection in the first trimester can lead to severe long-term sequelae [ 7 ]. Maternal primary infection is identified by seroconversion.…”

Section: Introductionmentioning

confidence: 99%

“…When seroconversion cannot be demonstrated, screening is based on IgG and IgM testing followed by IgG avidity testing in cases with positive IgM. A low IgG avidity index is suggestive of a recent primary infection [ 7 – 10 ]. In seropositive women, serological testing is not informative to confirm non-primary infection [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard for prenatal diagnosis is a PCR for CMV DNA in the amniotic fluid because infected fetuses pass the virus in their urine. Timing of amniocentesis is crucial since the sensitivity for CMV detection is higher after 20 weeks of gestation and at least 6 to 8 weeks after the diagnosis of maternal infection with a sensitivity of 90 to 100% [ 7 – 10 ]. When cCMV infection is confirmed, fetal US is recommended every 2 to 4 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Pre- and postnatal brain magnetic resonance imaging in congenital cytomegalovirus infection: a case report and a review of the literature

et al. 2022

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Background Congenital cytomegalovirus infection (cCMV) is the most common known viral cause of neurodevelopmental delay in children. The risk of severe cerebral abnormalities and neurological sequelae is greatest when the infection occurs during the first trimester of pregnancy. Pre- and postnatal imaging can provide additional information and may help in the prediction of early neurological outcome. Case presentation This report presents the case of a newborn with cCMV infection with diffuse parenchymal calcifications, white matter (WM) abnormalities and cerebellar hypoplasia on postnatal brain imaging after magnetic resonance imaging (MRI) and neurosonogram (NSG) at 30 weeks showing lenticulostriate vasculopathy, bilateral temporal cysts and normal gyration pattern according to the gestational age (GA). No calcifications were seen on prenatal imaging. Conclusion cCMV infection can still evolve into severe brain damage after 30 weeks of GA. For this reason, a two-weekly follow-up by fetal NSG with a repeat in utero MRI (iuMRI) in the late third trimester is recommended in cases with signs of active infection.

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Is it not time for international guidelines to combat congenital cytomegalovirus infection? A review of central nervous system manifestations

Cited by 14 publications

References 74 publications

Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings

Short- and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 in utero or during the perinatal period: preliminary findings

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

Pre- and postnatal brain magnetic resonance imaging in congenital cytomegalovirus infection: a case report and a review of the literature

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