ABSTRACT
OBJECTIVE: To determine the ability of neonatal clinical, audiologic, and computed tomography (CT) findings to predict long-term neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection. METHODS: Longitudinal cohort study of children (n = 41) with symptomatic congenital CMV infection evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. The performance of birth characteristics as predictors of long-term outcome were determined, and clinical and CT scoring systems were developed and correlated with intellectual outcome. RESULTS: Microcephaly was the most specific predictor of mental retardation (100%; 95% CI 84.5-100) and major motor disability (92.3%; 95% CI 74.8-99). An abnormality detected by CT was the most sensitive predictor for mental retardation (100%; 95% CI 82.3-100) and motor disability (100%; 95% CI 78.2-100). A highly significant (P <.001) positive correlation was found between head size at birth and the intelligence/developmental quotient (IQ/DQ). Approximately 29% of children had an IQ/DQ >90. There was no association between sensorineural hearing loss at birth and cognitive outcome. However, children with sensorineural hearing loss on follow-up (congenital and late-onset) had a lower IQ/DQ (P =.006) than those with normal hearing. CONCLUSIONS: The presence of microcephaly at birth was the most specific predictor of poor cognitive outcome in children with symptomatic congenital CMV infection, whereas children with normal findings on head CT and head circumference proportional to weight exhibited a good cognitive outcome.
Subject(s)
Cytomegalovirus Infections/congenital , Developmental Disabilities/virology , Nervous System Diseases/virology , Cerebral Palsy/diagnosis , Cerebral Palsy/virology , Chorioretinitis/diagnosis , Chorioretinitis/virology , Cytomegalovirus Infections/complications , Developmental Disabilities/diagnosis , Female , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/virology , Humans , Infant, Newborn , Intellectual Disability/diagnosis , Intellectual Disability/virology , Longitudinal Studies , Male , Microcephaly/diagnosis , Microcephaly/virology , Nervous System Diseases/diagnosis , Neurologic Examination , Prognosis , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
A preterm breast-fed infant had three episodes of type Ia/c group B streptococcus septicemia. After the second episode rifampin was given to the infant, but further Ia/c exposure to maternal breast milk ensued. We propose rifampin treatment for both the mother and infant in cases of recurrent group B streptococcus disease.
Subject(s)
Leprostatic Agents/therapeutic use , Milk, Human/microbiology , Rifampin/therapeutic use , Streptococcal Infections/drug therapy , Streptococcus agalactiae/isolation & purification , Breast Feeding , Electrophoresis, Gel, Pulsed-Field , Female , Humans , Infant, Newborn , RecurrenceABSTRACT
To determine the diagnostic value of the polymerase chain reaction (PCR) in establishing the rapid diagnosis of herpes simplex virus encephalitis (HSE) in the pediatric age group, we performed PCR to detect herpes simplex virus (HSV) in the cerebrospinal fluid of 8 neonates with HSV infection (4 with central nervous system involvement), 11 infants and children with suspected HSE (4 proved, 1 presumed, 6 excluded), and 105 control patients who had cerebrospinal fluid obtained as part of the evaluation for other diagnoses. The HSV DNA was amplified and typed by using primers specific for the DNA polymerase gene of HSV types 1 and 2. Herpes simplex virus DNA was detected in the cerebrospinal fluid of 3 of 4 neonates with CNS involvement (all with HSV type 2) and 3 of the 4 patients with proved HSE (all with HSV type 1). No HSV DNA was detected in the 4 neonates without CNS disease, the 1 patient with presumed HSE, the 6 patients who had HSE excluded from the diagnosis, and the 105 control patients. Overall, HSV PCR had a sensitivity of 75%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%. These results indicate that PCR is a useful noninvasive test in establishing the diagnosis of acute HSE, but a negative result did not exclude the diagnosis.