Significance of postmyelinating white matter abnormalities in children with congenital cytomegalovirus

Background White matter abnormalities (WMAs), which are common in patients with congenital cytomegalovirus (cCMV) infection, have not been widely studied in terms of their impact on neurological prognosis. The aim of our study was to investigate the clinical significance of postmyelinating WMAs on magnetic resonance imaging (MRI) of the head in patients with cCMV infection. Methods This was a retrospective, single‐center, observational study conducted between January 2008 and December 2020 at Saitama Children's Medical Center, Japan. cCMV patients without intracranial morphologic abnormalities were divided into three groups according to the extent of WMA: Group I (no WMAs), Group II (limited to two lobes), and Group III (extended to three or more lobes). Results A total of 85 patients diagnosed with cCMV who underwent MRI after 18 months of age were analyzed. Sensorineural hearing loss was more common in Group III patients (64%, 14/22) than in Group I (15%, 5/34) and Group II patients (21%, 6/29) ( p < 0.01). In addition, poor neurodevelopmental outcomes were significantly more common in Group III patients (32%, 7/22) than in Group I patients (2.9%, 1/34) and Group II patients (7%, 2/29) ( p < 0.001). Conclusions We conclude that cCMV infection in patients with extensive WMAs, even if they are asymptomatic at birth, may contribute to the risk of neurological impairment and therefore requires more careful follow‐up.