Evaluation of clinically asymptomatic high risk infants with congenital cytomegalovirus infection

Abstract

Objective To determine the frequency of abnormal findings on evaluation of neonates with congenital CMV infection who have a normal physical examination Study design Retrospective, 2-center study (1996-2017) that reviewed results of complete blood cell count and platelets, serum alanine aminotransferase (ALT) and bilirubin concentrations, eye examination, cranial ultrasonography or other neuroimaging, and brainstem evoked responses performed on neonates with congenital CMV infection and a normal physical examination Results Of 34 infants with congenital CMV infection and a normal physical examination, 56% (19/34) had ≥1 abnormality: 39%, elevated ALT concentration; 45%, abnormal neuroimaging (five, lenticulostriate vasculopathy; six, intraventricular hemorrhage; four, calcifications); 12%, anemia; 16%, thrombocytopenia; and 3%, chorioretinitis. Seven (21%) infants had sensorineural hearing loss, and 18 infants received antiviral therapy. Conclusion Some infants with congenital CMV infection and a normal physical examination had abnormalities on laboratory or neuroimaging evaluation, which in some cases prompted antiviral treatment.

An observational study for appraisal of clinical outcome and risk of mother-to-child SARS-CoV-2 transmission in neonates provided the benefits of mothers’ own milk

“…The natural history of SARS-CoV-2 infection in neonates is still unknown, and as of now the learning experience from other congenital infections such as cytomegalovirus infection may be utilized [ 44 , 45 ]. Routine follow-up for 1 month seems inadequate, and a long-term comprehensive surveillance till school age for neuromotor, intellectual, audio-visual, respiratory and cardiovascular outcomes is warranted among neonates with perinatal SARS-CoV-2 exposure.…”

Blood genome expression profiles in infants with congenital cytomegalovirus infection

“…Symptomatic cCMV infection was defined by any abnormality identified on (a) physical examination (hepatomegaly, splenomegaly, skin rashes (petechial, blueberry muffin, or purpura), and microcephaly defined as a head circumference <10% for gestational age); (b) laboratory testing including anemia (hematocrit < 35%), thrombocytopenia (platelet count of <150,000 mm 3 ), direct hyperbilirubinemia (>2 mg/dL) or increase transaminases (ALT ≥ 40 U/mL for term newborns born at ≥37 weeks' gestation, and ALT > 45 U/mL if <37 week's gestation); (c) neuroimaging (lenticulostriate vasculopathy, periventricular calcifications, cortical dysplasia); (d) ophthalmologic examination, or (e) hearing evaluation at birth. Infants who did not have any of these findings were classified as asymptomatic 41 . Late-onset SNHL was defined as the presence of a normal newborn hearing evaluation followed by an abnormal hearing evaluation (BSER) at any of the follow-up evaluations.…”

“…Infants with asymptomatic cCMV infection were identified through the CMV & Hearing Multicenter Screening (CHIMES) study, and blood for transcriptome analyses obtained under a separate IRB-approved study protocol (see above) 38 . Symptomatic and asymptomatic infants with cCMV infection underwent a complete evaluation that included physical examination, laboratory, audiologic, ophthalmologic, and radiologic studies 41 . Specifically, results of CBC and platelets, serum alanine aminotransferase and bilirubin (total/direct) concentrations, eye examination, cranial ultrasonography (or other neuroimaging studies), auditory brainstem evoked responses (BSER), and results from neurodevelopmentally appropriate behavioral auditory evaluations were recorded.…”

“…For visualization purposes, the significant abundance of transcripts relative to a baseline (or healthy controls) are represented by a colored dot. When the proportion of overexpressed transcripts in a given module is increased, the module is represented by a red dot, whereas an increased proportion of underexpressed transcripts is represented by a blue dot, with the intensity of the color, indicating the proportion of transcripts expressed in any given module 10 , 15 – 17 , 41 ; (d) MDTH, a tool that converts the global transcriptional perturbation of each individual patient sample into an objective score in relation to the healthy control baseline 11 , 18 – 20 , was calculated and compared between symptomatic and asymptomatic infants with cCMV infection and healthy controls.…”

Congenital Cytomegalovirus Infection: Transmission, Diagnosis and Treatment.

“…(18) Additionally, congenital CMV infection is reported to be the most common non-genetic reason behind sensorineural auditory impairment and delay in neurological development in children. (18) About 90% of the newborns infected with CMV have a clinically silent infection and show no perceivable symptoms or signs. (18) However, up to 56% of these apparently asymptomatic patients may have laboratory, ophthalmologic, or neuroimaging findings that would recategorize them as symptomatic cases when evaluated.…”