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Published on: August 25, 2014
Brain Abnormalities, Neurodevelopmental Milestones, and Long-term Follow-up in Newborns With Congenital
Sara Vila-Bedmar1, Ana Martinez de Aragon Calvo2, Constanza Liebana-Rojas2
1From the Pediatric Neurology Department.
Insights
Congenital cytomegalovirus (cCMV) in newborns can cause brain abnormalities, primarily white matter abnormalities (WMAs), detected by MRI. Isolated WMAs often lead to good outcomes, but further research is needed.
Area of Science:
- Neonatal neurology
- Pediatric infectious diseases
- Diagnostic imaging
Background:
- Congenital cytomegalovirus (cCMV) is a common infection in newborns.
- Early detection and monitoring are crucial for managing potential long-term complications.
- Brain magnetic resonance imaging (MRI) plays a key role in assessing neurological involvement.
Purpose of the Study:
- To determine the frequency and types of brain MRI abnormalities in newborns with cCMV.
- To evaluate the association between MRI findings and neurodevelopmental outcomes, hearing loss, chorioretinitis, and epilepsy.
- To assess the predictive value of neonatal brain MRI for long-term sequelae.
Main Methods:
- Prospective screening for cCMV in newborns via saliva viral load.
- Neonatal brain MRI performed on cCMV-diagnosed infants.
- Follow-up evaluation for neurodevelopment, hearing, and other complications over 6 years.
Main Results:
- Fifteen newborns (0.47% prevalence) were diagnosed with cCMV.
- Brain abnormalities were identified in 10 out of 15 MRIs, with white matter abnormalities (WMAs) being most frequent.
- Children with normal MRIs showed normal development; those with isolated WMAs and no other symptoms had good outcomes.
Conclusions:
- Neonatal brain MRI is valuable for identifying cCMV-related brain abnormalities.
- Isolated WMAs on neonatal MRI may not predict severe long-term neurodevelopmental issues.
- Larger studies with control groups are recommended to further elucidate outcomes in cCMV-affected infants.
Objective:
To investigate the spectrum and frequency of abnormalities on brain magnetic resonance imaging (MRI) in a cohort of newborns diagnosed with congenital cytomegalovirus (cCMV) through a screening program and evaluate the risk of sensorineural hearing loss, neurodevelopmental disorders, chorioretinitis and epilepsy.
Methods:
A prospective screening for cCMV by CMV viral load in saliva in newborns was performed in 2017-2018 in a tertiary center in Madrid. Neonatal brain MRI was performed without sedation in all newborns with cCMV and evaluated by 2 experienced neuroradiologists. The degree of agreement between the 2 radiologists was analyzed using Cohen's Kappa coefficient. All infected children were followed up for 6 years and evaluated every 6 months for neurodevelopment, behavioral issues and sensorineural hearing loss by auditory brainstem response.
Results:
Of 3190 newborns evaluated, 15 had cCMV (prevalence 0.47%, 95% CI: 0.29-0.77%) and were included in the study. Cranial ultrasound (US) and neonatal brain MRI were performed. Brain abnormalities were found in 4 US and 10 MRI, being white matter abnormalities (WMAs) the most common finding. Two children were diagnosed with psychomotor delay, and the other 2 with attention-deficit hyperactivity disorder, and all of them presented WMA in the neonatal brain MRI. Children with a normal MRI (5/15) developed normally without long-term sequelae in the follow-up.
Conclusions:
Children with isolated WMA without other clinical symptoms showed overall good outcomes, although more studies with a larger sample and a control group should be performed. Interobserver agreement about the presence of abnormalities in MRI was good.
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