Researchers at St Orsola General Hospital, Bologna, Italy, monitored symptoms of cytomegalovirus virus (CMV) at birth and during long-term follow-up of 74 congenitally infected newborns, and analyzed the distribution of gN variants in relation to virological parameters, clinical signs at birth, and sequelae, psychomotor impairment and sensorineural hearing loss. The population examined consisted of 29 (39.2%) symptomatic and 45 (60.8%) asymptomatic infants at birth; 2 (2.7%) died in the first weeks, and follow-up data were available for 64 (86.5%) children. The asymptomatic group with a favorable long-term outcome was significantly associated with gN-1 and gN-3a genotypes. The symptomatic group, with abnormal imaging and sequelae was associated with gN-4 genotypes (p<0.05). gN-1 and gN-3A genotypes reduce the risk of sequelae 5 fold, whereas variants of gN-4 increase the risk of sequelae 8 fold. gN genotypes are markers for virulence of CMV wild-type strains and the risk of sequelae in CMV-infected newborns. [1]

COMMENT. Markers for the early identification of newborns with CMV at increased risk of developing neurological sequelae should assist in monitoring follow-up and early intervention with ganciclovir for treatment of sensorineural deafness [2]. This report shows that genetic and immunologic variability affects CMV virulence and may be used as prognostic factors to determine severity of infection and outcome.

Normal psychomotor development in infants with CMV infection treated early with intravenous ganciclovir and antiepileptic drugs [3]. Onset of seizures was generally in the first 6 months of life, most frequently in the second and fourth months. Seizures were controlled in 19 infants (59.4%), and treatment was withdrawn successfully in 11 (34.4%) children after 30-36 months. At a median follow-up of 7 years, psychomotor development was normal in 15 (46.9%), including the 11 patients withdrawn from AEDs. Cerebral palsy was diagnosed in 17 (53.1%).