Evaluating neonates with congenital cytomegalovirus infection

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Although options for treating infants with congenital cytomegalovirus (CMV) expand, they are difficult. Accurate prediction of outcome if untreated would be very helpful. Ancora et al in this issue of The Journal offer up evidence for a new tool – cranial ultrasonography (US). In 57 neonates with congenital CMV infection, investigators performed neonatal and follow-up US at birth, with repeated study up to 3 months of age if normal and to 6 months of age if abnormal. They prospectively evaluated neurodevelopment and hearing through 24 months and school age, respectively (mean follow-up 42 months). All 10 of 18 infants with symptomatic CMV infection who had an abnormal neonatal US had at least one sequela, whereas none of the 8 symptomatic infants with normal US had long term sequelae (P < .001). In 37 asymptomatically infected neonates, 3 of 37 with normal US developed sensorineural hearing loss and one of two neonates with abnormal US developed serious neurologic sequelae.

The investigators have shown that in neonates with symptomatic congenital CMV infection, US is a valuable screening tool to predict outcome – comparable with other imaging modalities, less costly, available at the bedside, and with no radiation. Their data also give reason to believe that further study might prove the value of US in asymptomatically-infected infants as well.