Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment

Abstract Background Newborn screening for urinary cytomegalovirus (CMV) and early introduction of antiviral treatment are expected to improve neurological outcomes in symptomatic congenital CMV-infected infants. This cohort study prospectively evaluated neurological outcomes in symptomatic congenita...

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Published in:Brain & development (Tokyo. 1979) 2016-02, Vol.38 (2), p.209-216
Main Authors: Nishida, Kosuke, Morioka, Ichiro, Nakamachi, Yuji, Kobayashi, Yoko, Imanishi, Takamitsu, Kawano, Seiji, Iwatani, Sota, Koda, Tsubasa, Deguchi, Masashi, Tanimura, Kenji, Yamashita, Daisuke, Nibu, Ken-ichi, Funakoshi, Toru, Ohashi, Masanobu, Inoue, Naoki, Iijima, Kazumoto, Yamada, Hideto
Format: Article
Language:English
Subjects:
Antiviral Agents - therapeutic use
Antiviral Agents - urine
Cohort Studies
Cytomegalovirus - genetics
Cytomegalovirus Infections - diagnosis
Cytomegalovirus Infections - drug therapy
Cytomegalovirus Infections - urine
Female
Ganciclovir - analogs & derivatives
Ganciclovir - therapeutic use
Hospital-based study
Humans
Infant, Newborn - urine
Japan
Japanese cohort
Male
Neonatal Screening - methods
Neurological impairment
Neurology
Newborn urine screening
Polymerase Chain Reaction
Treatment Outcome
Valganciclovir
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Summary:Abstract Background Newborn screening for urinary cytomegalovirus (CMV) and early introduction of antiviral treatment are expected to improve neurological outcomes in symptomatic congenital CMV-infected infants. This cohort study prospectively evaluated neurological outcomes in symptomatic congenital CMV-infected infants following the introduction of hospital-based newborn urinary CMV screening and antiviral treatment. Subjects/methods Following institutional review board approval and written informed consent from their parents, newborns were prospectively screened from 2009 to 2014 for urinary CMV-DNA by PCR within 1 week after birth at Kobe University Hospital and affiliated hospitals. CMV-positive newborns were further examined at Kobe University Hospital, and those diagnosed as symptomatic were treated with valganciclovir for 6 weeks plus immunoglobulin. Clinical neurological outcomes were evaluated at age ⩾12 months and categorized by the presence and severity of neurologic sequelae. Results Urine samples of 6348 newborns were screened, with 32 (0.50%) positive for CMV. Of these, 16 were diagnosed with symptomatic infection and 12 received antiviral treatment. Four infants developed severe impairment (33%), three developed mild impairment (25%), and five developed normally (42%). Conclusions This is the first Japanese report of neurological assessments in infants with symptomatic congenital CMV infection who received early diagnosis and antiviral treatment. Urinary screening, resulting in early diagnosis and treatment, may yield better neurological outcomes in symptomatic congenital CMV-infected infants.
ISSN:0387-7604
1872-7131
DOI:10.1016/j.braindev.2015.08.003