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Long-term outcomes of children with symptomatic congenital cytomegalovirus disease

Abstract

Objective:

To assess long-term outcomes of children with symptomatic congenital cytomegalovirus (CMV) disease detected at birth.

Study Design:

We used Cox regression to assess risk factors for intellectual disability (intelligence quotient <70), sensorineural hearing loss (SNHL; hearing level 25 dB in any audiometric frequency) and vision impairment (best corrected visual acuity >20 or based on ophthalmologist report).

Results:

Among 76 case-patients followed through median age of 13 (range: 0–27) years, 56 (74%) had SNHL, 31 (43%, n=72) had intellectual disability and 18 (27%, n=66) had vision impairment; 28 (43%, n=65) had intellectual disability and SNHL with/without vision impairment. Microcephaly was significantly associated with each of the three outcomes. Tissue destruction and dysplastic growth on head computed tomography scan at birth was significantly associated with intellectual disability and SNHL.

Conclusion:

Infants with symptomatic congenital CMV disease may develop moderate to severe impairments that were associated with presence of microcephaly and brain abnormalities.

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Acknowledgements

We thank all the children who participated in the study, their families and physicians for their lifetime of dedication and support for this study, and Kim Van Naarden Braun for careful review of the manuscript. The study was supported, in part, by the CMV Research Fund Donors at Baylor College of Medicine; the Woman’s Hospital of Texas Research Foundation; the Office of Research Resources and the General Clinical Research Center for Children at Texas Children’s Hospital and Baylor College of Medicine (NIH 5M0I RR00188-33); the Mental Retardation Research Center at Baylor College of Medicine (NIH-CHHD 5 P30 HD24064P); the Research to Prevent Blindness, New York, NY; the Deafness Foundation, Houston, TX; the Vale Ashe Foundation, Houston, TX; the Maddie’s Mission Foundation, Katy, TX; the Naymola Foundation, Beaumont, TX; the American Pediatric Society-Society for Pediatric Research Summer Student Research Program (NIH-CHHD); and the Centers for Disease Control and Prevention (Cooperative Agreement FOA IP 10-006).

The Congenital CMV Longitudinal Study Group through the years has included: Shahzad Ahmed, Hanna Baer, Amit R Bhatt, Peggy Blum and Texas Children's Hospital Audiology, Frank Brown, Francis Catlin, Alison C Caviness, David K Coats, Jane C Edmonds, Marily Flores, Daniel Franklin, Cindy Gandaria, Jewel Greer, Carol Griesser, Mohamed A. Hussein, Isabella Iovino, Allison Istas, Haoxing (Douglas) Jin, Mary K Kelinske, Joseph T Klingen, Antone Laurente, Thomas Littman, Mary Murphy, Jerry Miller, Christopher Nelson, Daniel Noyola, Evelyn A Paysse, Alan Percy, Sara Reis, Ann Reynolds, Judith Rozelle, O’Brien Smith, Paul Steinkuller, Marie Turcich, Sherry Sellers Vinson, Robert G Voigt, Bethann Walmus, Jill Williams, Daniel Williamson, Kimberly G Yen, Martha D Yow and Gail J Demmler-Harrison.

Author contributions

TML conceptualized and conducted analysis contained in this report, interpreted the data, led the writing of the initial manuscript and revised versions and approved the final version; JL conducted analysis contained in this report, interpreted the data, revised the manuscript and approved the final version; WC conceptualized the analysis contained in this report, reviewed and interpreted individual audiological data, revised the manuscript and approved the final version; MF and JAM assisted with data management and quality control for the Longitudinal Congenital CMV Study, revised the manuscript and approved the final version; PB conceptualized and provided audiological follow-up in the Longitudinal Congenital CMV Study, revised the manuscript and approved the final version; ACC was the co-Principal Investigator for the Longitudinal Congenital CMV Study, revised individual clinical, laboratory and head computed tomography data, conducted analysis contained in this report, revised the manuscript and approved the final version; SRB conceptualized the analysis contained in this report, interpreted the data, revised the manuscript and approved the final version; SSV, MRT and RGV conducted the neurodevelopmental evaluations, revised the manuscript and approved the final version; GD-H was the Principal Investigator for the Longitudinal Congenital CMV Study, provided patient follow-up, conceptualized the analysis contained in this report, interpreted the data, revised the manuscript and approved the final version.

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Correspondence to T M Lanzieri.

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Dr Demmler-Harrison’s institution received funding from Merck Sharpe & Dohme Corporation since July 2016 to assist with salary support for further analysis on long-term outcomes of congenital CMV infection not included in this report. The remaining authors declare no conflict of interest.

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The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Lanzieri, T., Leung, J., Caviness, A. et al. Long-term outcomes of children with symptomatic congenital cytomegalovirus disease. J Perinatol 37, 875–880 (2017). https://doi.org/10.1038/jp.2017.41

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