Congenital Cytomegalovirus (cCMV)

Disclaimer

These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Congenital cytomegalovirus (cCMV) is the most common congenitally acquired infection.¹ Most infants are asymptomatic, however delayed complications of cCMV can include sensorineural hearing loss (SNHL)², chorioretinitis (which can lead to blindness), and neuro-disability such as cerebral palsy².

Features of symptomatic cCMV in the neonatal period include³:

Thrombocytopenia
Petechiae
Hepatomegaly
Splenomegaly
Hepatitis
Microcephaly
Unexplained intrauterine growth restriction (IUGR)
Chorioretinitis
Seizures.

cCMV is the leading non-genetic cause of SNHL, which may be apparent at birth or develop later.²

The diagnosis of cCMV is usually confirmed by positive CMV PCR on urine collected within the first three weeks of life.³

Please see Cytomegalovirus (CMV) Neonatal Pathway (health.wa.gov.au) for guidance on immediate management of infants with cCMV.

Pre-referral investigations

Antenatal and birth history (including any history of maternal influenza-like illness and/or abnormal scans)
Baby’s birth weight/length/head circumference
Newborn hearing screen or audiology assessment
Maternal CMV serology (if not available, please include details of the laboratory where antenatal serology was performed)
Bloods:
- FBP
- LFT (including conjugated bilirubin)
- UEC
MRI brain (or other neuroimaging if MRI not possible)
Ophthalmology referral or assessment

When to refer

All infants with confirmed cCMV:

Contact the on-call Infectious Diseases Registrar/Consultant via PCH Switchboard (6456 2222) to discuss management and ensure timely outpatient follow-up.

Older children with confirmed/suspected cCMV may be referred if required:

Refer to the PCH Infectious Diseases Clinic as below.

How to refer

Routine non-urgent referrals from a GP, Nurse Practitioner or a Consultant should go to the Central Referral Service.
Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office.
Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call PCH Switch on 6456 2222 to discuss referral with the Infectious Diseases on call Registrar/Consultant.

Essential information to include in your referral

Antenatal history (including any history of maternal influenza-like illness and/or abnormal scans)
Maternal CMV serology (if not available, please include details of the laboratory where antenatal serology was performed)
Birth history (gestation, mode of delivery, Apgars)
Baby’s birth weight/length/head circumference
Newborn hearing screen results
Clinical signs of cCMV
Any investigation results (blood tests, imaging)

References

Rawlinson WD, Boppana SB, Fowler KB, Kimberlin DW, Lazzarotto T, Alain S, Daly K, Doutré S, Gibson L, Giles ML, Greenlee J, Hamilton ST, Harrison GJ, Hui L, Jones CA, Palasanthiran P, Schleiss MR, Shand AW, van Zuylen WJ. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017 Jun;17(6):e177-e188. doi: 10.1016/S1473-3099(17)30143-3. Epub 2017 Mar 11. PMID: 28291720.
Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: A systematic review. Rev Med Virol. 2017 Sep 6. doi: 10.1002/rmv.1938. Epub ahead of print. PMID: 28876493.
Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI). Lancet Reg Health Eur. 2024 Apr 1;40:100892. doi: 10.1016/j.lanepe.2024.100892. Erratum in: Lancet Reg Health Eur. 2024 Jun 24;42:100974. doi: 10.1016/j.lanepe.2024.100974. PMID: 38590940; PMCID: PMC10999471.

Endorsed by	Infectious Diseases Department	Review date:	Sep 2025
		Next review:	Sep 2028

This document can be made available in alternative formats on request for people with disability.