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Congenital cytomegalovirus

Definition

Congenital cytomegalovirus is a group of symptoms that occur when an infant is infected with the cytomegalovirus (CMV) before birth.

Alternative Names

CMV - congenital; Congenital CMV; Cytomegalovirus - congenital

Causes, incidence, and risk factors

Congenital cytomegalovirus occurs when an infected mother passes CMV to the fetus through the placenta. The mother's illness may not have symptoms, so she may be unaware that she has CMV.

Symptoms

Most congenitally infected children do not have symptoms. Only about 1 out of 10 infants congenitally infected with CMV have these symptoms:

• Inflammation of the retina
• Jaundice
• Large spleen and liver
• Low birth weight
• Mineral deposits in the brain
• Rash at birth (petechiae)
• Seizures
• Small head size (microcephaly)

Signs and tests

During the exam, the health care provider may find:

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

Tests include:

• Antibody titer against CMV for both the mother and infant
• Bilirubin level and blood tests for liver function
• CBC
• CT scan or ultrasound of the head
• Fundoscopy
• TORCH screen
• Urine culture for CMV virus in the first 2 to 3 weeks of life
• X-ray of the chest

Treatment

There is no specific treatment for congenital CMV. Treatments, such as physical therapy and appropriate education for children with psychomotor retardation, focus on specific problems.

Experimental treatment with the drug ganciclovir may reduce hearing loss later in the child's life.

Support Groups

Expectations (prognosis)

Up to 90% of infants who have symptoms of their infection at birth will have neurologic abnormalities later in life. Only about 5 - 10% of infants without symptoms will have these problems.

Complications

• Psychomotor retardation
• Deafness

Calling your health care provider

Have your baby checked right away if he or she was not examined by a health care provider shortly after birth and you suspect that the head is small or you notice other symptoms of congenital CMV.

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 treated promptly.

Prevention

Cytomegalovirus is almost everywhere in the environment. The U.S. Centers for Disease Control and Prevention (CDC) recommend the following steps to reduce the spread of CMV:

• Wash hands with soap and water after touching diapers or saliva.
• Avoid kissing children under the age of 6 on the mouth or cheek.
• Do not share food, drinks, or eating utensils with young children.
• Pregnant women working in a day care center should work with children older than age 2 1/2.

References

Crumpacker CS II, Zhang JL. Cytomegalovirus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 138.