Congenital Cytomegalovirus Conference - Congenital CMV ...

Background: Cytomegalovirus (CMV), a common congenital infection is present in 0.5-2% of all newborns.
Irrespective of the presence or absence of symptoms in the newborn period, children with congenital CMV infection
have a significant risk to develop later sequelae most commonly sensorineural hearing loss (SNHL). The diagnosis
of congenital CMV beyond the neonatal period is challenging insofar as definitive diagnosis can only be made
by demonstrating the virus in samples obtained in the first 3 weeks of life. Novel molecular techniques and the
availability of newborn blood spots (NBS) have created the opportunity for retrospective diagnosis.
Objectives: To test the hypotheses that: 1) Congenital CMV infection can be retrospectively diagnosed by molecular
analysis of DNA extracted from archived NBS. 2) That the prevalence of congenital CMV infection in children with
SNHL is significantly higher than the background rate of 0.5-2%.
Design/Methods: The cohort consisted of children with SNHL referred to the University of Minnesota. Based
on evaluation by a geneticist and an otolaryngologist patients were further divided into those with or without a
genetic cause. Following IRB approval and with parental consent, NBS of enrolled children were retrieved from the
Minnesota Department of Health (MDH) and analyzed for CMV genome by real-time PCR.
Results: Twenty nine children with hearing impairment have been enrolled, from which 11 had a genetic etiology
for their SNHL (37%). The NBS of all subjects have been retrieved from the MDH for PCR analysis. Nine of the 29
enrolled children were diagnosed with congenital CMV infection (30%). CMV genome was found in 8 out of the 19
children who had no identifiable or suspected genetic etiology (42%), while one child with congenital CMV infection
was also diagnosed with long QT syndrome.
Conclusions: Congenital CMV infection can be diagnosed retrospectively using archived NBS. Our study shows
that congenital CMV infection is found in one in four children with SNHL referred to a university-based clinic.
Furthermore, we found that 42% of children with SNHL without a genetic etiology were born with CMV infection
demonstrating that this infection is a leading cause for acquired childhood hearing deficit.
P-37 Physical and intellectual development in children with CMV asymptomatic congenital infection.
Xinwen Zhang, Fen Li. MCH faculty of Medical College of XJTU, Xi’an, China.
Background: Although about 90% of congenital cytomegalovirus (CMV) infection is asymptomatic in newborn, some
of them could show sequelae later in life. Qinba mountain area is a place with high incidence of mental retardation
and a high rate of CMV intrauterine transmission in China. The correlation between asymptomatic congenital CMV
infection and developmental outcomes of children in this area remain unclear.
Objectives: To investigate the impact of asymptomatic congenital CMV infection on physical and intellectual
development of children during the first 6 years of life in Qinba mountain area.
Methods: Longitudinal cohort study. 49 of all the 54 children with asymptomatic congenital CMV infection, who
were born in Qinba mountain area during the 4-year period from January 1997 to December 2000,were followed
prospectively in a study for surveying physical growth and intellectual developments. Head circumference, length
and weight were used to assess physical growth. Gesell Developmental Schedule was used to assess the development
quotient (DQ) of the infants between 18 to 36 months. The intelligence quotients (IQ) of the preschool children
between 48 to 72 months were tested with WPPSI.
Results: Either in neonatal or in infant period, no significant difference was noted between the asymptomatic
congenital CMV infection children and the controls in average weight, height and head circumference (both p >0.05).
The intellectual development was disproportion in asymptomatic congenital infected children. Compared with the
control group, both global DQ and full-scale IQ scores of asymptomatically infected children were worse (t =2.19, p
=0.031; t =2.48, p =0.015), especially on language DQ scores (t =3.25, p =0.002) and verbal IQ scores (t =3.88, p =0.000).
However, the incidence rates of mental retardation (DQ/IQ 0.05).
Conclusions: Although asymptomatic congenital CMV infection did not have significant influence on the neonatal
physical development or incidence of mental retardation later in life, it is obviously an important factor correlating
with long-time cognitive outcomes, especially on the development of language. It is necessary to survey CMV
congenital infection and monitor the early intellectual development of children with asymptomatic congenital CMV
infection in this area.
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