Background
- Infection with cytomegalovirus acquired in utero
- See also CMV in pregnancy
Epidemiology
- Maternal seroconversion in about 2% of pregnancies
- Higher in childcare workers
- Risk of transmission to fetus
- About 1 in 200 live births in US
- 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 Manifestations
- Mother may have had asymptomatic infection
- At birth (10%)
- Microcephaly (35-50%)
- Periventricular calcifications
- Seizure (5-10%)
- Chorioretinitis (10-15%)
- Sensorineural hearing loss (35%)
- Optic nerve atrophy
- Petechiae (50-75%)
- Neonatal jaundice (40-70%)
- Hepatosplenomegaly (40-60%)
- Small size for gestational age (40-50%)
- Lethargy and hypotonia (30%)
- Poor suck (20%)
- Cytopenias
- Hemolytic anemia (5-10%)
- Pneumonia (5-10%)
- 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
