Spectrum of Disease and Outcome in Children with Symptomatic Congenital Cytomegalovirus Infection

Abstract

Objective To evaluate differences in presentation and outcomes in children with symptomatic congenital cytomegalovirus (cCMV) identified on newborn screening (screened group) and those identified based on clinical findings at birth (referred group). Study design Data on 178 infants with symptomatic cCMV were analyzed. Demographic characteristics, clinical and laboratory findings documented in the nursery, and sequelae data were compared between the screened and the referred groups using χ2 or Fisher exact test. Results Two or more clinical findings were detected at birth in 91% of referred infants, and only 58% of screened infants (p < 0.001). Significantly more children in the referred group had hearing loss compared with screened infants (p = 0.009). Fifty-one percent of screened children were free of sequelae compared with only 28% of the referred group (p < 0.003). Conclusions Infants with symptomatic cCMV identified based on clinical suspicion have more severe disease at birth and more commonly have sequelae than those identified on newborn screening. Inclusion of referral infants in many previous reports may have overestimated the severity of disease because of selection bias. Defining the complete spectrum of symptomatic disease due to cCMV and providing precise estimates of disease burden can only be gathered from large newborn screening studies.

Time-Series Analysis Comparing the Prevalence of Antibodies against Nine Viral Species Found in Umbilical Cord Blood in Japan

“…CMV is the most common congenital viral infection, with a birth prevalence of about 0.2z-2.2z in developed countries and 0.31z in Japan (1,2,15). Congenital CMV infection causes significant clinical consequences not only at birth but also later, presenting as neurological sequelae, including sensorineural hearing loss and developmental delay.…”

“…Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensorineural hearing loss, and CMV infection affects 0.2z-2.2z of live births in industrialized countries (1,2). Pre-existing maternal antibodies to CMV are the most important protective factor against congenital CMV infection, and primary CMV infection is more likely than non-primary infection to cause symptoms at birth and long-term disability (3).…”

Immunobiology of congenital cytomegalovirus infection of the central nervous system—the murine cytomegalovirus model

“…5,14 Remarkably, hearing defects due to congenital CMV infection can progress through early childhood, even when they are clinically unapparent at birth. It is assumed that hearing defects are caused by CMV-induced labyrinthitis; however, the mechanisms surrounding its pathogenesis and the role of the inflammatory response remain unclear.…”

Congenital cytomegalovirus infection: Diagnosis, treatment, and prevention

“…Последствия врожденной цитомегаловирусной инфекции Врожденная цитомегаловирусная инфекция, в от-личие от приобретенной, нередко ведет к серьезным отдаленным последствиям, таким как нейросенсорная тугоухость в сочетании с расстройствами равновесия (наиболее часто), интеллектуальная недостаточность, поведенческие расстройства, детский церебральный паралич, эпилепсия, нарушение зрения, микроцефа-лия. Риск последствий наиболее высок (до 40-65%) при симптоматической цитомегаловирусной ин-фекции [7,25,30,44]. При бессимптомном вариан-те основным неблагоприятным исходом является тугоухость -в 7-15% случаев [1,7,11,15,29,40].…”

“…У недоношенных детей с массой тела при рождении менее 1500 г риск отдаленных последствий врожден-ной цитомегаловирусной инфекции повышен до 83% [31]. Смертность при симптоматической врожденной цитомегаловирусной инфекции составляет 5-12% [15,25,44].…”