title: Congenital cytomegalovirus is associated with severe forms of cerebral palsy and female sex in a retrospective population-based study.
abstract: OBJECTIVE
  Congenital cytomegalovirus (cCMV) infection can result in poor outcomes including cerebral palsy (CP). The aim of this study was to describe the incidence and comorbidities of CP reported to the Australian Cerebral Palsy Register (ACPR) as attributed to cCMV infection.
  
  
  METHODS
  This was a retrospective population-based study. Cases were drawn from Australian state CP registers with population level ascertainment, 1993 to 2003 (n=2265; 56.4% males, Gross Motor Function Classification System [GMFCS] ratings available for Victorian cases only: 70% GMFCS levels I to III and 30% GMFCS levels IV to V). Clinical data were extracted and cases with cCMV reported as a known cause were compared with cases where cCMV was not reported.
  
  
  RESULTS
  Children with cCMV (n=34; 12 males, 22 females; mean [SD] gestational age, 36.4 wk [4.4], range 24-41 wk) accounted for 1.5% of CP cases; 2.9 per 100,000 live births, (95% confidence intervals 1.9-3.9). When compared with CP cases where cCMV was not reported, proportionally, more CP cases with cCMV were born to younger mothers (p<0.001), were female (64% vs 43%, p=0.014), had spastic quadriplegia (73% vs 21%, p<0.001), required wheeled mobility i.e. GMFCS IV or V (78% vs 28%, p<0.001), had epilepsy (70% vs 30%, p<0.001), deafness (40% vs 2%, p<0.001), functional blindness (20% vs 5%, p<0.001), and severe communication impairment (71% vs 25%, p<0.001).
  
  
  CONCLUSIONS
  cCMV is an important potentially preventable cause of CP and is associated with severe disability and female sex in cases reported to the ACPR. Future studies utilising prospective sample collection for cCMV testing are needed to confirm these findings.
authors.affiliation: Discipline of Paediatrics & Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Centre for Perinatal Infection Research or Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia; Cerebral Palsy Alliance Research Institute, University of Notre Dame Australia, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Hayley
authors.initials: H
authors.lastname: Smithers-Sheedy
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
authors.forename: Nadia
authors.initials: N
authors.lastname: Badawi
authors.forename: Sarah
authors.initials: S
authors.lastname: McIntyre
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Jones
mesh_terms: D001315:Australia / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors