Prenatal findings, neonatal symptoms and neurodevelopmental outcome of congenital cytomegalovirus infection in a university hospital in Montreal, Quebec

Anne-Frédérique MinsartORCID iD: https://orcid.org/0000-0001-8879-4930, Françoise Rypens
  • Department of Radiology, Université de Montréal – Sainte-Justine University Hospital, Montreal, Quebec, Canada
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, Mina Smiljkovic
  • Division of Infectious Diseases, Department of Pediatrics, Université de Montréal – Sainte-Justine University Hospital, Montreal, Quebec, Canada
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, Fatima Kakkar
  • Division of Infectious Diseases, Department of Pediatrics, Université de Montréal – Sainte-Justine University Hospital, Montreal, Quebec, Canada
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, Christian Renaud
  • Division of Infectious Diseases, Department of Pediatrics, Université de Montréal – Sainte-Justine University Hospital, Montreal, Quebec, Canada
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, Valérie Lamarre
  • Division of Infectious Diseases, Department of Pediatrics, Université de Montréal – Sainte-Justine University Hospital, Montreal, Quebec, Canada
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, Marc Boucher
  • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Université de Montréal – Sainte-Justine University Hospital, Montreal, Canada
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and Isabelle Boucoiran
  • Corresponding author
  • Women and Children Infectious Diseases Center, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, H3T 1C5, QC, Canada
  • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
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Abstract

Background

Outcome of congenital cytomegalovirus (cCMV) infection in the absence of routine CMV screening and third-trimester scan in North America is scarcely documented. The aim of this study was to assess the severe outcomes related to cCMV according to the indication for screening.

Methods

This was a retrospective study of 84 mother-child pairs followed for cCMV between 2003 and 2017 at CHU Sainte-Justine in Montreal, Canada. Prenatal ultrasound, neonatal symptoms, neuroimaging and severe outcomes (cerebral palsy, severe cognitive impairment, bilateral hearing loss or neonatal death) were reviewed.

Results

Among 38 cases with abnormal prenatal ultrasound, 41.9% of live-born infants developed severe outcomes. Sixteen (42.1%) were detected in the third trimester. Among 16 cases diagnosed prenatally because of maternal history, all had normal prenatal ultrasound, and none developed severe outcomes. Among cases diagnosed postnatally because of neonatal symptoms, 25% developed severe outcomes. All infants who developed severe outcomes had moderate/severe neonatal symptoms.

Conclusion

Outcome of cCMV infection varies according to the reason for screening and timing of diagnosis. Any prenatal ultrasound anomaly might indicate a risk of severe outcome, and warrants a detailed ultrasound scan. However, late detection, or postnatal diagnosis, represented more than half of the cases, and awareness of this will help ensuring optimal management.

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