Predizione ecografica dell’infezione congenita sintomatica da cytomegalovirus

OBJECTIVE: To assess the effectiveness of ultrasound in the antenatal prediction of symptomatic congenital cytomegalovirus infection. STUDY DESIGN: The sonograms of foetuses from mothers with cytomegalovirus primary infection were correlated to fetal/neonatal outcome. Infection status was disclosed by viral urine isolation at birth or CMV tissue inclusions at autopsy; classification of disease as symptomatic was based on clinical/laboratory findings at birth or macroscopic evidences of tissue damage at autopsy. RESULTS: Ultrasound abnormalities were found in 51/600 (8.5%) mothers with primary infection and in 23/154 congenitally infected fetuses (14.9%). Symptomatic congenital infection resulted in 18/23 and 68/131 cases with or without abnormal sonographic findings, respectively. The positive predictive value of ultrasound abnormalities decreased from 78.3% if related to congenitally infected fetuses/infants to 35.3% if related to all fetuses/infants exposed to maternal infection. CONCLUSION: When fetal infection status is unknown, ultrasound abnormalities only predict symptomatic congenital infection in a third of cases.