Neonatal screening for congenital cytomegalovirus infections

We evaluated a screening program for the detection of congenital cytomegalovirus
in 3075 unselected pregnant women. From each live-born child urine for CMV
culture was collected within 7 days after birth. Each fetus expelled after a
spontaneous second trimester abortion and each stillborn infant were also
evaluated for a possible congenital CMV infection. For each congenital infection
stored maternal sera were analysed to determine whether maternal infection was
primary or recurrent. Fifteen out of the 3075 pregnancies studied resulted in a
congenitally infected infant (0.49%). Nine maternal CMV infections were primary
infections; five were recurrent infections, and in one case the type of infection
could not be determined. Three congenital infections resulted in severe sequelae,
leading to the termination of pregnancy in two instances and to neonatal death in
one case. One of these severe fetal infections was due to a recurrent maternal
infection. Follow-up of the other 12 neonates demonstrated hearing disorders in
two children. One was born after a primary maternal infection and one after a
recurrent maternal infection. We conclude that congenital CMV infections occurs
in 0.49% of all pregnancies in the population studied. Twenty percent of the
congenitally infected infants present severe sequelae at birth or during
pregnancy, and an additional 17% have audiological deficits at 1 year of age.
Severe sequelae may occur after both primary and recurrent maternal CMV
infection.