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Practice Clinical Updates

Congenital cytomegalovirus infection

BMJ 2021; 373 doi: (Published 03 June 2021) Cite this as: BMJ 2021;373:n1212
  1. Megan H Pesch, assistant professor1,
  2. Katie Kuboushek, audiologist2,
  3. Michael M McKee, associate professor3,
  4. Marc C Thorne, associate chair2,
  5. Jason B Weinberg, associate professor4
  1. 1Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Michigan, Ann Arbor, MI, USA
  2. 2Department of Otolaryngology and Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, MI, USA
  3. 3Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
  4. 4Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
  1. Correspondence to M H Pesch pesch{at}

What you need to know

  • Congenital cytomegalovirus (cCMV) is common, occurring in one in every 100-200 live births

  • The mainstay of prevention is prenatal education about behaviour change to reduce contact with saliva and urine of young children who may be shedding CMV

  • cCMV most often presents with no visible signs at birth, yet infected infants are at increased risk for sensorineural hearing loss in childhood

  • cCMV can be diagnosed shortly after birth using polymerase chain reaction to detect viral DNA in urine or saliva, or later in life by testing residual newborn dried blood spot (Guthrie card)

  • All children with cCMV require close monitoring of their hearing and development

Congenital cytomegalovirus (cCMV) infection is a common congenital infection, affecting one in every 100-200 live births globally.1 Long term neurodevelopmental sequelae occur in a quarter of children affected. This article provides a clinical update of the literature on the prevention, diagnosis, treatment, and anticipatory management of infants and children with cCMV. Recommendations from the 2015 European Society of Paediatric Infectious Diseases (ESPID) Expert Consensus Group (largely based on expert opinion) are presented along with more recent literature relevant to the general practitioner.2

What is congenital cytomegalovirus infection?

Cytomegalovirus (CMV) can cause self-limited generalised symptoms such as fatigue and lymphadenopathy in most healthy individuals, including pregnant people.3 cCMV infection occurs when CMV transplacentally infects a developing fetus. The virus can cause damage to the placenta, and replicate in fetal central nervous system (CNS) cells, which may result in disrupted fetal development, miscarriage, or intrauterine fetal demise.4 Neonates with cCMV may experience a wide range of signs, symptoms, and long term sequelae (fig 1), although most experience no recognisable signs or symptoms.3

Fig 1

Expected incidence of disease manifestations and developmental outcomes of infants with congenital cytomegalovirus demonstrated in 1000 hypothetical infants born with congenital cytomegalovirus

Neonates born with …

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