The prognostic potential of fetal platelet count and viral load in prenatal cytomegalovirus infection: A retrospective cohort of 74 cases.

BACKGROUND

Congenital cytomegalovirus (CMV) infection is the most common congenital infection and a leading cause of childhood deafness and neurological impairment. Prenatal prognosis depends on gestational age at maternal infection, infection type, fetal brain imaging (ultrasound and MRI), and fetal blood markers such as viral load (VL) and platelet (plt) count.

OBJECTIVES

We aimed to evaluate the prognostic value of two fetal blood markers - CMV VL and plt count - for fetal, neonatal, and long-term outcomes.

STUDY

DESIGN

This retrospective cohort study included 74 cases of cordocentesis performed between 2001 and 2021 at CUB-Hôpital Erasme and CHIREC hospitals in Brussels.

RESULTS

Of the 74 infections, 52 occurred in the first trimester, 20 in the second and 2 in the third. Twenty-one pregnancies were terminated (19 first trimester, 2 s trimester). Severe brain abnormalities on antenatal imaging were significantly associated with being symptomatic at birth (OR 24.5; CI 2.69 - 223.34; p = 0.01) and during follow-up (OR 30.75; CI 4.59 - 205.86; p = 0,00). A fetal platelet count below 100.000/mm³ increased the risk of severe cerebral lesions (OR 2.59; CI 1.09 - 14.28; p = 0.04), but neither VL nor plt count alone correlated significantly with clinical symptoms at birth or later. The positive predictive value for being symptomatic at birth increased from 87.5 % to 100 % when severe imaging abnormalities were combined with VL ≥ 50.000 copies/ml and a plt count < 100.000/mm³ .

CONCLUSION

In our study, cordocentesis assessing VL and plt count appears to provide limited additional prognostic information beyond severe antenatal brain imaging in fetuses with congenital CMV infection.