Infant suffers uncommon complications from common virus

When Trudy Davis found out she was pregnant with twins, she was scared and knew it would be hard. When her newborn son Kaiden turned a yellow color and couldn't keep any food down, she was worried and took him to the emergency room.

Doctors told Davis, who turned 18 in November, that Kaiden had congenital cytomegalovirus. Though CMV is the most common virus transmitted to an unborn child, according to the Centers for Disease Control and Prevention, most cases go unnoticed and cause no harm.

Kaiden was born with symptomatic CMV. He has already lost hearing in one ear, had a double hernia operation and has been on a feeding tube for more than a week because he cannot keep food down.

His twin sister Jayden has shown no signs and tested negative twice. Davis was able to see Jayden recently when she returned to Cape Girardeau for a doctor's appointment, though the young mother and father have spent most of January with Kaiden in Cardinal Glennon Children's Medical Center in St. Louis.

The CDC reports that 10 out of every 1,000 babies born in the U.S. have CMV, but only one of those 10 may develop problems from it.

Kaiden Wipfler is being treated for complications from congenital cytomegalovirus at Cardinal Glennon Children's Medical Center in St. Louis. (Submitted photo)

CMV is the most common cause of deafness in children younger than 2, stunts growth and can cause a number of developmental problems. Congenital CMV can cause temporary lung problems, liver problems and jaundice -- the cause of Kaiden's yellowish color. Long-term effects include hearing loss, vision loss, lack of coordination, seizures, mental disability or death.

The virus passes through bodily fluids -- urine, semen and saliva. To contract it, a person must come into direct contact with another person who has an active virus. If a person then touches his own mouth, nose or eyes, he could catch the virus.

Doctors said changing diapers at day care or being around other unknowingly infected children are common ways to pass the virus. If an adult contracts CMV, symptoms may not show or will resemble mono or the common cold.

"But the effects on the fetus can be devastating," said Dr. Karlyle K. Christian-Ritter, medical director of the Saint Francis Medical Center Level III Neonatal Intensive Care Unit.

Kaiden "keeps losing weight. It's hard on the kids," said Teresa McLane, the twins' grandmother. "It's hard being 18 and having one baby and now having two and one being in the hospital."

When her son told her that Kaiden had CMV, McLane searched the term on the Internet. The mother and grandmother had never heard of the virus. McLane and Davis said the lack of information upsets them and they want women to be more aware.

Many pregnant women have children who are in day care, she said.

During her pregnancy, Davis traveled to and helped out in a day care as part of her school curriculum. She said the doctors warned her that because of her age and having twins, they might be born premature.

"They never said anything about CMV," she said.

One reason she may not have heard anything is because while symptomatic CMV and developmental problems are rare, CMV is quite common.

"It's ubiquitous," said Dr. Dean Huffman, a perinatologist at Saint Francis.

Between 50 and 80 percent of adults are infected with CMV by the age of 40, according to the CDC. Most cases are "silent," meaning they show no signs or symptoms, but if the person is pregnant, the virus can cause problems with the fetus.

"For most patients, it's not a problem," Huffman said. "One of the problems with cytomegalovirus is there's no vaccination for it. If there were, we would probably be giving it to most people."

CMV has many different strains, making it hard for doctors to develop a vaccine. One is in the works, but isoa only effective 50 percent of the time according a study reported in the March 2009 issue of the New England Journal of Medicine.

For now, doctors have to settle for identifying it and trying to prevent or treat the effects, which can include "global developmental delays," said Dr. Gary Olsen of Olsen Pediatrics.

There has been a surge in the medical community wondering if screenings should be performed, Christian-Ritter said. She has seen six cases of symptomatic CMV in the past year.

"I've seen more in the last year than I have in 16 years of being a neonatologist," she said.

But Olsen points out that to screen every baby for CMV would get expensive because to find the virus, doctors have to take a culture.

"Obviously they do it on the babies that have symptoms," he said. "A lot of these kids don't have symptoms."

Infants get metabolic screenings and are checked for sickle cell, cystic fibrosis and other issues when they're born. They are also screened for hearing problems. Though hearing loss is the No. 1 side-effect of CMV, those hearing screens won't always give the virus away.

"The thing is, with CMV, it's a progressive hearing loss," Christian-Ritter said.

The virus affects hearing because it anchors in the inner ears, causing destruction of the tissue. The body attacks the virus, but in killing the CMV, it kills part of the inner ear.

In newborn screening, medical professionals look for things they know about and can deliver treatment for right away. CMV has no real treatment.

Doctors usually find CMV because the child is small or not growing or has abnormal blood work.

Once a child is diagnosed with CMV, he is put into programs to curb the effects: speech and language therapy, possibly sign language, getting hearing aids, physical therapy.

"The best treatment would be prevention," Christian-Ritter said.

Pregnant women should steer clear of sick people in general and wash their hands often.

"We as people do not wash our hands enough," she said.

charris@semissourian.com

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