The clinical, radiological and neuropathological findings in 15 premature infants with lethal congenital cytomegalovirus infection were studied at the Departments of Pediatrics and Pathology, University of Texas Southwestern Medical Center, Dallas, TX. Six infants were stillborn and 9 were live born, but died at a postnatal age of 18±21 days. Clinical findings included microcephaly (77%), seizures (55%), hypotonia (33%), multiple contractures (18%), chorioretinitis, optic atrophy and corneal opacities. CT scan in 2 infants showed periventricular calcification; MRI in 1 infant demonstrated cerebellar hypoplasia and diffuse cortical atrophy. Sonograms were normal in 4 infants and 2 had ventriculomegaly and periventricular calcification. Neuropathological findings included periventricular necrosis and calcification, cerebellar hypoplasia, leukomalacia, intraventricular hemorrhage, hydrocephalus and porencephalic cyst. Systemic inclusion bodies were present in all infants and intranuclear bodies within the brain in 4 infants. The atypical findings in preterm infants which are rarely reported in term infants included hypotonia, multiple contractures, periventricular leukomalacia and optic atrophy. [1]

COMMENT. These findings indicate that cytomegalovirus infection should be considered in the differential diagnosis of unexplained hypotonia and arthrogryposis multiplex congenita in premature infants. Newer antiviral agents such as ganciclovir may modify the prognosis and may be indicated in treatment of some preterm infants with congenital CMV infection.

Fowler KB and colleagues at the University of Alabama, Birmingham, AL, compared the outcomes of CMV-infected infants born to mothers who acquired primary CMV during pregnancy (primary-infection group) with those born to mothers with immunity (recurrent-infection group). Infants in the primary-infection group had symptomatic CMV infection at birth in 18%, sequelae in 25% including sensorineural hearing loss in 15%, and mental impairment in 13%. Infants born to mothers with recurrent infection and having antibody to CMV before conception had no symptoms at birth, sequelae in only 8%, and none became mentally impaired at early childhood follow-up. The presence of maternal antibody to CMV before conception provides protection against sequelae to congenital CMV in the newborn. [2]

CMV was the most common viral infection complication in 100 children who underwent liver transplantation at Addenbrooke’s Hospital, Cambridge, England. Of 23 infected, 13 had primary infections and one died of encephalitis. Of 9 receiving ganciclovir, 8 recovered fully. [3]