Congenital cytomegalovirus

Alternative names
CMV - congenital; Congenital CMV

Definition
Congenital cytomegalovirus is a cluster of findings associated with infection of the fetus by cytomegalovirus.

Causes, incidence, and risk factors

Congenital cytomegalovirus is caused when an infected mother passes CMV virus to the fetus through the placenta. The mother’s illness may be subclinical (without symptoms or asymptomatic), and she may be unaware that any problems exist.

The majority of congenitally infected children are asymptomatic. The symptomatic infant is characteristically born with a petechial rash (a rash that looks like fine purplish-colored dots), a large spleen and liver, jaundice, inflammation of the retina, intracranial calcifications (mineral deposits within the brain), and a small head (microcephaly).

Only about 1 out of 10 infants congenitally infected with CMV are thought to exhibit these symptoms.

Symptoms

• Low birth weight
  
• Small head size (microcephaly)
  
• Seizures
  
• Rash at birth (petechiae)
  
• Jaundice

In examining the body, the health care provider, may also find:

• enlarged liver
  
• enlarged spleen
  
• Abnormal breath sounds indicating pneumonia
  
• Psychomotor retardation

• Urine culture for CMV virus in the first 2-3 weeks of life
  
• Antibody titer against CMV for both the mother and infant
  
• CT scan or ultrasound of the head (which can show cerebral calcifications if they are present)
  
• Bilirubin level and blood tests for liver function (to assess the extent of jaundice and liver involvement)
  
• Fundoscopy (which may show chorioretinitis)
  
• CBC (which may show anemia)
  
• X-ray of the chest (which may show pneumonia)
  
• TORCH screen

There is no specific treatment for congenital CMV. Treatment focuses on specific problems such as physical therapy and appropriate schooling of children with psychomotor retardation. Experimental treatment with the drug ganciclovir may reduce hearing loss that infected infants suffer later in life.

Expectations (prognosis)

Between 45-90% of infants who have symptoms of their infection at birth will have neurologic abnormalities later in life, while only about 15% of infants without symptoms will have these problems.

Complications

• Psychomotor retardation
  
• Deafness

Have the baby examined promptly if your baby was not examined by a health care provider shortly after birth and you suspect that the head is small or if other symptoms of congenital CMV are present.

If your baby has congenital CMV, it is important to follow the health care provider’s recommendations for well-baby examinations. That way, any growth and development problems can be identified early, and appropriate therapy can begin promptly.

Prevention

Cytomegalovirus is almost everywhere in the environment, and is almost impossible to avoid.

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