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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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Use of cytomegalovirus hyperimmunoglobulin for prevention of congenital cytomegalovirus disease: a retrospective analysis

Horst Buxmann
  • Department of Neonatology, University Hospital, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
  • :
/ Otto M.v. Stackelberg
  • Department of Neonatology, University Hospital, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
/ Rolf L. Schlößer
  • Department of Neonatology, University Hospital, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
/ Gisela Enders
  • Laboratory Prof. G. Enders and Partner and Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Germany
/ Markus Gonser
  • Clinic of Obstetrics and Prenatal Medicine, Dr. Horst Schmidt Clinic, Wiesbaden, Germany
/ Matthias Meyer-Wittkopf
  • Department of Prenatal Diagnosis, Mathias Hospital, Rheine, Germany
/ Klaus Hamprecht
  • Institute of Medical Virology and Epidemiology of Viral Disease, University Hospital, Eberhard-Karls University, Tuebingen, Germany
/ Martin Enders
  • Laboratory Prof. G. Enders and Partner and Institute of Virology, Infectious Diseases and Epidemiology e.V., Stuttgart, Germany
Published Online: 2012-03-27 | DOI: https://doi.org/10.1515/jpm-2011-0257

Abstract

Aims: The aim of this study was to investigate the current prenatal “off-label use” of cytomegalovirus hyperimmunoglobulin (CMV-HIG) in the prevention and treatment of congenital CMV (cCMV) infection, including the long-term outcome of the children.

Methods: This retrospective observational study comprised mothers and their children, born between January 1, 2006, and October 30, 2010. Prenatal CMV-HIG was administered after diagnosis of primary CMV infection of the mother. Clinical and virological data were collected from maternal and pediatric medical and laboratory reports. Follow-up was 12–36 months after birth.

Results: Forty-two women and 43 children met the study criteria. In total, 40 mothers and six unborn infants received 115 doses of CMV-HIG. The treatment group (TG; CMV-DNA polymerase chain reaction-positive amniotic fluid) included four mothers; the multinomial group (MG; CMV-positive mother and unknown CMV status of fetus) included 38 mothers (39 infants). For the four unborn infants in TG, CMV-HIG was administered either intraumbilically or into the amniotic fluid; three of the four mothers received intravenous CMV-HIG. Three children in TG remained CMV-positive and were asymptomatic at birth and during follow-up. One infant in TG had symptomatic cCMV infection in utero, at birth, and during follow-up. In MG, 37 of 38 women received intravenous CMV-HIG and two of 39 infants received CMV-HIG in utero. In total, 9 (23.1%) of 39 children in MG were positive for cCMV (including a terminated pregnancy). All eight instances of cCMV infection at birth in MG were asymptomatic at birth and during follow-up. The fetus from the terminated pregnancy showed no sonographic symptoms of cCMV infection. No severe side effect occurred in 115 CMV-HIG applications.

Conclusion: CMV-HIG was well tolerated. Compared with published untreated mother-child pairs, we observed a trend toward a smaller risk for intrauterine CMV transmission following CMV-HIG application. Signs of prenatal cCMV disease were not reversed after CMV-HIG.

Keywords: CMV hyperimmunoglobulin; congenital cytomegalovirus disease; congenital cytomegalovirus infection; cytomegalovirus; cytomegalovirus transmission; pregnancy; prevention; primary cytomegalovirus infection; treatment

Corresponding author: Dr. med. Horst Buxmann University Hospital Johann Wolfgang Goethe University Department of Neonatology Theodor Stern Kai 7 D-60590 Frankfurt am Main Germany Tel.: +49 69 6301 5524 Fax: +49 69 6301 4757


Received: 2011-10-12

Revised: 2011-12-18

Accepted: 2012-02-07

Published Online: 2012-03-27

Published in Print: 2012-06-01


Citation Information: . Volume 40, Issue 4, Pages 439–446, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2011-0257, March 2012

©2012 by Walter de Gruyter Berlin Boston. This content is open access.

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