Cranial ultrasound scanning significantly predicted developmental outcomes in symptomatic newborns with cytomegalovirus, based on a study of 57 infants reported in the February issue of the Journal of Pediatrics.
To determine how well cranial ultrasound predicted clinical outcomes, two of the researchers reviewed the scans of the infants while blinded to the results (J. Pediatr. 2007;150:157–61). The ultrasound scans were taken during the first week of life and repeated weekly for the first month in cases of abnormal findings, and then repeated monthly until the infants were 6 months old.
Overall, 18 newborns had clinical and laboratory signs of cytomegalovirus (CMV) at birth, and 39 had no observable symptoms at birth. A total of 12 of the 57 (21%) infants had brain abnormalities that were visible on an ultrasound image. Ultrasound lesions were found in 10 of 18 (56%) newborns with clinical and laboratory symptoms, compared with 2 of 39 (5%) asymptomatic newborns.
None of the infants with normal ultrasound findings at birth had developed lesions at follow-up evaluations, and the negative predictive value of the ultrasound was 100% for motor delay and low developmental quotient and 93.3% for sensorineural hearing loss, Dr. Gina Ancora of the University of Bologna (Italy) and her colleagues wrote.
Data from evaluations at 12 months of age were available for 56 of 57 patients; one infant with visible ultrasound lesions had died of aortic thrombosis. Ten of the 11 remaining symptomatic newborns with abnormal ultrasound findings at birth developed at least one sequela, whereas none of the 8 newborns who were symptomatic but had normal ultrasound findings developed sequelae.
Similarly, only 3 of the 37 asymptomatic infants with no ultrasound abnormalities had poor outcomes at 12 months (sensorineural hearing loss), and 1 of 2 asymptomatic infants with abnormal ultrasound findings developed severe sequelae.
The presence of CMV symptoms at birth may not be enough to differentiate between children who will and will not develop lesions later, and ultrasound is a safe and easy diagnostic tool in this population, even for children in critical condition, the researchers wrote.
But the data were insufficient to make recommendations for ultrasound imaging in asymptomatic children, they said.