title: Fetal manifestations and poor outcomes of congenital cytomegalovirus infections: possible candidates for intrauterine antiviral treatments.
abstract: OBJECTIVE
  This retrospective study was performed to reveal the natural history of cytomegalovirus (CMV) infected fetuses during the perinatal period and to find prenatal findings associated with poor outcomes.
  
  
  METHODS
  33 neonates with CMV infection, born after 30 weeks of gestation, were registered from a total of 12 414 infants between 1995 and 2003. Maternal and neonatal medical records were reviewed regarding fetal growth; abdominal signs including ascites and hepatosplenomegaly; cerebral signs including ventriculomegaly, microcephaly, and calcification; and fetal heart rate monitoring, for signs which may have been detected by the standard obstetric ultrasonography. Univariate and multivariate analyses were performed to test for any associations between these manifestations and poor outcomes such as death and neurological damages.
  
  
  RESULTS
  Among the 33 infants, 6 died, 10 developed neurological damage including cerebral palsy (n = 8), epilepsy (n = 5), and hearing difficulties (n = 5), and the remaining 17 were normal. After adjusting for ganciclovir treatment and gender, death was 40-fold more likely associated with infants having abdominal signs (OR 40, 95%CI 4.6-930) than those without abdominal signs. Similarly, poor outcomes (death or neurological damage) were more likely associated with infants having either abdominal or cerebral signs (OR 39, 95%CI 3.8-1323). Fetal growth restriction and non-reassuring fetal heart rate patterns were not significantly associated with poor outcomes.
  
  
  CONCLUSIONS
  The absence of abdominal signs guarantees the infant's survival. The presence of abdominal or cerebral signs is associated with poor outcomes, suggesting that these fetuses are possible candidates to receive in-utero therapy of congenital CMV infection.
authors.affiliation: Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sameshima
authors.forename: Masato
authors.initials: M
authors.lastname: Kamitomo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ibara
authors.forename: Masatoki
authors.initials: M
authors.lastname: Kaneko
authors.forename: Tsuyomu
authors.initials: T
authors.lastname: Ikenoue
authors.forename: Toshio
authors.initials: T
authors.lastname: Minematsu
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Eizuru
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000254:growth & development*; D003586:Cytomegalovirus Infections / Q000151:congenital* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir