A two-step strategy for detecting intrauterine cytomegalovirus infection with clinical manifestations in the mother, fetus, and newborn.

摘要

We selected a high-risk group based on clinical manifestations and performed virological tests to detect intrauterine cytomegalovirus (CMV) infection. We tested the efficacy of this detection protocol in this study. We analyzed 2,309 newborns at 22 weeks or more of gestation from January 1992 to December 2000. Clinical manifestations of the mother, fetus, and newborn were used in the initial step to identify the high-risk group. For the high-risk group, if the causes of clinical manifestation remained unclear, we assayed for CMV DNA in the amniotic fluid, umbilical cord blood, or newborn urine using polymerase chain reaction (PCR) as a second step. Positive PCR results were confirmed by isolating CMV. The initial step detected 287 high-risk cases from 2,309 deliveries. In this group, 100 cases did not have reasonable explanations for the clinical manifestation. In the second-step PCR, intrauterine CMV infection was diagnosed in 10 of 100 cases (10%). The initial clinical classification reduced the proportion of cases needing laboratory investigation to 4%. Thus, our strategy detected intrauterine CMV infection in as many as 10% of high-risk patients after the first step, which is much higher than the general screening rate.