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Congenital Cytomegalovirus Infection After a Multiple Birth Pregnancy

Shmueli, Einat MD*; Hadar, Eran MD†‡; Pardo, Joseph MD†‡; Attias, Joseph MD§¶; Amir, Jacob MD†‡; Bilavsky, Efraim MD*‡

The Pediatric Infectious Disease Journal: December 2017 - Volume 36 - Issue 12 - p e298–e302
doi: 10.1097/INF.0000000000001725
Original Studies

Background: Congenital cytomegalovirus (cCMV) infection is an important cause of hearing loss and neurodevelopment delay. While data on vertical transmission and neonatal outcome after singleton pregnancy with cCMV are well established, only scarce reports have addressed cCMV in multiple birth pregnancies. Furthermore, no studies have yet compared the outcome after birth and long-term follow-up of children with cCMV born after a singleton versus multiple pregnancies.

Methods: Infant outcome after birth of symptomatic versus asymptomatic infection was compared for infants born with cCMV after multiple (study group) and singleton (control group) pregnancies in a 1:2 ratio.

Results: Of 508 infants diagnosed with cCMV, 25 (4.9%) were born after a multiple pregnancy. Children in the study and control groups did not differ in terms of specific prenatal CMV investigations including amniocentesis and brain magnetic resonance imaging studies. However, prematurity rates were significantly higher in the study compared with control group (52% vs. 4%, P < 0.001). There was a higher rate of symptomatic cCMV infection in the study group than in the controls (48% vs. 14%, P < 0.001). Hearing impairment at birth was also more frequent in the study group (32% vs. 8%, P = 0.016). A long-term follow-up demonstrated that children in the study group had higher rates of neurologic sequelae (hearing impairment or neurodevelopmental delay) compared with children in the control group (20% vs. 4%, P = 0.016).

Conclusions: Infants with cCMV born after multiple birth pregnancies are born earlier and have a higher risk of symptomatic disease at birth and worse long-term neurologic outcome than those born after a singleton pregnancy. This important group of children warrants meticulous prenatal and postnatal care.

From the *Department of Pediatrics C, Schneider Children’s Medical Center, and Department of Gynecology and Obstetrics, Rabin Medical Center, Beilinson Hospital Petah Tikva, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; §Institute of Audiology and Clinical Neurophysiology, Schneider Children’s Medical Center, Petah Tikva, Israel; and Department of Communication Sciences & Disorders, University of Haifa, Haifa, Israel.

Accepted for publication April 21, 2017.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Efraim Bilavsky, MD, Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tiqva 49202, Israel. E-mail:

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