Is Neonatal Viremia a Possible Predictor of the Timing of Maternal Infection in Asymptomatic Congenital Cytomegalovirus Infection? A Retrospective Study.

Physical and intellectual development in children with asymptomatic congenital cytomegalovirus infection: A longitudinal cohort study in Qinba mountain area, China

Congenital cytomegalovirus (CMV) infection is the major infectious cause of birth defects and hearing loss globally. There is a growing recognition of the potential clinical impact of congenital CMV infections in high-seroprevalence settings. A cross-sectional study of neonatal admissions at a large referral center in sub-Saharan Africa to determine the prevalence of both symptomatic and asymptomatic congenital CMV infection was performed. Real-time polymerase chain reaction was used to screen DNA-extracted sera, urine, and saliva, and an enzyme-linked immunosorbent assay was used to screen serum samples for anti-CMV immunoglobulin M. Multivariate binary logistic regression was used to identify risk factors associated with increased odds of congenital CMV infection. Congenital CMV was detected in 3.8% (15/395) of neonates. Among these infants, 6 of 15 (40%) presented with jaundice, 1 of whom also had petechiae. Congenital CMV infection was detected in 9 of 79 (11.4%; 95% confidence interval [CI], 6.1%-20.3%) neonates born to human immunodeficiency virus (HIV)-infected mothers, and both maternal HIV (odds ratio [OR], 6.661 [95% CI, 2.126-20.876], P = .001) and jaundice (OR, 5.701 [95% CI, 1.776-18.306], P = .003) were independently linked with significantly increased odds of congenital CMV infection. Congenital and early infant CMV infections may have important consequences for child health in sub-Saharan Africa and other high HIV and CMV seroprevalence populations globally.

Ultrasonographic estimation of placental thickness with advancing gestational age

BackgroundLow back pain (LBP) is one of the most common musculoskeletal problems affecting pregnant women. While the etiology/pathogenesis of pregnancy-related LBP (PR-LBP) has not been fully explained, it is thought...

Should You Follow the Better-Hearing Ear for Congenital Cytomegalovirus Infection and Isolated Sensorineural Hearing Loss?

Hearing in Children with Congenital Cytomegalovirus Infection: Results of a Longitudinal Study

Correlation Between White Matter Lesions and Intelligence Quotient in Patients With Congenital Cytomegalovirus Infection

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Background and Aim: Cytomegalovirus (CMV) is the main cause of congenital infection in developed countries leading to deafness but the burden of sensorineural hearing loss (SNHL) in asymptomatic children remains incompletely characterized. Aim of this study was to evaluate the long-term audiological outcome in this group of patients.Methods: Consecutive neonates with congenital CMV infection were followed from 2002 to 2018. Patients were considered asymptomatic if free from any clinical and instrumental impairment at referral and underwent serial clinical exams, audiological evaluations and CMV-PCR determinations.Results: A cohort of 258 children was analyzed and the disease onset was asymptomatic in 125 (48%) infants. Among these, we studied 102 patients with a follow-up longer than 1 year and a median observation period of 2.8 years (range: 1–10.3 years). No patient developed a stable delayed SNHL but only 14 (14%) presented a variable hearing impairment, seven of which bilateral. The unstable SNHL was mild in 12 infants and moderate in two. Patients with fluctuating SNHL had significantly higher urine viral load (p 0.002) and more often positive viremia (p 0.015) than babies with stable normal hearing.Conclusions: CMV infected, asymptomatic neonates have a low risk of transient SNHL later in infancy. Positive viremia and high urine viral load at onset are significant risk factors for delayed fluctuating SNHL. These data are relevant for an appropriate follow up plan of these patients.

Anxiety and depression during pregnancy in women and men

Objective: The present study was conducted to study the changes in serum levels of thyroid hormones and thyroid stimulating hormone (TSH) in different trimesters of normal pregnancy.
 Methods: This cross-sectional study was conducted in the Department of Physiology, Rangpur Medical College Hospital over a period 1 year from July 2008 to June 2009. Apparently healthy pregnant women aged between 20 - 35 years were consecutively included in the study. Patients suffering from thyroid disorders or any other systemic diseases and lactating mothers were excluded from the study. A total of 100 subjects - 75 pregnant women (25 selected from each trimester of pregnancy) and 25 non-pregnant women were purposively selected as case and control groups respectively.
 Result: The mean age was almost identically distributed between the two groups (23.8 ± 3.9 vs. 24.9 ±4.6, p = 0.343). Lower class patient was predominant in case and control group (68% vs. 64%, p =0.756). The mean serum T3 level was higher in case group compared to control group. The mean serum T3 level was identically distributed in 1st and 3rd trimester (p = 0.536 and p = 0.145 respectively) but significant difference was found in 2nd trimester (p = 0.001). The mean serum T4 level of control group did not experience any change throughout the whole observation period. The serum T4 level was 210 nmol/L at 1st trimester then it began to increase almost a plateau at 2nd trimester and then gradually dropped 232.2 nmol/L at third trimester. The mean serum TSH level was 1.1 mIU/L at 1st trimester then it began to increase sharply assumed a mean score 1.3 mIU/L at 2nd trimester. From 2nd trimester onwards it began to decrease upto the end of observation when no change in the non-pregnant women in 1st, 2nd & 3rd trimester.
 Conclusion: Thyroid hormones (T3, T4) increase in the 2nd trimester of pregnancy and fall again in the 3rdtrimester but TSH does not experience any significant change throughout the pregnancy.
 Ibrahim Cardiac Med J 2012; 2(2): 19-23

Placental growth factor and soluble fms-like tyrosine kinase-1 are useful markers for the prediction of preeclampsia but not for small for gestational age neonates: a longitudinal study

To assess the prevalence, characteristics, and risk of sensorineural hearing loss (SNHL) in children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected children. We included 92 case-patients and 51 controls assessed by using auditory brainstem response and behavioral audiometry. We used Kaplan-Meier survival analysis to estimate the prevalence of SNHL, defined as ≥25 dB hearing level at any frequency and Cox proportional hazards regression analyses to compare SNHL risk between groups. At age 18 years, SNHL prevalence was 25% (95% confidence interval [CI]: 17%-36%) among case-patients and 8% (95% CI: 3%-22%) in controls (hazard ratio [HR]: 4.0; 95% CI: 1.2-14.5; P = .02). Among children without SNHL by age 5 years, the risk of delayed-onset SNHL was not significantly greater for case-patients than for controls (HR: 1.6; 95% CI: 0.4-6.1; P = .5). Among case-patients, the risk of delayed-onset SNHL was significantly greater among those with unilateral congenital/early-onset hearing loss than those without (HR: 6.9; 95% CI: 2.5-19.1; P < .01). The prevalence of severe to profound bilateral SNHL among case-patients was 2% (95% CI: 1%-9%). Delayed-onset and progression of SNHL among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. However, the risk of developing SNHL after age 5 years among case-patients was not different than in uninfected children. Overall, 2% of case-patients developed SNHL that was severe enough for them to be candidates for cochlear implantation.

Congenital CMV is one of the commonest congenital infections and a recognised cause of sensorineural hearing loss and neurodevelopmental impairment. Ninety percent are clinically inapparent at birth but are reported to be at risk of developing such abnormalities throughout childhood, the extent of which requires further elucidation. A systematic literature review was conducted using Medline and Embase databases, manual citation review, and personal libraries for articles reporting primary data on hearing and neurodevelopmental outcomes for children with asymptomatic congenital CMV. PROSPERO registration number CRD42015025407. Thirty-seven of 480 articles identified between 1969 and 2016 met the eligibility criteria. Twenty-nine of these contributed primary data on hearing outcomes and 20 on neurodevelopmental outcomes (12 of the 37 studies contributed data on both). Cumulative incidence of sensorineural hearing loss with follow-up to at least 5 years was 7% to 11%, which is more than healthy controls but less than children with symptomatic congenital CMV (34%-41%). The onset, course, and severity of hearing loss was variable with no reliable virological prognostic marker. In comparison to controls, children with asymptomatic congenital CMV did not perform worse than controls in neurodevelopmental assessments and performed better than children with symptomatic congenital CMV. Studies show children with asymptomatic congenital CMV are at increased risk of developing hearing loss but perform equally well on neurodevelopmental assessments when compared with healthy controls. There is no reliable virological marker to determine which infants will develop sequelae. Regular follow-up until school entry is supported by the literature.

In a study published in this issue of Pediatrics, Pinninti et al1 report that vestibular, balance, and gaze disorders occur in up to 45% of children born with asymptomatic congenital cytomegalovirus (cCMV) infection. This study was based on the evaluation of 40 children from among the 449 newborns diagnosed with cCMV through the CMV & Hearing Multicenter Screening (CHIMES) study, which screened >100 000 newborns from 7 medical center sites across the United States from 2007 to 2012.2 The subjects in this study represent a sample from a single CMV & Hearing Multicenter Screening study site.This study represents the largest cohort identified and systematically tested for vestibular and balance disorders in children with asymptomatic cCMV. Previous smaller studies, which included symptomatic and asymptomatic children with cCMV and hearing loss, reported balance and vestibular problems, paving the way for this study.3–6 With this study, Pinninti et al1 are the first to report disorders of gaze in cCMV. The findings are a significant contribution to our knowledge about the sequelae associated with otherwise clinically unrecognized asymptomatic cCMV. Disorders of gaze, balance, and vestibular function may subtly impact the ability of children to perform activities of daily living and influence their reading, academics, and sports performance in school. Early identification of these subtle disorders and use of functional therapies may mitigate the impact they have on the daily lives of these affected children. Future research is needed to evaluate whether all infants with cCMV should receive vestibular testing. Another important consideration is the degree to which there are differences of age, hearing loss status, race, and ethnicity in the risk of vestibular disorders, as suggested in this study. If these findings are confirmed, future work is needed to assess the underlying causes of the disparities.It is critical to recognize that cCMV is not rare. It is a globally common congenital infection, with 0.4% to 0.6% (range 0.2%–2.2%) of all newborns reported to be infected, and is a leading cause of newborn illness and childhood sequelae including hearing loss; vision loss; speech, language and developmental delays; seizure disorders; and motor disorders such as cerebral palsy. Most (85%–90%) born with cCMV are asymptomatic and thus are usually undiagnosed. However, asymptomatic cCMV may contribute more to the overall public health burden of the disease than symptomatic disease on the basis of the differences in overall incidence.7 In addition to congenital and later-onset hearing loss and auditory processing disorders,8–12 clinicians should now consider gaze, vestibular, and balance disorders may occur in children with asymptomatic cCMV.1Much work is going on to evaluate strategies for newborn screening for cCMV and to evaluate treatment strategies for infants detected with cCMV.13–16 The study by Pinninti et al1 suggests that gaze, balance, and vestibular disorders should be included as key outcomes of clinical research.17,18 Ultimately, the hope is that early cCMV detection can treat or even prevent the many now recognized outcomes of this common congenital infection.