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 virus
          40% risk of transmission in primary infection
          Studies suggest increased risk of transmission later in pregnancy
          However, more severe sequalae associated with 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
Cytomegalovirus CMV Infection in Newborn. Transmission of CMV Infection from Mother to Baby
Massive ventricle Enlargement 


Diagnosis:

          Maternal IgG shows only past infection
          Infection common – this is useless
          Viral isolation from urine or saliva in 1st 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 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 cessation of therapy
          Treatment currently not recommended in asymptomatic infants due to side effects
          Area of active research to include use of valgancyclovir, treating asx patients, etc.

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