The long-term neurodevelopmental outcome in 41 children with symptomatic congenital cytomegalovirus (CMV) infection was studied by investigators at Baylor College of Medicine and the Houston CMV Study Group. The median age at last follow-up was 5.7 years (range, 11 months-13 years). Neurologic abnormalities at birth included seizures in 7%, chorioretinitis (17%), microcephaly (19%), hearing loss (41%), intracranial calcifications (58%), and abnormal CT scan (78%). At follow-up, 29% had an intelligence/developmental quotient (IQ/DQ) of >90, and 24% had an IQ/DQ of 70-89. The IQ/DQ was <50 in 36%, and 36% had a major motor disorder. The most specific predictor of mental retardation and major motor disability was microcephaly, and the most sensitive predictor was a CT abnormality. The correlation between head size at birth and the ID/DQ was highly significant (P<.001). Children with sensorineural hearing loss had lower IQ/DQ than those with normal hearing. [1]

COMMENT. One third of children with symptomatic congenital CMV infection have a normal cognitive outcome. Microcephaly at birth is the most specific predictor of a poor cognitive outcome. The combination of a normal head circumference proportional to weight and a normal CT scan are predictive of a good cognitive outcome and an IQ/DQ>70.

Time of maternal CMV infection and infant prognosis. CMV-infected infants born to mothers with recurrent infection and having antibody to CMV before conception have a significantly better prognosis than those with maternal primary CMV infection. A study at the University of Alabama [2] showed that infants in the primary-infection group had symptomatic CMV at birth in 18% and neurodevelopmental sequelae in 25%, whereas those born to mothers with immunity had no symptoms at birth and sequelae in only 8%, none with mental impairment. CMV is a common complication risk of infant liver transplantation. For further review of CMV infection, see Progress in Pediatric Neurology II, PNB Publ, 1994;pp 412-3.