Primary infection: 30% risk of congenital CMV; higher risk later in pregnancy, but worse outcomes earlier
Non-primary
Reinfection: 5% risk
Reactivation: 1% risk
Clinical Presentation
At birth
Microcephaly
Periventricular calcifications
Chorioretinitis
Sensorineural hearing loss
Optic nerve atrophy
Hepatosplenomegaly
Cytopenia
Later
Cognitive deficits (7%)
Sensorineural hearing loss (20%)
Diagnosis
In mom, IgM antibodies
In baby, urine PCR within 2 weeks of birth
Management
Treatment is indicated for symptomatic babies
Brain
Hearing
Eye
IV ganciclovir or PO valganciclovir, for 6 months
Monitor CBC while on therapy
References
^Gisela Enders, Anja Daiminger, Ursula Bäder, Simone Exler, Martin Enders. Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age. Journal of Clinical Virology. 2011;52(3):244-246. doi:10.1016/j.jcv.2011.07.005.
^William D Rawlinson, Suresh B Boppana, Karen B Fowler, David W Kimberlin, Tiziana Lazzarotto, Sophie Alain, Kate Daly, Sara Doutré, Laura Gibson, Michelle L Giles, Janelle Greenlee, Stuart T Hamilton, Gail J Harrison, Lisa Hui, Cheryl A Jones, Pamela Palasanthiran, Mark R Schleiss, Antonia W Shand, Wendy J van Zuylen. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. The Lancet Infectious Diseases. 2017;17(6):e177-e188. doi:10.1016/s1473-3099(17)30143-3.
