Predictors of the Outcome at 2 years in Neonates with Congenital Cytomegalovirus Infection. Fourgeaud J, Magny J-F, Couderc S et al.

Read article: Submitted by: Dr Rebecca Ward, Dr Julia Clark & Dr Angela Berkhout, Queensland Childrens Hospital. April 2024.Background:Congenital CMV (cCMV) affects 0.7% of the global population, with ~20% of cases leading to long term sequalae. Increasing awareness and neonatal screening programs are expected to identify more cCMV cases. This study aims to develop a neonatal scoring system to predict long term sequelae risk, enhancing parental counselling and potentially enabling personalised management pathways. Main Findings:253 neonates from 13 hospitals in France, who had been diagnosed with cCMV at <10days were recruited between 2013-2017. 227 were followed up for > 2 years. Maternal primary infection (MPI) accounted for 82% of cases, with 49% occurring in the first trimester. At birth, 40% (91/227) showed cCMV symptoms, including 27% with sensorineural hearing loss (SNHL). 45% had cranial ultrasound abnormalities (at a median of 7 days of age), while 25% had MRI-brain abnormalities (at a median of 5 months). Antenatal valaciclovir was administered to 52 cases in the second trimester, and valganciclovir/ganciclovir to 57 neonates within the first month of life, for a median duration of 51 days. At 2 years, 19% experienced sequelae: 15% SNHL and 8% neurologic sequelae. First trimester MPI was the strongest predictor of sequelae (OR 38.34 95%CI 5.02-293] P <.001), with no SNHL after second or third trimester MPI. Bilateral SNHL, splenomegaly, axial hypotonia, petechiae, respiratory distress, cranial ultrasound abnormality (particularly subependymal cysts), MRI-brain (particularly abnormal white matter) and thrombocytopenia were significant predictors of long-term sequalae. Logistic regression showed that if at birth there is normal hearing, a normal platelet count and a normal cranial ultrasound, this predicted the absence of long term sequalae (P < 0.001). Two children in this group had delayed SNHL with no neurologic deficit. Take home message:In neonates with cCMV, those with normal hearing, cranial ultrasound & platelet count can be identified as having no long-term risk of neurological sequalae and a low risk of SNHL.