Full length articleNeonatal and long-term ophthalmological findings in infants with symptomatic and asymptomatic congenital cytomegalovirus infection
Section snippets
Background
Congenital cytomegalovirus (CMV) infection is the most common congenital viral infection, with an estimated incidence of 0.6-2% of all live births [1], [2]. It contributes to a high burden of disease and is recognized as the leading non-genetic cause of sensorineural hearing loss (SNHL) in children [3], [4], [5], [6].
Ocular abnormalities and visual impairment have been reported in a high percentage of symptomatic infants with congenital CMV (cCMV) infection, whereas they are considered uncommon
Objectives
The aim of this study was to evaluate ophthalmological findings and visual function in the neonatal period and during a long-term follow-up in infants with cCMV infection. The ocular involvement in relation to type and timing of maternal infection was also explored.
Study design
All infants with cCMV infection referred to the Outpatient Clinic of the Neonatal Division of St. Orsola-Malpighi Hospital, Bologna, Italy between January 2006 and December 2015 were enrolled in a prospective observational study.
Infants were identified because of suspected/confirmed maternal CMV infection during pregnancy or because of the presence of symptoms consistent with cCMV infection at birth.
Data regarding timing and type (primary vs. non-primary) of maternal infection, neonatal and
Results
Forty-eight infants with cCMV infection were enrolled, including 18/48 (37.5%) symptomatic and 30/48 (62.5%) asymptomatic infants (Table 1).
In the symptomatic group 11/18 infants (61%) were born to mothers with a primary CMV infection, diagnosed during the first trimester of pregnancy in 6/11 (55%) cases and during the second trimester in the other 5/11 (45%) cases. Instead, 5/18 (28%) infants were born to mothers with a non-primary CMV infection. For two infants, maternal serology during
Discussion
Natural history studies of cCMV infection reported variable rates of long-term morbidity, up to 60% in symptomatic infants [3], [5], [15], [16]. The long-term prognosis of cCMV infection however remains a matter of speculation for some aspects; first, since in most countries a systematic neonatal screening program for cCMV does not exist, the rate of sequelae might differ from what currently accepted, because it is likely that most asymptomatic patients are missed, and thus not enrolled in
Funding
None.
Competing interests
None declared.
Ethical approval
The findings presented in this study are not experimental investigations, as the proposed protocol overlaps with the clinical management of babies, and performed at physician’s discretion. Infant’s parents or guardians had given consent to utilize collected data.
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Treatment with valacyclovir during pregnancy for prevention of congenital cytomegalovirus infection: a real-life multicenter Italian observational study
2023, American Journal of Obstetrics and Gynecology MFMViral Infections of the Fetus and Newborn
2023, Avery's Diseases of the NewbornCytomegalovirus infection during pregnancy: state of the science
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :These and other studies consistently show a strong association between type and number of cranial imaging abnormalities in newborns and permanent neurological sequelae because of cognitive, motor, and sensory impairments.139,140 Ocular abnormalities because of congenital CMV infection, mainly chorioretinitis, often manifest as retinal scarring,141 have been recognized almost exclusively in patients who were symptomatic at birth, although the frequency of ocular abnormalities has varied widely from around 10% to 40%.135,142–144 Chorioretinitis was found in 19% of the symptomatic group and in 3.9% of the asymptomatic group.
Outcome and management of newborns with congenital cytomegalovirus infection
2020, Archives de PediatrieCitation Excerpt :However, none of the asymptomatic children had ophthalmological lesions or visual disturbances (P = 0.01). They found no correlation between the type of maternal infection (primary infection or not) and the occurrence of visual disturbances [32]. These abnormalities must be detected early, but there is no consensus concerning their treatment and specific studies are required.
Outcome and management of cytomegalovirus-infected newborns
2020, Bulletin de l'Academie Nationale de MedecinePediatric liver diseases and ocular changes: What hepatologists and ophthalmologists should know and share with each other
2020, Digestive and Liver DiseaseCitation Excerpt :Diagnosis in the neonate is made by viral detection in body fluids via PCR, culture, or antigen testing (pp65 antigen) within the first 3 weeks of life, in addition to clinical symptoms and laboratory data [29]. Concerning the eye, ophthalmological abnormalities were common in symptomatic infants, though often not associated with long-term visual impairment, and correlated with the presence of central nervous system involvement [31]. Later occurring retinal disorders were found in symptomatic patients, and there is no clear evidence that CMV can reactivate in the retinas of children who were congenitally infected [32].