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Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection

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Abstract

Introduction

Congenital cytomegalovirus (CCMV) infection is a common neonatal infection affecting 1% of all live births, 10% of which are symptomatic. Many of these infants have long-term sequelae. The objective is to document the clinical presentation of SCCMV infection in neonates, the frequency of sequelae and severity of adverse neurologic outcomes and risk factors.

Methods

A review and analysis of all symptomatic infants diagnosed with SCCMV infection are given. SCCMV was defined as a diagnosis of CCMV infection in the first three weeks of life in the presence of any clinical manifestations. Outcome data from 2 years of age and later are analyzed.

Results

There were 104 patients identified as having SCCMV infection and of these 42 cases had definite infection. The common findings at presentation were hepatosplenomegaly 19/42 (45%), thrombocytopenia 21/42 (50%), elevated transaminases 21/42(50%), abnormal cranial US scan 24/41(56%), abnormal head CT scan 29/41(71%) and abnormal brain MRI 17/19(89%). The risk factors for an adverse outcome including death or deafness or blindness or moderate to severe neurological deficits included an abnormal cranial US scan (OR 8.5), abnormal head CT scan (OR 21) and abnormal brainstem auditory evoked responses (BAER) (OR 8.7).

Conclusions

There was only three (7%) patients without any deficits and severely affected infants have been identified with a diverse clinical presentation, reinforcing the importance of CMV as a major public health problem.

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Abbreviations

CMV:

Cytomegalovirus

CCMV:

congenital CMV

HCMV:

Human CMV

ACCMV:

asymptomatic CCMV

CT:

computed tomography

MRI:

magnetic resonance imaging

SCCMV:

symptomatic congenital cytomegalovirus

SD:

standard deviation

db:

decibel

BAER:

brainstem auditory evoked responses

CI:

confidence intervals

OR:

odds ratio

US:

ultrasound

HC:

head circumference

IUGR:

intrauterine growth retardation

SNHL:

sensorineural hearing loss

SGA:

small for gestational age

HUSS:

cranial ultrasound scan

HCT:

head computed tomography

EEG:

electroencephalogram

AST:

Aspartate aminotransferase

SSEP:

somatosensory evoked potentials

ALT:

Alanine aminotransferase

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Authors and Affiliations

  1. Division of Neonatology, Pediatrics Department, University of Tennessee, Le Bonheur Children’s Hospital, 50 N Dunlap St, Memphis, TN, 38103, USA

    Ranjit I. Kylat

  2. Pediatrics Department, University of Toronto, Toronto, Canada

    Ranjit I. Kylat, Edmond N. Kelly & Elizabeth Lee Ford-Jones

Authors
  1. Ranjit I. Kylat
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  2. Edmond N. Kelly
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  3. Elizabeth Lee Ford-Jones
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Corresponding author

Correspondence to Ranjit I. Kylat.

Appendix

Appendix

Definitions

Sensorineural Hearing Loss: unequivocal failed or >30 db hearing loss on two or more age-appropriate audiologic tests (soundfield or pure tone audiometry) and middle ear disease ruled out or use of hearing aids in one or both ears

Visual impairment: blindness in one or both eyes or the need for corrective lenses

Blindness: visual acuity in both eyes of less than 6/60

Abnormal ophthalmologic exam: chorioretinitis, retinal scars, cataracts and other anomalies, like high myopia, strabismus, glaucoma, corneal opacities

Neuro-developmental delay: delay of more than 2SD below the mean for age (<70) when assessed by the Bayley Scales of Infant Development or equivalent scale

Abnormal CT scan of brain: cortical atrophy, cortical dysgenesis/dysplasia, moderate to severe ventriculomegaly/ hydrocephalus, cerebellar hypoplasia/asymmetry, migration abnormalities, intracranial calcifications (any one). Isolated abnormalities like subependymal, choroidal cysts, cephalhematoma were not included as an abnormal scan

Abnormal head ultrasound scan of brain: moderate to severe ventriculomegaly/hydrocephalus intracranial calcifications (any one). Presence of subependymal and choroidal cysts were also noted but not included as abnormal scan

Abnormal MRI scan of brain: the presence of any of the following: cortical atrophy, cortical dysgenesis, moderate to severe ventriculomegaly/ hydrocephalus, cerebellar hypoplasia/asymmetry, migration abnormalities, intracranial calcifications, pachygyria, lissencephaly (any one)

Abnormal EEG: abnormal background activity, assymmetric background activity, burst suppression or focal abnormality or if electrographical seizures, rolandic sharp waves (any one)

Cerebral Palsy: nonprogressive central nervous system disorder characterised by abnormal motor tone in at least one extremity and a decreased range or abnormal control of movement or posture, accompanied by neurologic signs

Microcephaly: HC<2SD below mean for age

SGA: birth weight<2SD below mean for gestational age

SCCMV infection: CMV detected in urine, saliva, secretions or tissue obtained within the first three weeks of life in a newborn with any clinical manifestations of an intrauterine infection including one or more of the following: petechiae or purpura, splenomegaly, hepatomegaly, jaundice at birth, microcephaly (<2SD), chorioretinitis, unexplained neurologic abnormalities, seizures, small for gestational age (SGA) or intrauterine growth retardation (<2SD), intracranial calcifications, hearing impairment, thrombocytopenia<100,000 mm3, alanine aminotransferase (ALT)>100 IU/dl, aspartate aminotransferase (AST)>100  IU/dl, conjugated hyperbilirubinemia>3 mg/dl

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Kylat, R.I., Kelly, E.N. & Ford-Jones, E.L. Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr 165, 773–778 (2006). https://doi.org/10.1007/s00431-006-0172-6

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  • DOI: https://doi.org/10.1007/s00431-006-0172-6

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