A congenital CMV infection model for follow-up studies of neurodevelopmental disorders, neuroimaging abnormalities, and treatment

ObjectiveHuman cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood.DesignInfants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit.PatientsInfants born between 2006 and 2011 with confirmed congenital CMV infection.MethodsMaternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age.ResultsForty confirmed cases of congenital CMV infection were reported (6.6:105 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27).ConclusionThe reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

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Follow-up of pregnant women with active cytomegalovirus infection

Eastern Mediterranean Health Journal ◽

10.26719/1999.5.5.949 ◽

1999 ◽

Vol 5 (5) ◽

pp. 1049-1054

Author(s):

H. Y. Al Ali ◽

S. A. Yasseen ◽

T. Y. Raof

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Pregnant Women ◽

Congenital Malformations ◽

Cmv Infection ◽

Serological Evidence ◽

Congenital Cmv Infection ◽

The Central Nervous System ◽

Congenital Cmv

Pregnant women [60]with and without serological evidence of active cytomegalovirus [CMV]infection were followed until delivery to detect the incidence and types of overt congenital CMV infection in neonates in Mosul, Iraq. Infection was diagnosed by the detection of CMV-IgM, using ELISA. CMV-IgM was detected in cord blood samples of six [10%]overtly sick infants [with different congenital malformations]born to mothers with active CMV infection. Central nervous system abnormalities were detected in all six cases [two with microcephaly and four with hydrocephaly]. Congenital CMV infection should be suspected in infants born with congenital malformations, especially those of the central nervous system. The detection of a significant number of hydrocephalus cases in our study is notable

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OP14.09: Congenital CMV infection-a new approach to prenatal follow up

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.9393 ◽

2011 ◽

Vol 38 (S1) ◽

pp. 97-97

Author(s):

L. Levitt ◽

D. V. Valsky ◽

N. Yanai ◽

D. Hochner-Celnikier ◽

D. Wolf ◽

...

Keyword(s):

Cmv Infection ◽

New Approach ◽

Congenital Cmv Infection ◽

Congenital Cmv

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2336. Adherence to Follow-up and CMV Testing in Infants Who Failed Newborn Hearing Screens: Evaluation of New Protocol to Ensure Follow-up and Testing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2014 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S802-S802

Author(s):

Manuel Penton ◽

Aaron Herzog ◽

Jun Pan ◽

Charles Manopla ◽

Caitlin Otto ◽

...

Keyword(s):

Otoacoustic Emissions ◽

Hearing Screening ◽

Screening Tests ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

Brainstem Response ◽

Hearing Test ◽

Lost To Follow Up ◽

Congenital Cmv

Abstract Background CMV is the most common non-hereditary cause of sensorineural hearing loss (SNHL) in children in the United States. SNHL may be the only presenting symptom in otherwise asymptomatic infants. Several states are making CMV testing mandatory for newborn infants who have a hearing deficit. Testing should be performed before 21 days of life to diagnose congenital CMV infection and provide effective therapy. However, the results of a retrospective 1 year audit of all newborn patients in the nursery of University Hospital of Brooklyn (UHB) who failed their hearing screen found that none were tested for CMV and approximately half failed to follow-up with audiology. Therefor we developed a new protocol to ensure testing and follow-up. Methods Under the new protocol, newborns who fail an initial and repeat hearing screen are tested for CMV in urine by culture and the audiology appointment is scheduled before discharge. Patients are tracked by a pediatric infectious disease fellow to ensure adherence to protocol. Results The pre-intervention audit conducted from November 1, 2017 to October 31, 2018 found 37/923 (4%) infants failed their hearing screening tests. Although 34/37 (92%) of these children had audiology appointments made before discharge, only 19 (56%) actually attended. Two (11%) children failed an otoacoustic emissions hearing test. One infant also went on to fail an auditory brainstem response test; both were lost to follow-up. None of these infants was tested for CMV. The new protocol was initiated November 1, 2018, 11/372 (3%) infants failed initial and repeat hearing screening tests. All 11 (100%) of these children had audiology appointments made before discharge, of which 9 (82%) attended. 2 (18%) of these children failed the otoacoustic emissions hearing test at that visit, 1 infant was lost to follow-up; 9 infants who failed hearing test were tested for CMV; 1 (9%) was positive. Conclusion Although it has only been in place for 5 months, the new protocol has increased adherence to audiology appointments. CMV testing has increased from 0% to 82% and 1 patient has tested positive for congenital CMV infection. The ongoing success of this protocol could facilitate timely and appropriate treatment of CMV with valgancyclovir. Disclosures All authors: No reported disclosures.

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