利用唾液标本筛查先天性巨细胞病毒感染

目的 探讨利用唾液标本,采用聚合酶链反应技术筛查新生儿先天性巨细胞病毒(cytomegalovirus,CMV)感染的可行性及感染患儿的临床表现. 方法 2010年11月1日至2012年2月29日,南京医科大学附属常州妇幼保健院出生的6733例新生儿出生3d内采集唾液标本0.2ml,采用实时荧光定量-聚合酶链反应技术检测唾液中CMV DNA,采用手持式EroScan瞬态耳声发射仪筛查听力.计算新生儿先天性CMV感染筛查阳性率,总结筛查阳性患儿的临床表现.统计学分析采用卡方检验. 结果 6733例新生儿接受筛查,筛查阳性率为1.59％(107/6733).其中88例(82.2％,88/107)为无症状感染,19例(17.8％,19/107)为症状性感染.19例症状性CMV感染患儿主要临床表现包括病理性黄疸13例,肝脏肿大合并肝功能异常5例,粒细胞减少、血小板减少性紫癜、贫血和小于胎龄儿各2例.14例患儿有1项临床表现,3例患儿同时合并2项临床表现,2例患儿同时合并3项临床表现.CMV筛查阳性患儿听力筛查单耳未通过者占8.4％(9/107),双耳未通过者占3.7％(4/107),与CMV筛查阴性患儿[分别为5.8％(382/6626)和2.4％(159/6626)]相比,差异没有统计学意义(x2=2.776,P=0.241). 结论 利用唾液标本筛查先天性CMV感染是可行的.     

脑性瘫痪患儿合并癫疒间32例临床分析

目的探讨合并癫疒间的脑性瘫痪患儿的临床特点及癫疒间治疗效果。 方法总结1999年10月至2004年5月在西安交通大学第二医院住院的合并癫疒间的脑性瘫痪患儿的癫疒间发生率、临床类型、头颅计算机体层成像(CT)和(或)磁共振成像(MRI)、脑电图等方面的特点以及抗癫疒间治疗效果。 结果139例脑性瘫痪患儿中有32例合并癫疒间，占230%(32/139)；常见的癫疒间类型为强直 阵挛发作12例(375%)和部分性发作6例(188%)；25例(781%)癫疒间首发于1岁前；合并癫疒间脑性瘫痪儿童的头颅影像异常及脑电图异常分别占30例(938%)和27例(844%)；常见的头颅影像异常为脑发育不良11例(367%)、脑积水6例(200%)，余为脑萎缩、缺氧缺血性脑病样改变等13例(433%)；脑电图异常中局灶性和弥漫性所占比例分别为482%(13/27)和518%(14/27)；癫疒间多发生于痉挛性脑性瘫痪中(688%)；813%(26/32)的癫疒间需要2种及2种以上的抗癫疒间药物治疗。 结论脑性瘫痪患儿中癫疒间的发生率较高，其头颅影像学和脑电图分别以脑发育不良和弥漫性背景活动异常伴疒间样波发放为主；脑性瘫痪儿童的癫疒间大多为难治性，需要联合用药治疗。     

不同实验方法在诊断和监测新生儿先天性巨细胞病毒感染中的临床研究

目的　探讨外周血白细胞巨细胞病毒(cytomegalovirus, CMV)抗原(即刻早期抗原和早期抗原)检测、唾液聚合酶链反应(PCR)检测CMV DNA和血清学检测CMV IgM三种实验方法在诊断和监测新生儿先天性CMV感染中的作用。　方法　对98 例患儿之母在孕期血CMV IgM阳性的高危新生儿出生后14 d 内检查血CMV IgM、外周血白细胞CMV抗原和唾液PCR CMV DNA,比较三种方法的检测结果,并对新生儿进行临床观察和随访。　结果　(1)98 例中,48 例诊断先天性CMV感染。症状性感染7 例,无症状性感染41 例;无一例CMV IgM阳性。症状性感染组CMV抗原、PCR阳性检出率分别为7/7、5/7;无症状性感染组阳性检出率分别为71%(29/41)、46%(19/41)。CMV抗原检测法、PCR检测法的诊断敏感性分别为75%、54%。症状性感染儿每5 万白细胞中CMV阳性细胞数16~52个,无症状性感染儿3~31个,症状性感染儿CMV抗原指数水平显著高于无症状感染儿(P<0.05)。(2)随访10例患儿,2 例症状性感染儿CMV抗原和PCR转阴,症状消失;1例CMV肝炎治疗后CMV抗原和PCR检测仍阳性,最后发展为肝硬化。7 例无症状性感染儿,CMV抗原在6个月内转阴或减少至低水平;2 例伴唾液PCR阳性,复查时1 例转阴,1 例仍阳性。　结论　CMV抗原检测法具有早期、敏感、量化的特点,PCR法能发现潜伏性感染     

小婴儿巨细胞病毒感染临床诊治分析

目的观察小婴儿巨细胞病毒(CMV)感染的临床特点及诊治情况。方法 2014年10月至2016年10月郑州市儿童医院小婴儿科收治住院的CMV感染患儿72例。采用酶联免疫吸附试验法检测血清CMV-IgM阳性,进一步行PCR荧光探针法检测患儿血浆CMV-DNA-PCR量高于正常者。72例患儿均给予更昔洛韦治疗,治疗分为诱导治疗及维持治疗。进行血常规、肝肾功能、胸片、头颅CT、脑干听觉诱发电位、超声等检查,同时检测母亲乳汁CMV-DNA-PCR,并对其临床表现、诊治情况进行分析。结果 72例患儿中临床表现为婴儿肝炎45例,高胆红素血症35例,肺炎31例,脑损伤18例,脑干听觉诱发电位异常9例,营养不良6例,先天性心脏病5例,遗传性代谢病3例。60例纯母乳喂养患儿中母亲乳汁CMVDNA-PCR高于正常者45例。治疗后好转或治愈65例,放弃治疗7例。结论小婴儿易发生CMV感染,其临床表现多样,以肝胆系统异常最多见。对于确诊CMV感染的患儿,应同时检测患儿母亲乳汁CMVDNA-PCR并进行早期干预。经更昔洛韦抗病毒治疗大多数病例预后良好,及早进行诊断和治疗有利于改善预后。     

34例脑性瘫痪合并癫痫患儿临床发作类型及脑电图分析

目的总结脑性瘫痪合并癫痫的临床分型脑电图特点及癫痫治疗效果。方法对2009-01/2010-03诊断为脑性瘫痪合并癫痫发作的患儿34例癫痫的发作类型、脑性瘫痪临床分型、首次发作年龄、头颅影像学、脑电图、以及抗癫痫药物应用进行回顾性分析。结果 378例脑性瘫痪患儿中有34例合并癫痫,占8.9%。癫痫发病年龄小于1岁22例(64.7%)。脑性瘫痪合并癫痫患儿头颅影像异常改变28例(82.3%)。癫痫以部分性发作泛化为全身发作12例(35.2%),简单部分性发作6例(17.6%),复杂部分发作4例(11.7%),强直-阵挛性发作4例(11.7%),强直发作1例(2.9%),肌阵挛1例(2.9%),Lennox-Gastaut综合征1例,婴儿痉挛症5例(14.7%)。28例(82.3%)的癫痫患儿需2种以上的抗癫痫药物治疗。结论脑性瘫痪合并癫痫的发生率较高,其头颅影像和脑电图分别以脑发育不良和弥漫背景活动异常伴痫样波发放为主,脑性瘫痪患儿的癫痫大多为难治性,需要联合用药治疗。     

生物素缺乏症18例临床研究

目的　探讨生物素缺乏症的临床特征、诊断与治疗。方法　对2007年3月至2009年12月首都医科大学附属北京儿童医院门诊疑似生物素缺乏症患儿进行生物素（免疫法）和生物素酶（化学发光法）检测,确诊18例。对其进行临床资料分析及随访。结果　（1）临床表现：16例患儿发生皮肤湿疹样皮疹和（或）皮肤干粗。9例头发异常。13例有不同程度的精神发育迟滞。6例抽搐。4例反复呼吸道感染。2例听力障碍。（2）共患病：注意缺陷多动障碍（ADHD）2例。先天性眼发育异常、甲状腺功能低下、抽动障碍各1例。（3）实验室检查：血生物素均 < 100 ng/L,生物素酶均正常。15例尿有机酸分析,2例提示甲基丙二酸血症。13例智力测查Gesell评分中9例29～81分。部分患儿有头颅影像学非特异性异常（7/13）、脑电图异常（6/13）及听力异常（2/5）。（4）治疗与随访：确诊后给予生物素10～40 mg/d治疗,患儿精神状态、食欲、皮肤毛发异常均明显改善。结论　生物素缺乏症临床表现多样,皮肤和（或）毛发异常是诊断本病的重要线索和特征。生物素治疗效果显著。生物素缺乏症可与其他疾病共患,需加强对该病的认识以早期诊断和治疗。     

新生儿先天性巨细胞病毒感染的诊断及治疗探讨

目的 探讨新生儿先天性巨细胞病毒(CMV)感染的主要临床表现、诊断及治疗效果.方法采用酶联免疫吸附试验定量检测血清CMV抗体,用荧光实时定量PCR法检测尿CMV-DNA,2007年1月至2008年12月间共确诊新生儿先天性CMV感染145例,其中的101例症状性感染患儿采用更昔洛韦治疗,观察其疗效及副作用.各指标改善情况的比较采用卡方检验. 结果 症状性CMV感染主要临床表现及实验室指标异常为:病理性黄疸、肝脾肿大、间质性肺炎、皮肤瘀点、吸吮力差、血小板下降、血清谷丙转氨酶增高等.尿CMV-DNA阳性87例(60.0%),血清CMV-IgM阳性43例(29.7%),生后2周内血清IgG增高4倍21例(14.5%);13例(9.0%)患儿尿CMV-DNA阳性或血清CMV-IgM阳性,其血清IgG也比母亲高1倍以上.更昔洛韦治疗后,CMV感染的相关症状及体征和实验室指标得到明显改善.治疗期间副作用较少,主要有粒细胞减少、血小板下降,但未见肝肾功能损害. 结论 新生儿先天性CMV感染可造成多器官系统损害,临床表现多样;实验室依据包括尿CMV-DNA阳性,检测阳性率高;其他依次为血清CMV-IgM阳性及CMV-IgG4倍增高;患儿CMV-IgG比母亲增高1倍以上可能是诊断CMV感染实验室依据之一;更昔洛韦治疗症状性CMV感染效果较好.     

新生儿先天性巨细胞病毒感染的诊断及治疗探讨

目的 探讨新生儿先天性巨细胞病毒(CMV)感染的主要临床表现、诊断及治疗效果.方法采用酶联免疫吸附试验定量检测血清CMV抗体,用荧光实时定量PCR法检测尿CMV-DNA,2007年1月至2008年12月间共确诊新生儿先天性CMV感染145例,其中的101例症状性感染患儿采用更昔洛韦治疗,观察其疗效及副作用.各指标改善情况的比较采用卡方检验. 结果 症状性CMV感染主要临床表现及实验室指标异常为:病理性黄疸、肝脾肿大、间质性肺炎、皮肤瘀点、吸吮力差、血小板下降、血清谷丙转氨酶增高等.尿CMV-DNA阳性87例(60.0%),血清CMV-IgM阳性43例(29.7%),生后2周内血清IgG增高4倍21例(14.5%);13例(9.0%)患儿尿CMV-DNA阳性或血清CMV-IgM阳性,其血清IgG也比母亲高1倍以上.更昔洛韦治疗后,CMV感染的相关症状及体征和实验室指标得到明显改善.治疗期间副作用较少,主要有粒细胞减少、血小板下降,但未见肝肾功能损害. 结论 新生儿先天性CMV感染可造成多器官系统损害,临床表现多样;实验室依据包括尿CMV-DNA阳性,检测阳性率高;其他依次为血清CMV-IgM阳性及CMV-IgG4倍增高;患儿CMV-IgG比母亲增高1倍以上可能是诊断CMV感染实验室依据之一;更昔洛韦治疗症状性CMV感染效果较好.     

先天性巨细胞病毒感染的研究进展

巨细胞病毒(CMV)是宫内感染最常见类型，整个妊娠期CMV均可传播给胎儿，母亲原发及妊娠16周内感染对胎儿损害较严重。CMV感染可多方面抑制机体细胞免疫功能，感染新生儿出现低体质量、紫癜、肝脾肿大、视网膜炎、颅内钙化和听力减退。产前筛查可以降低胎儿受先天性CMV感染的损害，避免智力障碍和听力丧失。运用细胞培养、PCR和ELISA检测羊水和胎血中CMV是诊断先天性CMV感染较好方法。丙氧甲基鸟嘌呤可减轻先天性CMV感染导致的神经发育损伤，降低发病率最有效方法是应用CMV疫苗。关键词巨细胞病毒先天性感染产前筛查产前诊断     

儿童病毒性脑炎87例临床特点分析

目的总结病毒性脑炎患儿的临床表现,分析脑脊液及头颅CT检查结果。方法分析87例病毒性脑炎患儿的临床表现、脑脊液及头颅CT检查。结果临床表现:发热78例(89.7%),呕吐67例(77.0%),头痛63例(72.4%),嗜睡和精神差17例(19.5%),抽搐5例(5.7%),意识恍惚1例(1.1%)。87例患儿脑脊液常规、生化检查:正常17例(19.5%);9例(10.3%)腰椎穿刺有损伤,脑脊液外观呈现微混,淡红色,其余外观均呈无色透明状。蛋白质呈轻度增高者33例(37.9%);有核细胞增多者64例(73.6%),均以淋巴细胞为主;糖、氯化物均正常;脑脊液涂片及培养均未见细菌。2/86例头颅CT检查显示脑实质低密度影。结论病毒性脑炎患儿临床表现多种多样,且轻重不一。脑脊液检查有助于诊断。腰椎穿刺检查前,常规检查头颅CT,尽早行脑脊液常规、生化检查,有条件的尽量同时进行脑脊液细胞学检查,提高病毒性脑炎的早期诊断率。     

Neonatal screening for congenital cytomegalovirus infection in preterm and small for gestational age infants

Abstract

Congenital cytomegalovirus (CMV) infection affects many organs: reticuloendothelial and central nervous system are particularly involved. Congenital CMV infection is the leading cause of non-genetic sensorineural hearing loss. Hearing impairment can be present at birth or it can occur months or even years after birth. It is as well an important risk factor for antenatal stillbirth, preterm birth and small for gestational age (SGA) condition. For these reasons we should early identify congenital CMV infection investigating at least at risk newborns such as preterm or SGA babies given that a simple and standardized method for a large scale screening program is lacking. In our study, we found an association between congenital CMV infection and preterm births (3.03%) and with SGA condition (3.7%). Consequently, routine CMV urine detection should be performed at least in all babies born before 37 weeks of gestational age and in term SGA newborns.     

A trial of immunoglobulin fetal therapy for symptomatic congenital cytomegalovirus infection

No medical intervention guideline for prenatally diagnosed symptomatic congenital cytomegalovirus infection (CCMVI) is currently available. The aim of the study was to assess the efficacy of immunoglobulin fetal therapy for symptomatic CCMVI. With informed consent, hyper-immunoglobulin was injected into the peritoneal cavity of affected fetuses or into the maternal blood in 12 women who had symptomatic CCMVI. After immunoglobulin therapy, ultrasound examinations demonstrated the following changes: Ascites disappearance 57.1% (4/7) and a decrease in ascites volume 14.3% (1/7); improvement in intrauterine growth restriction 54.5% (6/11); disappearance of mild ventriculomegaly 40% (2/5); and in one case hepatomegaly and hydronephrosis disappeared. The survival rate of affected infants was found to be 83.3% (10/12). Concerning morbidity, 25.0% (3/12) of the infants developed normally. An additional two cases had only unilateral hearing difficulty without other sequelae. Therefore, 41.7% (5/12) of symptomatic CCMVI infants whose mothers received prenatal immunoglobulin therapies had no or only minimal sequelae (unilateral hearing difficulty). No direct adverse effects were observed. Immunoglobulin therapy may be effective for symptomatic CCMVI, reducing the incidence and severity of sequelae. To confirm the efficacy, a randomized study should be further performed.     

DNA-positive,IgM-negative symptomatic congenital cytomegalovirus infection: Two case reports

The characteristics of two newborns that had clinical symptoms of congenital cytomegalovirus have been presented here, whose CMV-DNA was found to be positive by the PCR method, despite serological analysis being negative for CMV IgM. In conclusion, when congenital CMV infection is suspected in newborns, it should not be forgotten that the sensitivity of serological CMV IgM assay is 70% and other methods such as CMV-DNA analysis should be performed in case of negative test results.     

Neonatal screening for congenital CMV infection stresses the importance of maternal nonprimary infection even in an area where prenatal serology testing is common

Aim and Methods: Dried blood spots from 2149 newborns were examined to diagnose congenital cytomegalovirus (cCMV).

Results: Prenatal CMV-IgG antibodies had been measured during prenatal care in 1287 (60.3%) of mothers and 980 (76.1%) of them were found seropositive. cCMV incidence was 0.47%. All newborns were asymptomatic; 9/10 were born post nonprimary maternal infection; two developed sensorineural hearing loss.

Conclusions: In a country where prenatal CMV testing is common and therefore a false sense of control might prevail, nonprimary maternal infection should not be overlooked. Indeed, women of childbearing age should be educated on CMV prevention measures irrespectively to their serostatus.     

Cytomegalovirus and pregnancy.

Cytomegalovirus remains the most common congenital infection worldwide, with approximately 1% of all newborns infected in utero. Of those infected in utero, approximately 10% will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. Recent data indicate that more than 90% of symptomatic infections or infections causing sequelae occur following a primary maternal infection during pregnancy. The overall risk of delivering an infant who will develop significant handicaps following a primary maternal infection is between 10% and 20%. Between 1% and 2% of seronegative women may acquire a primary cytomegalovirus infection during pregnancy, but seronegative women at high risk include day-care workers, who have a 10% to 20% annual infection rate, and the seronegative mothers of infected children under 2 years of age, 50% of whom will acquire cytomegalovirus annually from their children. Adolescents are another group who may have a high infection rate during pregnancy. Although a cytomegalovirus vaccine is still many years from introduction, these observations strengthen the need and feasibility for a cytomegalovirus vaccine. Pending vaccine development and evaluation, several possible strategies for intervention to prevent primary infection for high-risk pregnancies are suggested.     

Effect of antenatal and postnatal corticosteroid therapy on weight gain and head circumference growth in the nursery.

OBJECTIVE: To assess the effect of antenatal and postnatal corticosteroids on head circumference growth and weight gain from birth to discharge. METHODS: We conducted a retrospective analysis of nonanomalous newborns admitted to the neonatal intensive care unit from 23 to 34 6/7 weeks of gestation. Independent variables included maternal age, race, nulliparity, poor prenatal care, multiple gestation, obstetric complications, alcohol, tocolytic drugs, smoking, illicit drugs, gestational age at birth, presentation, method of delivery, 5-minute Apgar score < 7, surfactant use, severe intracranial hemorrhage, and length of stay. RESULTS: Antenatal and postnatal corticosteroids were given in 62% and 14% of the newborns, respectively, and 10% of newborns received both. The mean (+/-SD) weight gain and head circumference growth in the nursery was 440 +/- 582 g (n = 14,217) and 2.54 +/- 3.42 cm (n = 12,808), respectively. After multivariable analysis, use of antenatal corticosteroids did not affect weight gain (3.6 +/- 4.6 g) and head circumference growth (0.05 +/- 0.04 cm) compared with no exposure to perinatal corticosteroids, but postnatal corticosteroids were associated with significant reductions in weight gain and head circumference growth (-120 +/- 12.2 g and -0.53 +/- 0.11 cm, respectively). CONCLUSIONS: Antenatal corticosteroid therapy did not affect weight gain or head circumference growth in the nursery, even when used in conjunction with postnatal corticosteroid therapy.     

孕妇巨细胞病毒感染及其宫内传播的探讨

探讨孕妇人巨细胞病毒感染的宫内传播情况以及先天性ＨＣＭＶ感染对胎婴儿的近期影响。方法酶联免疫吸附试验筛查孕妇血清ＨＣＭＶ－ＩｇＭ１８８１例,聚合酶链反应检测血ＨＣＭＶＤＮＡ６５６例;追踪感染孕妇的胎婴儿ＨＣＭＶ感染情况和近期预后。     

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit.

OBJECTIVE: The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia. STUDY DESIGN: Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life. RESULTS: A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (chi (2)=15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32+/-2 in the hypothermic group vs 28+/-3 in the control group, P<0.01). CONCLUSIONS: Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.     

Prenatal diagnosis of congenital cytomegalovirus infection

OBJECTIVE: To assess prospectively the diagnostic reliability and prognostic significance of prenatal diagnosis of cytomegalovirus (CMV) infection. METHODS: One hundred ten pregnant women (four with twin pregnancies) with a risk of congenital CMV infection were investigated. Prenatal diagnosis was carried out by amniocentesis and fetal blood sampling (n = 75) or amniocentesis alone (n = 35). Serial ultrasonographic examinations were performed from time of referral until pregnancy end. All infected neonates were given long-term follow-up. Autopsy was performed in all cases of termination of pregnancy. RESULTS: Nearly 23% (26 of 114) of fetuses were infected and prenatal diagnosis was positive in 20 cases. Sensitivity of prenatal diagnosis was 77% and specificity 100%. In eight cases, parents requested termination of pregnancy on the basis of abnormal ultrasonographic findings and/or biologic abnormalities in fetal blood. In 12 cases, parents decided to proceed with the pregnancy. In this group, one intrauterine and one neonatal death were observed. In one case, prenatal diagnosis revealed an abnormal cerebral sonography and the infant had bilateral hearing loss at birth. In 15 cases (nine positive and six false-negative prenatal diagnoses), no apparent lesion was present at birth, nor did it develop during the follow-up period (mean 31 months). In 88 (77.2%) of 114 infants, no evidence of vertical transmission was found during the pre- or postnatal period. CONCLUSION: Prenatal diagnosis provides the optimal means for both diagnosing fetal infection (amniocentesis) and identifying fetuses at risk of severe sequelae (ultrasound examination, fetal blood sampling), thus allowing proper counseling.     

Screening, diagnosis, and management of cytomegalovirus infection in pregnancy

Congenital cytomegalovirus (CMV) is the most common intrauterine infection and the leading infectious cause of sensorineural hearing loss and mental retardation. This article reviews the issues that relate to the diagnosis and management of this disease, detailing the points that led to the recent published guidelines by the Society of Obstetricians and Gynaecologists of Canada. A MEDLINE/Cochrane search of CMV infection, pregnancy, and prenatal diagnosis found 195 studies between 1980 and 2010. Of these, we examined 59 relevant studies. The probability of intrauterine transmission following primary infection is 30% to 40%, but only 1% after secondary infection. About 10% to 15% of congenitally infected infants will have symptoms at birth, and 20% to 30% of them will die, whereas 5% to 15% of the asymptomatic infected neonates will develop sequelae later. Children with congenital CMV infection following first trimester infection are more likely to have central nervous system sequelae, whereas infection acquired in the third trimester has a high rate of intrauterine transmission but a favorable outcome. The prenatal diagnosis of fetal CMV infection should be based on amniocentesis performed 7 weeks after the presumed time of infection and after 21 weeks of gestation. Sonographic findings often imply poor prognosis, but their absence does not guarantee a normal outcome. The value of quantitative determination of CMV DNA in the amniotic fluid is not yet confirmed. The effectiveness of prenatal therapy for fetal CMV is not yet proven, although CMV-specific hyperimmune globulin may be beneficial. Routine serologic screening of pregnant women or newborns has never been recommended by any public health authority. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to evaluate the principles of prenatal diagnosis of congenital CMV infection so doctors will be familiar with the tests and procedures needed, in order to reach a diagnosis of congenital CMV; to assess the natural history and outcome of congenital CMV infection enabling obstetricians to counsel prenatally pregnant women with CMV; and to analyze the prognostic markers for fetal CMV, so managing physicians will be able to predict more accurately the outcomes of fetuses infected by CMV.