La gestione neonatologica dell'infezione congenita da citomegalovirus

Cytomegalovirus (CMV) is the leading cause of congenital infection in humans, affecting 0.2-2% of all live births, and thus constitutes a major public health problem. Congenitally infected infants, both symptomatic and asymptomatic at birth, may develop sequelae, especially sensorineural hearing loss and brain damage. The virus can be transmitted to the fetus following either a primary or a non-primary maternal infection during pregnancy. Even though the transmission rate is much higher in primary infected mothers than in mothers with preconceptional immunity, routine CMV screening of pregnant women is not recommended today because no consensus exists on prenatal treatment options. Intravenous ganciclovir or oral valganciclovir are used to treat neonates with symptoms at birth. Valganciclovir treatment for six months is recommended for congenitally infected neonates with moderately to severely symptomatic disease. All infants with congenital CMV infection, both symptomatic and asymptomatic at birth, need a followup evaluation to detect sequelae as early as possible, so that infants can receive intervention promptly. For several years, a universal newborn screening for congenital CMV infection has been suggested by many Authors, inasmuch it would allow us to detect sequelae promptly even in neonates asymptomatic at birth born to women with non-primary infection in pregnancy. A real-time PCR assay of saliva specimens seems to offer the best characteristics for use in screening. Large-scale studies to evaluate the cost/benefit ratio of a universal newborn screening for congenital CMV infection are needed to further reduce the burden of congenital CMV infection.