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Neurodevelopmental After Congenital Cytomegalovirus Infection
Neurodevelopmental After Congenital Cytomegalovirus Infection
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Archives of Disease in Childhood, 1986, 61, 323-326
Original articles
Congenital cytomegalovirus infection, which occurs matched for sex, maternal age (<20, 20-24, 25-29,
in three to four of every 1000 live births in the and > 30 years), race (white, black, or Asian),
United Kingdom, may cause severe handicap in up parity, and social class (manual, non-manual, or
to 10% of cases.' In addition to causing cerebral other, this latter group mainly including single
palsy or sensorineural deafness, or both, it has been mothers with no classifiable employment or women
claimed that cytomegalovirus is a major cause of whose. partners were unemployed).
mental retardation.2 3 There is little evidence, The children who were congenitally infected and
however, to confirm or refute this, and there are few the controls were followed up at regular intervals
reports of congenital cytomegalovirus infection pre- and children with neurological damage such as
*senting with isolated mental retardation. As part of spastic quadriplegia or sensorineural deafness
an ongoing prospective study to determine the identified.' At 2 years of age a neurodevelopmen-
consequences of congenital cytomegalovirus infec- tal assessment was carried out using the Griffiths
tion the intellectual development of 41 infected scale.4 The overall developmental quotient was
children and their controls was assessed at 2 years of calculated as the mean of five subscales, where
age using the Ruth Griffiths developmental scale.4 locomotor function, personal social skills, language
development skills, eye-hand coordination, and fine
Patients and methods motor performance skills were assessed.
The development quotients of children with
In a prospective study, details of which have been congenital cytomegalovirus and specific neurologi-
described elsewhere,5 infants were screened for the cal abnormalities (that is, symptomatic) were ana-
presence of cytomegalovirus as soon as possible lysed separately from those with no neurological
after birth. Isolation of virus within the first 3 weeks abnormalities (asymptomatic) and from the con-
of life was the criterion for the diagnosis of trols. None of the controls suffered from specific
congenital cytomegalovirus infection. Details of neurological abnormalities. Children with psycho-
maternal age, race, marital state, occupation, and motor delay but who had no specific neurological
parity were obtained from all mothers. For each abnormalities were included with the children in
infected child two control infants were selected whom neurological examination was normal. For
323
Arch Dis Child: first published as 10.1136/adc.61.4.323 on 1 April 1986. Downloaded from http://adc.bmj.com/ on 15 October 2018 by guest. Protected by copyright.
324 Pearl, Preece, Ades, and Peckham
children who were unable to complete the full test and the subscores of the three groups. The scores
the mean score of three or more subscales was used achieved by children with asymptomatic congenital
to calculate the overall development quotient. If less cytomegalovirus were similar to those of the control
than three subscales were completed the overall children. In addition, the subscores showed no
development quotient was not calculated. Means specific area of development to be affected. The
and standard deviations were calculated for each mean score for the five symptomatic congenitally
subscale for symptomatic, asymptomatic, and con- infected children was 69, which was more than 30
trols. In a further analysis multiple regression was points below the control group and the asympto-
used to examine the possible effect on overall matic group. This suggests that only symptomatic
development quotient of matching variables such as congenital cytomegalovirus is associated with
social class and to remove any variation association psychomotor delay.
with them. Because some of the variation in development
quotient scores may be associated with the maternal
Results factors used in matching cases and controls, multiple
regression analysis was carried out on the overall
By December 1984, 42 congenitally infected children development quotient scores. The development
and 75 controls had reached 2 years of age. Two of quotients of children with symptomatic congenital
these children (one case and one control) were cytomegalovirus was 35-6 points lower than that of
unable to complete any subscale of the Griffiths the controls, which is highly significant (t,00= -6-2,
assessment and were excluded altogether. Both p<00001). In contrast, children with asymptomatic
children have subsequently been found to be congenital cytomegalovirus had marginally higher
developing normally. development quotients than the controls (tj(0=0. 1,
Subscale scores were therefore available for 41 p>0.5). Congenital cytomegalovirus infection,
cases and 74 controls and overall development therefore, had no significant effect on developmen-
quotient scores for 40 cases and 73 controls. None of tal achievement at 2 years when it was not associated
the 74 control children had detectable neurological with neurological abnormality. Furthermore, the
abnormalities, and none were detected in 36 of the narrowness of the 95% confidence interval, -3-0 to
41 congenitally infected infants. This asymptomatic +7-2 development quotient points, suggests that if
group included one child with congenital cytomega- asymptomatic cytomegalovirus has an effect it is
lovirus with mild psychomotor delay and the addi- unlikely to be of educational significance (Figure).
tional stigmata of fetal alcohol syndrome and one Social class was the only other variable to show a
control with mild psychomotor delay but no specific significant effect on development quotient (F2,100=
neurological abnormalities. Five congenitally in- 4.97, p=0.009). Compared with the children of
fected children had pronounced neurological abnor- non-manual parents the development quotient of
malities: two unilateral sensorineural deafness, two children whose parents were of manual social class
bilateral sensorineural deafness, and two spastic was lower by 6-6 (95% confidence interval: 0-3-12-9)
quadriplegia and epilepsy (associated in one child and children of unclassifiable social class by 9-0
with bilateral sensorineural deafness). Of the three (95% confidence interval: 2-7-15.3). Maternal age,
children with no neurological abnormalities other race, parity, and infant sex did not have a significant
than deafness, two had essentially normal Griffiths effect on development quotients (p> 0.06).
scores, except on the Hearing and speech subscale. Statistical tests for interactions showed that the
The third, with unilateral deafness, had uniformly effect of asymptomatic cytomegalovirus was the
low Griffiths scores, averaging 81. same irrespective of social class and of all other
The Table shows the overall development quotient variables (p> 0.2).