Asymptomatic congenital CMV infection: long-term cognitive outcome and brain imaging findings

Infants with symptomatic congenital cytomegalovirus infection (cCMV) are at high risk of neurodevelopmental impairments. However, long-term cognitive outcomes in children with asymptomatic cCMV (acCMV) remain unclear.

Through universal CMV screening of approximately 20,000 newborns, children with acCMV (n = 36), children with symptomatic cCMV (n = 4), and matched healthy controls (n = 54) were identified and followed prospectively. Brain MRI and neuropsychological assessments were performed in children with acCMV and controls at 6-8 years of age.

Brain MRI findings were more common in children with acCMV than in controls (14/23, 60.9% vs. 3/31, 9.7%;p < 0.001). Punctate white matter lesions were the most frequent finding and occurred more often in children with acCMV than in controls (10/23, 43.5% vs. 3/31, 9.7%;p 0.004). Ventriculomegaly, cerebellar cortical malformations, and cerebral cortical malformations were less common and occurred only in children with acCMV. Mean full-scale IQ did not differ significantly between children with acCMV (n = 26) and controls (n = 28) (116.91 ± 11.67 vs. 118.68 ± 13.12, p NS), nor did the mean subtest scores. The full-scale IQ in children with acCMV with brain MRI abnormalities (n = 12) did not significantly differ from those without abnormalities (n = 8) (109.67 ± 13.72 vs. 120.75 ± 9.24, p NS). Neither did the mean subtest scores differ between them.

Despite the high frequency of brain MRI abnormalities, predominantly white matter lesions, cognitive outcomes at early school-age did not differ significantly between children with acCMV and controls. Larger studies are needed to confirm these findings and determine the prognostic significance of brain MRI abnormalities in acCMV.