Hideto Yamada1, Kenji Tanimura2, Sachiyo Fukushima3, Kazumichi Fujioka3, Masashi Deguchi2, Yuki Sasagawa2, Shinya Tairaku4, Toru Funakoshi4, Ichiro Morioka5. 1. Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: yhideto@med.kobe-u.ac.jp. 2. Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan. 3. Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan. 4. Department of Obstetrics and Gynecology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan. 5. Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVES: This prospective cohort study aimed to evaluate the efficacy of the universal neonatal urine screening, followed by diagnosis, workup and antiviral therapy for symptomatic congenital cytomegalovirus (CMV) infection to reduce neurological impairments and sequelae. METHODS: Neonates born in three facilities underwent the universal urine screening of PCR analyses for CMV-DNA. Neonates with symptomatic congenital CMV infection (cCMV) received oral valganciclovir (VGCV) of 32 mg/kg/day for six weeks or six months, and were evaluated for neurological outcomes including developmental quotient (DQ) and hearing function at around 18 months of corrected age. RESULTS: cCMV was diagnosed in 56 (0.48%) of 11,736 neonates, consisting of 23 neonates with symptomatic and 33 with asymptomatic cCMV. The incidence of cCMV in the general perinatal medical center (0.69%) was higher than that in the primary maternity hospital (0.23%, p<0.01%). Twenty of the 23 infants with symptomatic cCMV received VGCV therapy, and 19 underwent neurological assessment. Eight neonates (42%) had severe sequelae of DQ < 70, bilateral hearing dysfunction, and/or epilepsy. Four neonates (21%) had mild sequelae of DQ 70-79 or unilateral hearing dysfunction only, and seven (37%) showed normal development without any impairment. CONCLUSIONS: This study on a large scale demonstrated that a series of universal neonatal urine screening, diagnosis, workup, and VGCV therapy for neonates with symptomatic cCMV may decrease neurological impairments, because 58% of the treated infants had normal development or mild sequelae. The universal urine screening likely identifies subclinical symptomatic cCMV. Mothers with fetuses of cCMV seem to be selectively transferred to perinatal medical centers before deliveries.
OBJECTIVES: This prospective cohort study aimed to evaluate the efficacy of the universal neonatal urine screening, followed by diagnosis, workup and antiviral therapy for symptomatic congenital cytomegalovirus (CMV) infection to reduce neurological impairments and sequelae. METHODS: Neonates born in three facilities underwent the universal urine screening of PCR analyses for CMV-DNA. Neonates with symptomatic congenital CMV infection (cCMV) received oral valganciclovir (VGCV) of 32 mg/kg/day for six weeks or six months, and were evaluated for neurological outcomes including developmental quotient (DQ) and hearing function at around 18 months of corrected age. RESULTS:cCMV was diagnosed in 56 (0.48%) of 11,736 neonates, consisting of 23 neonates with symptomatic and 33 with asymptomatic cCMV. The incidence of cCMV in the general perinatal medical center (0.69%) was higher than that in the primary maternity hospital (0.23%, p<0.01%). Twenty of the 23 infants with symptomatic cCMV received VGCV therapy, and 19 underwent neurological assessment. Eight neonates (42%) had severe sequelae of DQ < 70, bilateral hearing dysfunction, and/or epilepsy. Four neonates (21%) had mild sequelae of DQ 70-79 or unilateral hearing dysfunction only, and seven (37%) showed normal development without any impairment. CONCLUSIONS: This study on a large scale demonstrated that a series of universal neonatal urine screening, diagnosis, workup, and VGCV therapy for neonates with symptomatic cCMV may decrease neurological impairments, because 58% of the treated infants had normal development or mild sequelae. The universal urine screening likely identifies subclinical symptomatic cCMV. Mothers with fetuses of cCMV seem to be selectively transferred to perinatal medical centers before deliveries.
Authors: Kai Chen; Yaqin Zhong; Yuanyuan Gu; Rajan Sharma; Muting Li; Jinjun Zhou; Youjia Wu; Yuexia Gao; Gang Qin Journal: JAMA Netw Open Date: 2020-12-01
Authors: Paddy Ssentongo; Christine Hehnly; Patricia Birungi; Mikayla A Roach; Jada Spady; Claudio Fronterre; Ming Wang; Laura E Murray-Kolb; Laila Al-Shaar; Vernon M Chinchilli; James R Broach; Jessica E Ericson; Steven J Schiff Journal: JAMA Netw Open Date: 2021-08-02