Abstract：
OBJECTIVE: This case series aims to evaluate the long-term outcomes of congenital cytomegalovirus (CMV) infection in a population treated with valaciclovir during pregnancy. The study focuses on assessing the prevalence of long-term sequelae in infants with confirmed CMV fetal infection.
METHODS: A retrospective analysis was conducted on 33 pregnancies corresponding to 34 fetus with confirmed CMV congenital infection. They were followed from November 2004 to December 2020. Valaciclovir treatment was initiated after confirmation of fetal infection, and fetal outcomes were monitored through serial ultrasounds, neurosonography, and fetal magnetic resonance imaging (MRI). Postnatal assessments included: PCR confirmation, symptoms evaluation at birth, and long-term follow-up protocols for visual, auditory, and neurodevelopmental assessment.
RESULTS: Therapy was started at a median gestational age of 24 weeks. Of the 34 newborns 79.4 % were asymptomatic at birth. Median follow-up time was 6 years and 32.35 % developed long-term sequelae. Neurosensorial hearing loss (SNHL) was the predominant sequelae. In the cases which developed sequelae 54.5 % had imaging findings, and all with major findings developed long-term sequelae.
CONCLUSIONS: In our treated population we had a higher asymptomatic rate at birth comparing with a non-treated population, similar to those found in previous studies. We had a long-term sequelae rate of 32.35 %, similar to recent studies on non-treated population, although we registered a slightly lower rate of SNHL. A larger multicenter studies with a longer follow-up time, where treatment is started in the first trimester, is of the utmost importance, so we can truly understand the correlation between these imaging findings, therapy and long-term sequelae.
METHODS: A retrospective analysis was conducted on 33 pregnancies corresponding to 34 fetus with confirmed CMV congenital infection. They were followed from November 2004 to December 2020. Valaciclovir treatment was initiated after confirmation of fetal infection, and fetal outcomes were monitored through serial ultrasounds, neurosonography, and fetal magnetic resonance imaging (MRI). Postnatal assessments included: PCR confirmation, symptoms evaluation at birth, and long-term follow-up protocols for visual, auditory, and neurodevelopmental assessment.
RESULTS: Therapy was started at a median gestational age of 24 weeks. Of the 34 newborns 79.4 % were asymptomatic at birth. Median follow-up time was 6 years and 32.35 % developed long-term sequelae. Neurosensorial hearing loss (SNHL) was the predominant sequelae. In the cases which developed sequelae 54.5 % had imaging findings, and all with major findings developed long-term sequelae.
CONCLUSIONS: In our treated population we had a higher asymptomatic rate at birth comparing with a non-treated population, similar to those found in previous studies. We had a long-term sequelae rate of 32.35 %, similar to recent studies on non-treated population, although we registered a slightly lower rate of SNHL. A larger multicenter studies with a longer follow-up time, where treatment is started in the first trimester, is of the utmost importance, so we can truly understand the correlation between these imaging findings, therapy and long-term sequelae.
摘要：
目的：本病例系列旨在评估妊娠期间接受伐昔洛韦治疗的人群中先天性巨细胞病毒（CMV）感染的长期结局。该研究的重点是评估已确诊CMV胎儿感染的婴儿长期后遗症的患病率。
方法：对33例妊娠，对应34例确诊为CMV先天性感染的胎儿进行回顾性分析。从2004年11月到2020年12月。在确认胎儿感染后开始伐昔洛韦治疗，通过连续超声监测胎儿结局，神经超声检查,和胎儿磁共振成像（MRI）。产后评估包括：PCR确认，出生时的症状评估，以及视觉的长期随访方案，听觉,和神经发育评估。
结果：治疗开始于中位胎龄24周。在34例新生儿中，有79.4％的新生儿在出生时无症状。中位随访时间为6年，有32.35%的患者出现长期后遗症。神经感觉性听力损失（SNHL）是主要的后遗症。在出现后遗症的病例中，54.5%有影像学发现，所有有重大发现的人都会长期后遗症。
结论：在我们接受治疗的人群中，与未接受治疗的人群相比，出生时无症状率更高，类似于以前的研究。长期后遗症率为32.35%,类似于最近对未治疗人群的研究，尽管我们记录的SNHL比率略低。更大的多中心研究，随访时间更长，在妊娠早期开始治疗的地方，是最重要的,所以我们可以真正理解这些成像发现之间的相关性，治疗和长期后遗症。
方法：对33例妊娠，对应34例确诊为CMV先天性感染的胎儿进行回顾性分析。从2004年11月到2020年12月。在确认胎儿感染后开始伐昔洛韦治疗，通过连续超声监测胎儿结局，神经超声检查,和胎儿磁共振成像（MRI）。产后评估包括：PCR确认，出生时的症状评估，以及视觉的长期随访方案，听觉,和神经发育评估。
结果：治疗开始于中位胎龄24周。在34例新生儿中，有79.4％的新生儿在出生时无症状。中位随访时间为6年，有32.35%的患者出现长期后遗症。神经感觉性听力损失（SNHL）是主要的后遗症。在出现后遗症的病例中，54.5%有影像学发现，所有有重大发现的人都会长期后遗症。
结论：在我们接受治疗的人群中，与未接受治疗的人群相比，出生时无症状率更高，类似于以前的研究。长期后遗症率为32.35%,类似于最近对未治疗人群的研究，尽管我们记录的SNHL比率略低。更大的多中心研究，随访时间更长，在妊娠早期开始治疗的地方，是最重要的,所以我们可以真正理解这些成像发现之间的相关性，治疗和长期后遗症。
