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

OBJECTIVE: To evaluate the outcome of infants with congenital cytomegalovirus (CMV) infection and normal fetal imaging.

DESIGN: Retrospective cohort study.

SETTING: Tertiary paediatric medical centre.

PATIENTS: 98 infants born to mothers with primary CMV infection in the first and second trimesters (diagnosed by positive amniotic fluid findings) and normal fetal imaging.

METHODS: Initial evaluation included confirmatory urine culture, complete blood count, liver and kidney function tests, funduscopy, brain ultrasound and hearing test. Follow-up included periodic neurological and developmental evaluation, hearing tests until age 5 and Bayley-III Developmental Scale (in some patients).

MAIN OUTCOME MEASURES: The presence and rate of sequelae of congenital CMV.

RESULTS: 52 (53.1%) infants received early antiviral treatment for central nervous system symptoms or signs, mainly lenticulostriatal vasculopathy on postnatal ultrasonography (88.5%). Sensorineural hearing loss was found on first examination in 16 infants (25 ears), of whom 10 also had cranial ultrasound findings; another five with late-onset hearing loss were also treated. The median follow-up time was 32 (12-83) months. Most infants with moderate and severe hearing loss were infected in the first trimester (10 vs 2, p=0.053). At the last assessment, eight children (10 ears) still had hearing loss, including two with bilateral loss who underwent a cochlear implant. The mean Bayley-III score was 102.6±10.3 (range 85-127). All 98 children attended regular educational institutions.

CONCLUSIONS: 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.