engleski

Early predictors of neurodevelopmental outcome in children with congenital cytomegalovirus infection

INTRODUCTION: Congenital cytomegalovirus infection (CCMVI) is the most common vertically transmitted infectious disease. Infected children are often asymptomatic, but infection can also cause severe neurodevelopmental disorders such as hearing and visual impairments, cerebral palsy, mental retardation, epilepsy or autism. MATERIALS AND METHODS: The study is planned to describe 95 children with proven CCMVI in order to determine correlation between neurodevelopmental outcome and first symptom or group of symptoms of infection. Until now 54 children with clinical, laboratory, neurophysiological and neuroimaging perinatal examination was included in study, of which 31 was re-examined at the age more then 24 months. RESULTS: More than half of examined children were born from mothers first pregnancy, 75% children were term born. At least one of the symptoms of CCMVI was present in newborn period in 39/54 children, mostly isolated jaundice. Microcephaly, intrauterine growth retardation, neonatal sepsis syndrome or hepatitis were also observed, often combined. However, CCMVI was diagnosed in newborn period only in 13 patients. In others hepatitis (13), prolonged jaundice (3), neuroimaging findings (15) and psychomotor delay (7) were most often guide marks. Of the 31 re-examined children 8 developed cerebral palsy, 10 had minor neurological dysfunction, while others didn’t have larger motor disorder. Eleven children had mild and only one child severe vision impairment, seven had hearing impairment (4 with severe damage). Epilepsy occurred in 8 children and all of them were permanently treated. Cognitively impaired were 13 of them (mild 7, moderate 2, severe 4), while 18 had inappropriate speech development. DISCUSSION: From this preliminary data on relatively small sample it can be concluded that isolated jaundice as symptom of CCMVI is not a predictor of adverse psychomotor outcome in infected children. Other symptoms or their combinations have yet to be statistically validated when data for all children are collected. Determination of most reliable predictors is important for setting early suspicion on CCMVI, early diagnosing and predicting neurodevelopmental outcome. Thus, it would enable early habilitation and deciding upon potentially harmful antiviral therapy.

congenital cytomegalovirus infection; symptoms; neurodevelopmental outcome

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