The Pediatric infectious disease journal · 2026
Epidemiology, Early Therapy and Sequelae Predictors in Congenital CMV: A Nationwide Cohort Study.
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Gualtieri Renato, Tzani Aimilia, Papis Sebastien, Cao Van Hélène, Jaboyedoff Manon, Fougère Yves, Giannoni Eric, Ballester Marie, Zemmouri Abdelaziz, Russo Michael, Buettcher Michael, Kottanattu Lisa, Zimmermann Petra, Pittet Laure F, Posfay-Barbe Klara M, L'Huillier Arnaud G
Аннотация
BACKGROUND: Congenital cytomegalovirus (cCMV) is the most common congenital infection, with approximately 17%-20% of infected neonates developing permanent sequelae. Early risk stratification remains challenging yet crucial for therapeutic decision-making. We aimed to characterize national epidemiology, identify early predictors of sequelae, and assess the impact of early antiviral treatment on outcomes in infants with cCMV.
METHODS: We conducted a nationwide prospective observational study between 2017 and 2024, analyzing birth and 1-year follow-up data of infants with confirmed cCMV in Switzerland.
RESULTS: Two hundred and nine cCMV-infected children were included. The most common findings at birth were microcephaly (35%), intrauterine growth restriction (34%) and neuroimaging abnormalities (36%). Antiviral treatment was administered to 36% (75/209) of patients, among whom 75% (56/75) had treatment initiation within the first month of life. Multivariate analysis identified hepatosplenomegaly (odds ratio 13.2, 95% confidence interval, 2.3-75.2) and hypotonia at birth (odds ratio 6.6, 95% confidence interval, 1.1-41.1) as independent predictors of late-onset sensorineural hearing loss (SNHL). At the 1-year follow-up assessment, early treatment initiation was associated with significantly lower rates of neurodevelopmental disorders compared with delayed treatment initiation (23% vs. 50%, P = 0.004).
CONCLUSIONS: This Swiss nationwide study confirms the previously reported association between hepatosplenomegaly at birth and late-onset SNHL and identifies hypotonia as a new independent predictor of late-onset SNHL. The data also confirm the crucial role of early antiviral treatment, particularly for neurodevelopmental disorders, emphasizing the importance of prompt cCMV diagnosis and treatment when indicated.
METHODS: We conducted a nationwide prospective observational study between 2017 and 2024, analyzing birth and 1-year follow-up data of infants with confirmed cCMV in Switzerland.
RESULTS: Two hundred and nine cCMV-infected children were included. The most common findings at birth were microcephaly (35%), intrauterine growth restriction (34%) and neuroimaging abnormalities (36%). Antiviral treatment was administered to 36% (75/209) of patients, among whom 75% (56/75) had treatment initiation within the first month of life. Multivariate analysis identified hepatosplenomegaly (odds ratio 13.2, 95% confidence interval, 2.3-75.2) and hypotonia at birth (odds ratio 6.6, 95% confidence interval, 1.1-41.1) as independent predictors of late-onset sensorineural hearing loss (SNHL). At the 1-year follow-up assessment, early treatment initiation was associated with significantly lower rates of neurodevelopmental disorders compared with delayed treatment initiation (23% vs. 50%, P = 0.004).
CONCLUSIONS: This Swiss nationwide study confirms the previously reported association between hepatosplenomegaly at birth and late-onset SNHL and identifies hypotonia as a new independent predictor of late-onset SNHL. The data also confirm the crucial role of early antiviral treatment, particularly for neurodevelopmental disorders, emphasizing the importance of prompt cCMV diagnosis and treatment when indicated.