Cytomegalovirus CMV Infection in Newborn. Transmission of CMV Infection from Mother to Baby

Cytomegalovirus (CMV)

•          Most common congenital viral infection

•          ~40,000 infants per year in the U.S.

•          Mild, self-limiting illness

•          Transmission can occur with primary infection or reactivation of the virus

•          40% risk of transmission in primary infection

•          Studies suggest increased risk of transmission later in pregnancy

•          However, more severe sequelae associated with the earlier acquisition

Clinical Manifestations:

•          90% are asymptomatic at birth!

•          Up to 15% develop symptoms later, notably sensorineural hearing loss

•          Symptomatic infection

•          SGA, HSM, petechiae, jaundice, chorioretinitis, periventricular calcifications, neurological deficits

•          >80% develop long term complications

•          Hearing loss, vision impairment, developmental delay

Massive ventricle Enlargement 

Diagnosis:

•          Maternal IgG shows only past infection

•          Infection common – this is useless

•          Viral isolation from urine or saliva in 1^st 3weeks of life

•          Afterwards may represent post-natal infection

•          Viral load and DNA copies can be assessed by PCR

•          Less useful for diagnosis, but helps in following viral activity in the patient

•          Serologies not helpful given high antibody in population

Treatment:

•          Ganciclovir is given for the duration of 6wks in symptomatic infants

•          Studies show improvement or no progression of hearing loss at 6mos

•          No other outcomes evaluated (development, etc.)

•          Neutropenia often leads to the cessation of therapy

•          Treatment currently not recommended in asymptomatic infants due to side effects

•          Area of active research to include use of valganciclovir and treating the asymptomatic patients, etc.