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Delivery and Stay in the Newborn Nursery
Since a pregnancy with CMV is not generally considered to be a high risk pregnancy, the delivery itself is not different in any way from a "normal” delivery, except for the postnatal protocol.
However, in the event of a pregnancy with CMV, it is important to select a hospital according to the neonatal care routine. Not every hospital has a proper procedure and there are hospitals that do not even perform the basic urinalysis after birth.
The importance of conducting these tests in maximal proximity to the date of birth stems primarily from the need to start treating the baby as soon as possible in case the findings in the tests indicate a symptomatic baby.
In addition, the performance of the tests during the stay in the nursery saves the need to deal with a lot of bureaucracy involved in scheduling appointments, receiving 17 forms and going to the hospital several times during the first weeks of the baby’s life.
Therefore, it is important to make sure that the hospital in which you choose to give birth, conducts the following procedure:
The tests which confirm whether the baby is born with congenital CMV:
Urinalysis - provides a reliable and a final result to the question whether the baby was infected during pregnancy. The result is obtained after a few days.
Saliva Test provides a reliable result only if it is negative and the fetus was not infected.
A positive result may stem from the passage through the birth canal (which contains the virus) or from breastfeeding, and therefore it is not conclusive. In case the saliva test is positive, urine is usually collected and tested for confirmation.
It is important to perform the urinalysis and/or the saliva test within two weeks after birth, because after said period it is unclear whether the infection is congenital or occurred during or after delivery.
Negative Result seals the pregnancy story with regard to CMV and there is no need to be concerned about the virus.
The virus has no postnatal adverse effect on the baby and thus, there is also no significance to infection due to the passage through the birth canal or as a result of breastfeeding.
Positive Result means that the baby was infected during pregnancy.
Several tests must be performed after birth if the result of the urinalysis is positive.
All tests are painless and non-invasive:
Cranial ultrasound is performed by a specialized pediatric radiologist.
Fundoscopy is done to rule out findings which are consistent with congenital infection.
BERA Test is a hearing test which checks the brainstem response to auditory stimulations.
You can read more about the test in the FAQ tab.
Results for Postnatal Examinations and Follow-up
If all the targeted scans for the virus were normal during pregnancy, it is expected to receive normal results in the cranial ultrasound and the fundoscopy after birth.
The risk is that a baby will suffer from hearing problems that cannot be detected for certain in the imaging tests during pregnancy.
If all postnatal examinations are normal, the baby will be defined as asymptomatic. These babies are healthy in every respect and are expected to have normal neurological development like any other child.
However, asymptomatic babies may experience hearing loss after birth and because of that, these children will be closely monitored by an infectious disease specialist and will undergo hearing follow-ups during their first years.
The follow-up will be carried out once every six months until the age of two years. The follow-up will include a BERA test and a meeting with an infectious disease specialist who will examine the results, measure the head circumference of the child and check the child’s development.
By the age of two years, the BERA test will be replaced by a subjective hearing test.
The evaluations are conducted until the age of four if there aren’t any problems along the way or until the age of five in case problems are detected.
If there is a hearing impairment or an abnormal ultrasound finding called LSV, indicating that the baby may suffer from hearing loss in the future, the baby will be given a drug called Valganciclovir that has proven to be effective in preventing hearing deterioration and even reversing the hearing loss caused by the virus.
The Israeli treatment protocol was established following the work of Professor Jacob Amir, one of the first doctors in the world who extended the use of said medicine, initially for six months and recently for the first year of the infant's life.
For more information about the medicine please see the FAQ tab.