Original Article
Spectrum of Disease and Outcome in Children with Symptomatic Congenital Cytomegalovirus Infection

https://doi.org/10.1016/j.jpeds.2013.12.007Get rights and content

Objective

To evaluate differences in presentation and outcomes in children with symptomatic congenital cytomegalovirus (cCMV) identified on newborn screening (screened group) and those identified based on clinical findings at birth (referred group).

Study design

Data on 178 infants with symptomatic cCMV were analyzed. Demographic characteristics, clinical and laboratory findings documented in the nursery, and sequelae data were compared between the screened and the referred groups using χ2 or Fisher exact test.

Results

Two or more clinical findings were detected at birth in 91% of referred infants, and only 58% of screened infants (P < .001). Significantly more children in the referred group had hearing loss compared with screened infants (P = .009). Fifty-one percent of screened children were free of sequelae compared with only 28% of the referred group (P < .003).

Conclusions

Infants with symptomatic cCMV identified based on clinical suspicion have more severe disease at birth and more commonly have sequelae than those identified on newborn screening. Inclusion of referral infants in many previous reports may have overestimated the severity of disease because of selection bias. Defining the complete spectrum of symptomatic disease due to cCMV and providing precise estimates of disease burden can only be gathered from large newborn screening studies.

Section snippets

Methods

The study population consisted of 178 children with symptomatic cCMV enrolled in a longitudinal follow-up study. An additional 9 children were found to have cCMV but were not enrolled in follow-up (7 died and 2 were lost to follow-up). Data on asymptomatic infants from this population have been described in previous published studies.16, 17, 18 Infants were classified as having symptomatic cCMV when they were positive for CMV within the first 3 weeks of life and had any findings suggestive of

Results

Of the 178 children with symptomatic cCMV enrolled in follow-up between January 1980 and January 2002, 78 infants were identified on newborn virologic screening and the remaining 100 infants were referred from other hospitals. The demographic characteristics were compared between screened and referred children, and the results are shown in Table I. Infants in the screened group were more likely to be African American, born prematurely, and born to single mothers and to have received prenatal

Discussion

Studies estimating long-term outcome in children with symptomatic cCMV have reported varying rates of sequelae, from 35% to 100%.2, 3, 4, 5, 15, 23 The findings from the current study demonstrate that among children with confirmed cCMV, the sequelae rates vary significantly based on the clinical presentation at birth and on whether infants were identified by newborn screening or by clinical suspicion. The proportion of children with various newborn clinical findings in the referred group was

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  • Cited by (0)

    Funded in part by the grants from the National Institutes of Health (5-P01-HD-10699 [to W.B., K.F.], 5-R01-DC-02139 [to S.B., K.F.], 5-P01-A1-43681 [to S.B., W.B., K.F], and M01-RR-00032. The authors declare no conflicts of interest.

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