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.     

孕妇与胎儿巨细胞病毒感染的研究

目的 :探讨孕妇巨细胞病毒 (CMV)感染 ,早期诊断胎儿CMV感染。方法 :用酶联免疫法 (ELISA)和多聚酶链反应 (PCR)技术检测孕妇血中CMV特异性抗体及CMVDNA ,诊断孕妇CMV感染 ;检测羊水或脐血中CMVDNA诊断胎儿CMV感染。结果 :15 64例孕妇血清中CMV IgM阳性 2 9例 (占 1.8% ) ,CMV IgG阳性 130 6例 (83.5 % ) ,CMVDNA阳性 12 6例 (8.1% ) ;CMV IgM阳性者其CMVDNA均阳性。CMVDNA阳性的 12 6例孕妇其羊水或脐血中CMVDNA阳性 5 2例 (占 4 1.2 % ) ,CMV感染胎儿中有 5例胎儿畸形、2例死胎、3例IUGR ,出生时无明显症状的婴儿中 3例生后 1个月内患黄疸性肝炎 ,1例患新生儿肺炎。 1例发现室间隔缺损、2例出现单侧耳聋。结论 :孕妇CMV感染可造成胎儿严重危害 ,孕妇CMV感染后取羊水或脐血检测CMVDNA是诊断胎儿及新生儿CMV感染的最佳方法。     

育龄妇女ToRCH感染及与异常妊娠关系的研究

目的研究育龄妇女ToRCH系列感染及其与异常妊娠结局的关系.方法采用间接ELISA对250例育龄妇女作4种ToRCH病原体抗体检测,部分IgM(或IgG)阳性病例并作PCR检测.对其中21例异常妊娠结局的胚胎组织块作了PCR检测和对10例异常新生儿作了血清学诊断.结果250例育龄妇女ToX、RubV、CMV、HSVIgM阳性率分别为8.0%、12.8%、6.8%和8.4%,并发现同一病例有两种或两种以上病原体同时感染的情况,PCR结果与之基本一致.21例与ToRCH感染有关异常妊娠结局(流产、早产、死胎、先天缺陷)孕妇均有ToRCH中的一种、2种或2种以上病原体感染,从死胎脑组织块、人工流产混合物的PCR结果与之吻合.10例新生儿脑炎血清与对应母亲血清抗体检测表明,垂直传播率ToX与CMV分别为50%和40%.结论ToRCH系列感染与异常妊娠结局的关系十分密切.     

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     

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.     

孕期中药治疗对巨细胞病毒感染孕妇子代生长发育的影响

目的 探讨孕期中药治疗对巨细胞病毒(CMV)活动性感染孕妇子代生长发育的影响。方法 1996年1月至2002年6月,采用前瞻性随机对照研究方法,从有异常妊娠史的孕妇中筛查出CMV活动性感染孕妇240例,随机分组。观察组122例给予中药治疗,对照组118例不给予治疗,比较两组孕妇转阴率、胎盘和胎儿感染率以及子代生长发育情况。结果 观察组孕妇CMV IgM和CMV nRNA转阴率77.05％(94/122)、胎盘感染率48.98％(48/98)、宫内传播率21.74％(10/46),对照组分别为38.14％(45/118)、67.50％(54/80)和52.63％(20/38),两组差异均具有统计学意义(P均<0.01)。观察组子代出生时35例正常,11例异常;对照组20例正常,18例异常(P<0.01)。观察组6月龄婴儿智力发育指数和精神运动发育指数均高于对照组,但差异无统计学意义(P>0.05)。结论 孕期中药治疗在改善CMV活动性感染孕妇子代生长发育方面具有一定的意义。     

胎儿感染乙型肝炎病毒的临床研究

目的　探讨临床诊断胎儿感染乙型肝炎病毒 (HBV)的方法 ,及其与各种临床因素的相互关系。方法　采用聚合酶链反应 (PCR)及斑点杂交法 ,检测 14 1例HBV携带者孕妇及其分娩的 14 4例新生儿静脉血HBVDNA、HBV标志物及肝功能。其中 4 0例新生儿同时留取脐带血及出生后 2 4～4 8h外周静脉血用于检测HBVDNA。 14 4例新生儿根据有无HBV感染分为胎儿感染组及对照组 ,比较两组新生儿的临床资料及其肝转氨酶水平。结果　 (1) 14 4例新生儿中有 33例发生宫内HBV感染(胎儿感染组 ) ,感染率为 2 2 9% ;无宫内HBV感染 111例 (对照组 )。 4 0例新生儿脐血与外周静脉血HBVDNA阳性率相比 ,脐血的假阳性率为 2 0 0 % ,其敏感性、阳性预测值分别为 10 0 0 %、80 0 %。追踪HBV携带者孕妇所分娩的新生儿出生 6～ 9个月后 ,HBVDNA持续阳性者 7例 (7/2 8) ,抗 HBs转阳率为 85 3% ;出生时HBsAg阳性者 5例 ,均于 1个月后转为阴性。 (2 )在HBeAg或HBVDNA阳性孕妇中 ,其胎儿感染率分别为 70 5 %、6 1 1% ,显著高于HBeAg或HBVDNA阴性者的 2 0 % (2 /10 0 )、0 0 %(P <0 0 1)。胎儿感染组与对照组孕妇 ,在年龄、孕周、分娩方式、出生体重、身长、出生 1分钟Apgar评分等比较 ,差异均无显著性 (P >0 10 )。 (3)胎儿感染组天     

弓形虫感染与妊娠结局的关系

目的　探讨弓形虫 (toxoplasma ,Tox)感染治疗与妊娠结局的关系。 方法　采用ELISA结合PCR法检出Tox感染并要求治疗的孕妇 5 9例及育龄妇女 91例 (治疗组 ) ,均给予口服乙酰螺旋霉素治疗 ,与同期检出Tox感染 ,但未行治疗的孕妇 6 0例和育龄妇女 79例 (对照组 )进行比较 ,比较其Tox IgM及DNA转阴率、宫内垂直传播率及异常妊娠结局发生率。 　结果　治疗组孕妇及育龄妇女外周血中Tox转阴率分别为 83 0 5 % (49/ 5 9)和 70 33% (6 4 / 91) ,对照组孕妇Tox自然转阴率为35 % (2 1/ 6 0 ) ,育龄妇女为 37 97% (30 / 79) ;宫内垂直传播率为 8 4 % (5 / 5 9) ,明显低于对照组的 4 0 %(2 0 / 5 0 ) (χ2 =11 4 970 ,P <0 .0 0 1) ,相对危险度为 0 2 97;随访育龄妇女经治疗Tox转阴后怀孕 2 9例 ,足月分娩 17例 ,脐血Tox IgM、DNA均为阴性 ,体检未发现新生儿异常。　 结论　孕前检测和治疗Tox感染能有效控制胎儿受染 ;孕期治疗能减少孕妇感染 ,降低宫内垂直传播率 ,减少胎儿受损 ,改善妊娠结局。     

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.     

Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome

Prenatal diagnosis (PD) of fetal cytomegalovirus (CMV) infection was performed in 242 pregnancies, with known outcome in 189 cases. In 141/189 pregnancies, PD was carried out on account of suspicious maternal CMV serology up to gestational week (WG) 23, and in 48 cases on account of abnormal ultrasonic findings detected between WG 18 and 39. Chorionic villus samples (n = 6), amniotic fluid (AF, n = 176) and/or fetal blood specimens (n = 80) were investigated for detection of virus by cell culture, shell vial assay, PCR and/or CMV-specific IgM antibodies. Of 189 fetuses correctly evaluated by CMV detection either in fetal tissue following therapeutic abortion/stillbirth (n = 24) or in urine of neonates within the first 2 weeks of life (n = 33), 57 were congenitally infected. In women with proven or suspected primary infection, the intrauterine transmission rates were 20.6% (7/34) and 24.4% (10/41), respectively. Of the congenitally infected live-born infants, 57.6% (19/33) had symptoms of varying degree. The overall sensitivity of PD in the serologic and ultrasound risk groups was 89.5% (51/57). A sensitivity of 100% was achieved by combining detection of CMV-DNA and CMV-specific IgM in fetal blood or by combined testing of AF and fetal blood for CMV-DNA or IgM antibodies. There was no instance of intrauterine death following the invasive procedure. The predictive value of PD for fetal infection was 95.7% (132/138) for negative results and 100% (51/51) for positive results. Correct results for congenital CMV infection by testing AF samples can be expected with samples obtained after WG 21 and after a time interval of at least 6 weeks between first diagnosis of maternal infection and PD. In case of negative findings in AF or fetal blood and the absence of ultrasound abnormalities at WG 22-23, fetal infection and neonatal disease could be excluded with high confidence. Positive findings for CMV infection in AF and/or fetal blood in combination with CMV suspicious ultrasound abnormalities predicted a high risk of cytomegalic inclusion disease (CID). Furthermore, detection of specific IgM antibodies in fetal blood was significantly correlated with severe outcome for the fetus or the newborn (p = 0.0224). However, normal ultrasound of infected fetuses at WG 22-23 can neither completely exclude an abnormal ultrasound at a later WG and the birth of a severely damaged child nor the birth of neonates which are afflicted by single manifestations at birth or later and of the kind which are not detectable by currently available ultrasonographic techniques.     

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.     

A study on cytomegalovirus infection in 199 pregnant women and their infants

Cytomegalovirus (CMV) infection is common in human, and exerts harmful effects during pregnancy upon fetuses. In order to get a clear knowledge of CMV infection rate in pregnant women and their infants and of the relationship between maternal infection and congenital infection in our city, we tried to detect the CMV specific IgG and IgM in 199 paired serum samples of mother and infant. The results showed that 183 maternal serum samples and 179 umbilical cord serum samples were CMV-IgG positive, a positive rate of 92% and 90% respectively. While 6 maternal serum samples and 7 umbilical cord serum sample were CMV-IgM positive, a positive rate of 3.0% and 3.5% respectively. The close correlation of CMV-IgM levels between mothers and their babies indicates that the infant may acquire congenital infection from his CMV-IgM positive mother.     

Prevention and treatment of fetal cytomegalovirus infection with cytomegalovirus hyperimmune globulin: a multicenter study in Madrid

Introduction: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection.

Materials and methods: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009–2015, CMV-HIG (Cytotect^® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy.

Results: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38–40) and two children (5.5%) were premature (born at 28 and 34 weeks’ gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3–1185; p?=?.007).

Discussion: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.     

Herpes simplex virus testing of an obstetric population with an antigen enzyme-linked immunosorbent assay

Commercial herpes simplex virus antigen enzyme-linked immunosorbent assay kits were compared to conventional culture for herpes simplex virus with 3237 genital specimens from obstetric patients. These rapid enzyme-linked immunosorbent assay tests had a sensitivity of 34.3% and specificity of 98.1% with primarily cervical specimens from asymptomatic patients. Specimens from vulvar swabs had higher positive rates than those from cervical swabs from the same patient, whether symptomatic or asymptomatic with both culture and enzyme-linked immunosorbent assay. Fifty-six women had enzyme-linked immunosorbent assay false positive tests; use of enzyme-linked immunosorbent assay testing alone could have resulted in 1.7% unnecessary cesarean deliveries. Six cases of neonatal herpes simplex virus infection were identified; two of the mothers had negative cervical cultures the week of delivery preceded by positive vulvar cultures.     

Congenital cytomegalovirus infection among twin pairs

Objective: The purpose of this study was to describe the fetal/neonatal cytomegalovirus (CMV) status according to chorionicity and outcome in twin pregnancies diagnosed with CMV.

Methods: An opportunistic diagnosis of CMV infection was performed in a tertiary referral center. All cases diagnosed in twin pregnancies (2006–2011) were included. Prenatal diagnosis was performed by CMV-DNA in the amniotic fluid (AF) of both fetuses only on the evidence of sonographic findings in either one or both twins. Neonatal screening was selectively assessed in symptomatic newborns, preterm, and infants born to HIV-infected mothers. Congenital infection was considered in the presence of CMV-DNA in AF, fetal tissues or newborn urine within the first 2 weeks of life, and symptomatic disease with clinical findings at birth or autopsy.

Results: A total of six twin pregnancies with congenital CMV infection were diagnosed, five dichorionic and one monochorionic diamniotic. Only one sibling was infected among dichorionic pregnancies, two diagnosed prenatally, and three after birth. In the monochorionic pregnancy, the diagnosis was performed prenatally and the two fetuses were infected and severely damaged.

Conclusions: Congenital CMV infection in twins might be related, among other factors, to chorionicity, and in DC twins a non-concordant infection can be expected.     

婴儿巨细胞病毒肺炎40例临床分析

摘要：目的　探讨婴儿巨细胞病毒（CMV）肺炎的临床特点及诊治方法。方法　选取2005年5月至2006年7月于中国医科大学附属盛京医院小儿呼吸科住院的年龄1个月至1岁肺炎患儿60例,以血清CMV IgM抗体（CMV-IgM）阳性及尿CMV-DNA定量阳性的40例肺炎患儿为观察组;以CMV-IgM及尿CMV-DNA定量均阴性的20例肺炎患儿为对照组;将两组临床资料进行对比分析。结果　观察组较对照组在咳嗽、喘息、呼吸困难的临床表现方面差异无统计学意义（P > 0.05）;观察组肺部的喘鸣音和水泡音等体征少于对照组,差异有统计学意义（P < 0.05）。CMV肺炎的影像学诊断主要依靠肺CT,其敏感度为100％,而肺计算机X线摄影（CR）仅为29.4％。观察组中30例患儿予以更昔洛韦治疗,10例未用;更昔洛韦治疗组22例治愈,治愈率73.3％;未应用更昔洛韦组治愈率20.0％,两组比较有统计学意义（P < 0.05）。结论　婴儿CMV肺炎临床表现缺乏特异性,肺部体征不典型,普通胸片不易发现炎症,容易误诊。对疑诊患儿需及时检测血清CMV-IgM及尿CMV-DNA,及时做肺CT检查;确诊后首选更昔洛韦治疗。     

Prenatal diagnosis of fetal cytomegalovirus infection after primary or recurrent maternal infection

OBJECTIVE: To determine the reliability of prenatal diagnosis of cytomegalovirus infection in women with primary or recurrent infection. METHODS: Amniotic fluid (AF) samples from 117 pregnant women were evaluated for cytomegalovirus culture and cytomegalovirus-DNA detection. Neonatal and postnatal samples also were examined to confirm or exclude transmission of maternal-fetal cytomegalovirus infection. RESULTS: Of 25 women with primary cytomegalovirus infection, 13 (52%) had cytomegalovirus-positive AF samples by polymerase chain reaction (PCR), nine of which also were diagnosed by culture. All eight neonates born to mothers whose AF was cytomegalovirus-positive by PCR and culture were cytomegalovirus infected, and three were symptomatic. One aborted fetus had cytomegalovirus-DNAemia. Of four women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates and two aborted (one fetus had cytomegalovirus encephalopathy). Of 45 mothers with recurrent infection, two with AF cytomegalovirus-positive by PCR and culture, and another with cytomegalovirus-positive AF samples by PCR only, aborted cytomegalovirus-DNA-positive fetuses. Of the other seven women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates, two delivered neonates cytomegalovirus-positive by PCR only (one was symptomatic), and three delivered infants cytomegalovirus-negative by PCR and culture. All 47 mothers with nonactive cytomegalovirus infection and cytomegalovirus-negative AF samples had uninfected neonates. Polymerase chain reaction was superior to viral culture in sensitivity and negative predictive value (100% compared with 57% and 94%, respectively) but was lower in specificity and positive predictive value (97% and 83%, respectively, compared with 100%). CONCLUSION: Prenatal diagnosis of fetal cytomegalovirus infection should include PCR in addition to viral culture, particularly for congenital cytomegalovirus infections following maternal recurrence.