Twenty-four children with virologically confirmed symptomatic congenital CMV infection were prospectively studied to assess the predictive value of central nervous system (CNS) signs, symptoms, and radiographic abnormalities on neurodevelopmental outcome. Outcome was assessed by serial age-appropriate IQ testing and by complete physical, neurologic, and developmental examinations (mean age at most recent followup 4.4 yrs., range 11 mos. - 9 yrs.). Early CNS abnormalities seen were: abnormal head CT scan 22 patients, congenital sensorineural hearing loss (SNHL) 11, microcephaly 9, chorioretinitis 6, seizures 1, and other neurologic abnormalities(hypo/hypertonia, jitteriness, tremors) 11. The sum of CNS abnormalities for each patient was designated as that patient's CNS score, with scores of 0-6 possible (CNS score range 0-5, mean 2.5). Mental retardation (MR) (IQ<70), was found in 11/24 (46%) patients, and profound MR (IQ<50) was seen in 9/24(38%) patients. 6/24 (25%) patients had average or better intelligence(IQ≥90). 10 patients had intracranial calcifications (IC) and IQ<70(p=.033). Correlation also was found between microcephaly and IQ<70(p=.033), and IQ<50 (p=.003), as well as for chorioretinitis and IQ<50(p=.015). Correlation was found between all three IQ categories and CNS score, inclusive or exclusive of SNHL (p≤.011). Multiple logistic regression (MLR) correlated IC and IQ<70, the combination of cerebral radiolucency-ventricular dilatation and IQ<70, and microcephaly and IQ<50 (p<0.05). Conversely, absence of IC predicted IQ>90(p<0.05).

11 patients at followup had severe motor impairment (SMI), 11 had mild motor impairment (MMI) and 2 patients had no motor abnormalities. Correlation was found between CNS score (p=0.001), microcephaly (p=0.002), chorioretinitis(p=0.06), and IC (p=0.033) and development of SMI. MLR correlated microcephaly and development of SMI (p<0.05).

Although many infants with symptomatic congenital CMV infection develop significant neurodevelopmental sequelae, 1/4 of these children may have average or better IQ. Early neurologic, neuroradiologic, and ophthalmologic assessment is helpful in predicting neurodevelopmental outcome.