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


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.
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Kosuke
K
Nishida
Department of Pediatrics, Kobe University Hospital, Kobe, Japan. Electronic address: ichim@med.kobe-u.ac.jp.
Ichiro
I
Morioka
Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan.
Yuji
Y
Nakamachi
Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan.
Yoko
Y
Kobayashi
Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan.
Takamitsu
T
Imanishi
Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan.
Seiji
S
Kawano
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Sota
S
Iwatani
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Tsubasa
T
Koda
Department of Obstetrics and Gynecology, Kobe University Hospital, Kobe, Japan.
Masashi
M
Deguchi
Department of Obstetrics and Gynecology, Kobe University Hospital, Kobe, Japan.
Kenji
K
Tanimura
Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan.
Daisuke
D
Yamashita
Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan.
Ken-Ichi
K
Nibu
Department of Obstetrics, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Toru
T
Funakoshi
Nadeshiko Ladies Hospital, Kobe, Japan.
Masanobu
M
Ohashi
Department of Microbiology and Immunology, Gifu Pharmaceutical University, Gifu, Japan.
Naoki
N
Inoue
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Kazumoto
K
Iijima
Department of Obstetrics and Gynecology, Kobe University Hospital, Kobe, Japan.
Hideto
H
Yamada
D000998:Antiviral Agents / Q000627:therapeutic use / Q000652:urine; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000652:urine*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn / Q000652:urine; D007564:Japan; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
Hospital-based study; Japanese cohort; Neurological impairment; Newborn urine screening; Valganciclovir