Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection.
OBJECTIVE
To determine the ability of neonatal clinical, audiologic, and computed tomography (CT) findings to predict long-term neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection.


METHODS
Longitudinal cohort study of children (n = 41) with symptomatic congenital CMV infection evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. The performance of birth characteristics as predictors of long-term outcome were determined, and clinical and CT scoring systems were developed and correlated with intellectual outcome.


RESULTS
Microcephaly was the most specific predictor of mental retardation (100%; 95% CI 84.5-100) and major motor disability (92.3%; 95% CI 74.8-99). An abnormality detected by CT was the most sensitive predictor for mental retardation (100%; 95% CI 82.3-100) and motor disability (100%; 95% CI 78.2-100). A highly significant (P <.001) positive correlation was found between head size at birth and the intelligence/developmental quotient (IQ/DQ). Approximately 29% of children had an IQ/DQ >90. There was no association between sensorineural hearing loss at birth and cognitive outcome. However, children with sensorineural hearing loss on follow-up (congenital and late-onset) had a lower IQ/DQ (P =.006) than those with normal hearing.


CONCLUSIONS
The presence of microcephaly at birth was the most specific predictor of poor cognitive outcome in children with symptomatic congenital CMV infection, whereas children with normal findings on head CT and head circumference proportional to weight exhibited a good cognitive outcome.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
D E
DE
Noyola
G J
GJ
Demmler
C T
CT
Nelson
C
C
Griesser
W D
WD
Williamson
J T
JT
Atkins
J
J
Rozelle
M
M
Turcich
A M
AM
Llorente
S
S
Sellers-Vinson
A
A
Reynolds
J F
JF
Bale
P
P
Gerson
M D
MD
Yow
D002547:Cerebral Palsy / Q000175:diagnosis / Q000821:virology; D002825:Chorioretinitis / Q000175:diagnosis / Q000821:virology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital*; D002658:Developmental Disabilities / Q000175:diagnosis / Q000821:virology*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000175:diagnosis / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D008831:Microcephaly / Q000175:diagnosis / Q000821:virology; D009422:Nervous System Diseases / Q000175:diagnosis / Q000821:virology*; D009460:Neurologic Examination; D011379:Prognosis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed