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Literature Reviews: Pediatric Nephrology

CMV infection, the most common intrauterine infection in newborns, affects about 1% of all infants. Only 10% become symptomatic at birth. Early intrauterine infection results in severe neurologic sequelae with microcephaly, severe cognitive and motor impairment, and hearing loss. Neuroimaging shows migrational disorders, disturbed myelination, discrete periventricular calcifications, and cerebellar hypoplasia. CMV infection acquired late in pregnancy may have less prominent clinical and neuroimaging findings. This report describes the clinical and neuroimaging features of seven infants documented to have late-pregnancy-acquired CMV infections. Only one of the seven had already been shown to have CMV infection at the time of evaluation. Two had signs or symptoms as a newborn; one had hepatosplenomegaly and jaundice and one was a smallfor-gestational-age infant with thrombocytopenia. All had head size at (2) or below (5), the third percentile. Three were ataxic and three were hypotonic, two of whom were clumsy as well. All had decreased hearing either bilaterally (6) or unilaterally (1) and four of the six were hyperactive as well as autistic. Five of the seven were felt to have decreased pain sensation. The neuroimaging studies showed abnormal calcification in four of the infants on computed tomography (CT) scans. Magnetic resonance imaging (MRI) features included patchy diffuse or confluent myelination problems in all infants. Only two of the infants had any identifiable involvement of the cerebellum.