Brain Abnormalities, Neurodevelopmental Milestones, and Long-term Follow-up in Newborns With Congenital Cytomegalovirus Identified Through a Neonatal Screening Program

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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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