title: Surveillance of congenital cytomegalovirus in the UK and Ireland.
abstract: OBJECTIVE
  To explore the presentation and management of congenital cytomegalovirus (CMV) identified through routine clinical investigations, and ascertain outcome in early childhood.
  
  
  METHODS
  Active population-based surveillance.
  
  
  METHODS
  UK and Ireland.
  
  
  METHODS
  Infants born in 2001-2002 with confirmed or suspected congenital CMV infection were reported through the British Paediatric Surveillance Unit, and clinicians completed questionnaires on presentation, diagnosis, management and subsequent outcome.
  
  
  RESULTS
  86 confirmed and 70 possible cases of congenital CMV infection were reported. Over a third (27/72) of singleton infants with confirmed and 44% (27/61) with possible congenital infection were preterm (<37 weeks gestation). Among confirmed cases, 75% (64/85) presented with neonatal manifestations compatible with congenital CMV, over half (34/64) of whom had neurological signs; 17 infants were treated with gancyclovir. Among confirmed cases with information on outcome, 31% (24/78) were developing normally, 18% (14/78) had mild, 24% (19/78) moderate and 14% (11/78) severe sequelae, and 13% (10/78) had died. Median age at follow-up among survivors was 18 months (IQR 15-22 months). Children with neonatal CMV manifestations were significantly more likely than those without to have moderate or severe outcomes (including death) (60%, 36/60, vs 22%, 4/18, p=0.001). 27% of survivors (17/63) had bilateral hearing loss.
  
  
  CONCLUSIONS
  The number of confirmed cases of diagnosed congenital CMV reported in this study was lower than expected, highlighting the need for early and appropriate investigations when congenital infection is suspected. Due to the unexpectedly high proportion of preterm infants, resulting from differential case ascertainment, it was difficult to distinguish prematurity and CMV-related symptoms.
authors.affiliation: MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. c.townsend@ich.ucl.ac.uk
authors.forename: Claire L
authors.initials: CL
authors.lastname: Townsend
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Peckham
authors.forename: Pat A
authors.initials: PA
authors.lastname: Tookey
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002658:Developmental Disabilities / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D005865:Gestational Age; D006312:Hearing Loss, Bilateral / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir