From the Journals

Intellectual impairment seems not a risk of asymptomatic cCMV

Publish date: October 24, 2017
By
Erin Cheslow

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Bridging the gaps in CMV knowledge

Congenital cytomegalovirus (cCMV) infection is a leading nongenetic cause of hearing loss and neurodevelopmental disability, with the number of infants experiencing these symptoms approaching that of those with Down Syndrome and exceeding that of those with fetal alcohol syndrome, spina bifida, and childhood infections such as HIV. Most infected infants are asymptomatic, and the majority are not recognized at birth.

Yet little is known about intellectual outcomes and academic performance in these children. Lopez et al. provide encouraging findings and new insights that begin to bridge this gap in knowledge about children with asymptomatic cCMV up into adolescence.

There were some challenges in this study, including the large percentage of children whose mothers have medium to high socioeconomic status and the selection of appropriate controls. Although the controls were born within 6 days of the infants with cCMV, they were not matched for other demographic factors. It will be important to confirm these findings in children with families of lower socioeconomic status.

That said, this study is helpful in defining the disease burden from this common prenatal infection and in reassuring patients and doctors that these infants are not at increased risk for disabilities in terms of intellectual attainment and academic performance.

Suresh B. Boppana, MD, is a professor of pediatrics and microbiology, and Karen B. Fowler, DrPH, is a professor of epidemiology. Both practice at the University of Alabama in Birmingham. These remarks accompanied the Lopez et al. article (Pediatrics. 2017. doi: 10.1542/peds.2017-2526). Neither author reported any financial disclosures.


 

FROM PEDIATRICS

Infants with congenital cytomegalovirus (cCMV) who were asymptomatic at birth with normal hearing by age 2 years were not at higher risk of intellectual impairment or low academic achievement, compared with controls, but patients with sensorineural hearing loss may experience more difficulty, according to a longitudinal study.

Full-scale intelligence, language, and academic achievement was evaluated in 78 adolescents with cCMV and normal hearing, 11 with cCMV and sensorineural hearing loss (SNHL) by age 2 years, and 40 controls. Mean full-scale intelligence scores did not vary among the patients with normal hearing and the controls, said Adriana S. Lopez of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, and her coauthors. Each group scored a mean 108 (95% confidence interval, 105-110 and 104-111, respectively) at age 5 years and 111 (95% CI, 108-114 and 107-104, respectively) at age 18 years (P = .96). The scores of the patients with SNHL, however, were 7 points lower at both times (P less than .05).

Cytomegalovirus (CMV) particles glowing through the use of an immunofluorescent technique, magnified at 25X. CDC/Craig Lyerla

Cytomegalovirus (CMV) particles glowing through the use of an immunofluorescent technique, magnified at 25X.

Similarly, the investigators reported that the difference in receptive vocabulary scores between cCMV patients with normal hearing and controls was not statistically significant (P = .36), but patients with SNHL scored 13 points lower than the controls (P less than .05).

In the other categories (expressive vocabulary and academic achievement in math and reading), the differences between the three groups were not statistically significant (P less than .05 for all three categories), suggesting that the other scores may underestimate the full intellectual potential of cCMV patients with SNHL, according to the researchers (Pediatrics. 2017. doi: 10.1542/peds.2017-1517).

“Findings from our study suggest that the majority of children [with cCMV] that would be identified by newborn screening do not appear to be at increased risk of intellectual impairment and, therefore, may not need long-term monitoring for cognitive impairment and/or disabilities,” Dr. Lopez and her coauthors wrote. “This information could provide reassurance to parents.”

“Further studies are needed to better understand the impact of asymptomatic congenital CMV infection on behavior and specific cognitive domains such as attention, perception, and memory,” they concluded.

The study was funded by the National Institutes of Health and was supported in other ways by a number of other organizations. Dr. Lopez and her coauthors reported no financial disclosures.

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