Clinical Implications for Children Born With Congenital Cytomegalovirus Infection Following a Negative Amniocentesis.
Recently, congenital cytomegalovirus (cCMV) infection was reported irrespective of a negative amniotic fluid prenatal analysis for cytomegalovirus (CMV). The question of whether this phenomenon represents low sensitivity of the test or late development of fetal infection (after amniocentesis) was discussed, but not answered. However, if late transmission is the rule, then infants born with cCMV after negative amniocentesis would be expected to carry better prognosis than those who tested positive.



Data of all infants with cCMV infection, followed in 2 pediatric centers from 2006 to 2015, were reviewed. Infant outcome after birth of symptomatic vs asymptomatic disease was compared with infants born after a negative amniocentesis (study group) and those with a positive amniocentesis (control group).



Amniocentesis was performed in 301 pregnancies of our cohort of infants with cCMV and was negative for CMV in 47 (15.6%). There were fewer symptomatic cCMV neonates in the study group than in the control group (4.3% vs 25%; P < .001). Hearing impairment at birth was also less frequent in the study group (2.2% vs 17.4%; P = .012). None of the children in the study group had neurologic sequelae at long-term follow up, compared with 13 (14.1%) in the control group (P < .001).



Although negative amniocentesis does not exclude cCMV, infants with cCMV born after a negative amniocentesis seldom present with mild clinical symptoms or cerebral ultrasound features at birth. These children also have a very good long-term outcome. Our findings support the theory of a late development of fetal infection, after the time of the amniocentesis.
Department of Pediatrics C, Schneider Children's Medical Center, Petah Tiqva Sackler Faculty of Medicine, Tel Aviv University.
Efraim
E
Bilavsky
Sackler Faculty of Medicine, Tel Aviv University Department of Gynecology and Obstetrics, Rabin Medical Center, Beilinson Hospital.
Joseph
J
Pardo
Institute of Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Petah Tiqva Department of Communication Sciences and Disorders, University of Haifa.
Joseph
J
Attias
Sackler Faculty of Medicine, Tel Aviv University Infectious Diseases Unit, Schneider Children's Medical Center, Petah Tiqva, Israel.
Itzhak
I
Levy
University Paris Descartes, EA 73-28, Sorbonne Paris Cité Neonatal Intensive Care Unit, Hospital Necker-Enfants Malades.
Jean-François
JF
Magny
University Paris Descartes, EA 73-28, Sorbonne Paris Cité Department of Obstetrics and Fetal Medicine, Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP).
Yves
Y
Ville
University Paris Descartes, EA 73-28, Sorbonne Paris Cité Laboratory of Clinical Microbiology, Hospital Necker-Enfants Malades, National Reference Center for Cytomegalovirus-Associated Laboratory, AP-HP, Paris, France.
Marianne
M
Leruez-Ville
Department of Pediatrics C, Schneider Children's Medical Center, Petah Tiqva Sackler Faculty of Medicine, Tel Aviv University.
Jacob
J
Amir
D000649:Amniocentesis / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies
amniocentesis; congenital cytomegalovirus; congenital infection; cytomegalovirus; pregnancy