The full research article is available in the Archive for Infectious Diseases in Childhood however we are able to publish the following abstract:
Congenital human cytomegalovirus (CMV) infection is the most common congenital infection, affecting around 1 in 200 infants in high-income settings. It can have life-long consequences for up to one in four children, including sensorineural hearing loss and neurodisability. Despite the frequency of congenital CMV and the severity for some children, it is a little-known condition by pregnant women, families and healthcare providers.
Timely diagnosis of CMV infection in pregnancy is important to enable consideration of treatment with valaciclovir, which may reduce the risk of transmission to the fetus or reduce the severity of the outcomes for infected infants. Recognition of features of congenital CMV is important for neonatologists, paediatricians and audiologists to prompt testing for congenital CMV within the first 21 days of life. Early diagnosis gives the opportunity for valganciclovir treatment, where appropriate, to improve outcomes for affected infants. Further research is urgently needed to inform decisions about antenatal and neonatal screening, long-term outcomes for asymptomatic and symptomatic infants, predictors of these outcomes and optimal treatment for women and infants.
The authors make the following recommendations for diagnosis and treatment in pregnancy and infancy.
- ⇒ All women should be given advice about how to reduce their risk of CMV infection in pregnancy.
- ⇒ We should continue to review the evidence to inform decisions about antenatal serological screening in pregnancy.
- ⇒ Serological testing should be offered for CMV in women with symptoms or clinical or radiological signs suggestive of infection.
- ⇒ Amniocentesis should be discussed with women with confirmed primary CMV infection or suspected non-primary infection to determine fetal infection.
- ⇒ Health professionals should consider antenatal valaciclovir for the prevention of transmission of CMV infection and for the treatment of mildly and moderately affected fetuses, on a case-by-case basis.
Recommendations for diagnosis and treatment of infants with congenital CMV
- ⇒ We should continue to evaluate the evidence to review neonatal universal screening decisions.
- ⇒ Infants should be tested for congenital CMV infection where there is suspicion of maternal or fetal infection, or neonatal symptoms or signs of congenital CMV or sensorineural hearing loss are present.
- ⇒ Urine or saliva (or blood) should be collected before 21 days of age to confirm congenital CMV infection.
- ⇒ In infants >21 days of age, retrospective CMV PCR testing of the dried blood spot should be performed. It is essential that dried blood spots are stored appropriately and long enough to allow retrospective diagnosis of congenital CMV-related sequelae.
- ⇒ We should consider targeted testing for congenital CMV for those infants who are referred from newborn hearing screening for diagnostic hearing tests to allow earlier diagnosis.
- ⇒ Where this is not in place, CMV testing should be offered for all infants at the first diagnostic audiology showing results indicative of sensorineural hearing loss.
- ⇒ Infants diagnosed with congenital CMV should be referred to the regional Paediatric Infectious Diseases service.
- ⇒ Infants with congenital CMV with central nervous system abnormalities are eligible for treatment, after discussion with the parents about the risks and benefits of treatment.
- ⇒ Infants with isolated sensorineural hearing loss may be considered for treatment on a case- by-case, after full discussion with the parents about the risks and potential benefit of treatment.
- ⇒ Treatment is currently not advised for infants with no clinical or radiological features of CMV and without sensorineural hearing loss.
- ⇒ Treatment with valganciclovir (or intravenous ganciclovir where oral administration is contraindicated) should be started before 4 weeks of age in those infants where treatment is indicated.
- ⇒ Parents of infants with congenital CMV should be offered enrolment of their infant in a national CMV registry, such as CCMVNet.
- ⇒ Families affected by CMV should be given information about the national charity CMV Action (cmvaction.org).