Congenital Cytomegalovirus Among Children With Cerebral Palsy

Congenital cytomegalovirus (cCMV) infection is estimated to affect approximately 0.7% of newborn infants, although only approximately 10% to 15% of these show signs of infection at birth. Infected infants face a heightened risk of permanent neurodevelopmental disability, including cerebral palsy (CP). There are limited data describing the prevalence and epidemiology of CP associated with cCMV, and thus it is important to define the role of cCMVas a risk factor for CP. The purpose of this study was 2-fold; first to find the proportion of children with CP and CMV DNA (detected retrospectively in their newborn screening cards [NBSCs]) compared with the proportion of children with CMV DNA in their NBSC across CP spastic subtypes; second, to compare the sex and other characteristics of children with CP and CMV detected on their NSBC with those where CMV DNA had not been detected. For the purpose of this comparative evaluation, data were extracted from patient records on children with CP from 2 Australian state CP registers and statewide pediatric rehabilitation services. The birth years for which data were extracted were 1996 to 2014. From the selected cases, NBSCs were retrospectively analyzed for CMVDNA by nested polymerase chain reaction (PCR) using primers against gB, and all positive samples were validated by using real-time PCR for CMV UL83. Of the 401 recruited individuals with CP, it was found that 323 had an available NBSC. Of these, 31 tested positive for CMV DNA (cCMV-positive cases) in NBSC by nested PCR for CMV gB, and 28 of these had CMV DNA also detected by real-time PCR for CMV UL83. In all, 9.6% (95% confidence interval, 6.8%-13.3%) of children with CP had CMV DNA in their NBSC, confirming congenital CMV (cCMV) infection; this rate is significantly higher than the proportion of unselected children with CMVdetected in the general population in the same period (similar to 0.6%). The authors further determined that CMV DNA positivity was significantly associated with epilepsy, although not with other clinical or epidemiologic characteristics. In conclusion, cCMV infection manifesting as CMV viremia in the newborn period is relatively common among children with CP. More studies are needed to confirm the association of cCMV with CP, as well as to better understand the mechanisms.