Original articleRole of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection
Introduction
Congenital cytomegalovirus (CMV) infection is a major health problem in developed countries as it is a leading cause of hearing loss and neurodevelopmental impairment in children. CMV is a neurotropic virus, mostly involving the central nervous system (CNS) [1]. Almost all CNS cell types are susceptible to infection, with varying abilities to support a complete viral replication cycle. Fetal brain damage is the combined result of viral infection, inflammatory infiltration and hypoxia due to severe placentitis [1]. Congenital CMV infection can lead to a wide spectrum of brain abnormalities, including microcephaly, intraparenchymal calcifications, ventriculomegaly, intraventricular adhesions, periventricular pseudocystis, sulcation and gyral abnormalities, hypoplastic corpus callosum, cerebellar abnormalities, white matter injury [2], [3], [4].
Computed tomography (CT) has been widely used in CMV congenitally infected newborns to detect brain lesions, establish a prognosis [5] and identify newborns who could benefit from ganciclovir treatment to reduce hearing and neurodevelopmental impairment [6], [7].
However, there is great concern about the radiation exposure, especially in children, that are particularly at risk for adverse effects from overexposure to radiation because of several factors, including increased tissue sensitivity and longer life expectancy [8], [9], [10].
In recent years cerebral ultrasound (cUS) and cerebral magnetic resonance imaging (cMRI) have been advocated to evaluate brain injury in infants with CMV disease [11], [12], [13], [14].
A previous study reported a good correlation between pathological cUS and the prediction of outcomes in newborns congenitally infected with CMV [11], but insufficient data precluded any conclusion for asymptomatic infants. The study lacked a full CNS evaluation because all enrolled infants underwent cUS examination but cMRI was performed only in those with pathologic cUS findings.
The aim of this prospective observational study was to investigate further the feasibility, diagnostic and prognostic ability of cMRI compared with cUS to select CMV-congenitally infected newborns with cerebral involvement and to predict their neurodevelopmental outcome.
Section snippets
Study population
A prospective longitudinal observational study was carried out. All consecutive newborns born from January 2003 to January 2010 with congenital CMV infection diagnosed within the first two weeks of life were eligible for the study. Our study protocol is routinely applied to all infants with congenital CMV infection, as it overlaps with our care protocol. Before enrolment written informed consent was obtained from each infant’s parents.
Virological tests
Active CMV infection was documented in urine, saliva, or
Results
Forty newborns with congenital CMV infection were enrolled in the study from January 2003 to January 2010 (Fig. 1). Their mean GA was 38.9 ± 1.2 weeks and their mean birth weight (BW) was 3177 ± 493 g; one infant was late preterm (GA: 36 weeks); 21 were male. To date, at a median age of 36 months (range 24–72 months), none of the 40 CMV-infected infants has died.
Thirty out of the 40 newborns (75%) were born to mothers with established primary CMV infection during pregnancy, 5 (12.5%) were born to
Discussion
Early identification of CNS involvement in newborns with congenital CMV infection is essential to recognize symptomatic infected infants, establish the prognosis and counsel parents.
The main objective of neonatal evaluation of congenital CMV infection is to establish whether normal brain development was disrupted by viral infection, inflammatory infiltration or hypoxia due to placental impairment. Neonatal brain injury may be assessed by CT, cUS and MRI imaging.
Cranial CT has long been
Conflict of interest
We declare that we have no conflict of interest.
Acknowledgments
We are grateful to Dino Gibertoni for his assistance in statistical analysis. Anne Prudence Collins edited the English text.
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