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Biomedical subjects

M D Yow

Publications and source records attributed to M D Yow.

At least 19 recordsLinked to original sources
PubMed2001

Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection.

OBJECTIVE: To determine the ability of neonatal clinical, audiologic, and computed tomography (CT) findings to predict long-term neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection. METHODS: Longitudinal cohort study of children (n = 41) with symptomatic congenital CMV infection evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. The performance of birth characteristics as predictors of long-term outcome were determined, and clinical and CT scoring systems were developed and correlated with intellectual outcome. RESULTS: Microcephaly was the most specific predictor of mental retardation (100%; 95% CI 84.5-100) and major motor disability (92.3%; 95% CI 74.8-99). An abnormality detected by CT was the most sensitive predictor for mental retardation (100%; 95% CI 82.3-100) and motor disability (100%; 95% CI 78.2-100). A highly significant (P <.001) positive correlation was found between head size at birth and the intelligence/developmental quotient (IQ/DQ). Approximately 29% of children had an IQ/DQ >90. There was no association between sensorineural hearing loss at birth and cognitive outcome. However, children with sensorineural hearing loss on follow-up (congenital and late-onset) had a lower IQ/DQ (P =.006) than those with normal hearing. CONCLUSIONS: The presence of microcephaly at birth was the most specific predictor of poor cognitive outcome in children with symptomatic congenital CMV infection, whereas children with normal findings on head CT and head circumference proportional to weight exhibited a good cognitive outcome.

Cerebral Palsy↗
PubMed2000

Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection. Congenital CMV Longitudinal Study Group.

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital infection, and both symptomatic and asymptomatic infants may have long term sequelae. Children with congenital CMV infection are chronically infected and excrete CMV in the urine for prolonged periods. However, the effect of prolonged viral replication on the long term outcome of these children is unknown. OBJECTIVE: To determine whether duration of CMV excretion is associated with outcome at 6 years of life in symptomatic and asymptomatic congenitally infected children. METHODS: Longitudinal cohort study. Children congenitally infected with CMV were identified at birth and followed prospectively in a study of long term effects of congenital CMV infection. The relationship between duration of CMV urinary excretion and growth, neurodevelopment and presence and progression of sensorineural hearing loss (SNHL) at 6 years of age was determined. RESULTS: There was no significant difference in the duration of viral urinary excretion between children born with asymptomatic (median, 4.55 years) and symptomatic (median, 2.97 years) congenital CMV infection (P = 0.11). Furthermore there was no association between long term growth or cognitive outcome and duration of viral excretion. However, a significantly greater proportion of children who excreted CMV for <4 years had SNHL and progressive SNHL compared with children with CMV excretion >4 years (P = 0.019, P = 0.009, respectively). CONCLUSIONS: Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits. However, SNHL and progressive SNHL were associated with a shorter duration of CMV excretion.

Adolescent↗
PubMed1990

Asymptomatic congenital cytomegalovirus infection. Audiologic, neuroradiologic, and neurodevelopmental abnormalities during the first year.

Twenty-eight infants with asymptomatic congenital cytomegalovirus infection and 13 control infants were followed up prospectively. Congenital sensorineural hearing loss was documented by auditory brain-stem responses in four infected infants (two had mild bilateral loss, one had mild unilateral loss, and one had extreme unilateral loss) but in no controls. Four infected infants had diffuse periventricular radiolucencies on computed tomographic scan; none had calcifications or ventriculomegaly. No differences between groups were noted on neurologic examination results or on the Bayley Mental Developmental Index; however, one infected infant had a severely delayed Bayley Psychomotor Developmental Index score. In addition, the mean Mental Developmental Index score of the four infected infants with diffuse periventricular radiolucencies was significantly below that of the remaining infected infants (93 +/- 8 vs 109 +/- 13). These data suggest that asymptomatic congenital cytomegalovirus infection may be associated with a broad range of audiologic, subtle neuroradiologic, and neurodevelopmental differences in early infancy.

Cytomegalovirus Infections↗
PubMed1989

Prevalence of cytomegalovirus antibody in subjects between the ages of 6 and 22 years.

We determined the prevalence of antibody to cytomegalovirus (CMV) in three groups between 1985 and 1987. Group I consisted of 511 subjects 6-22 y old, group II consisted of 920 subjects 18-21 y old, and group III of 113 subjects 18-22 y old. The overall prevalence of antibody in these three groups was 34%, 24%, and 28%, respectively. Prevalence of antibody in white subjects (24%, 21%, and 24%, respectively) was significantly lower than that in nonwhite subjects. In group I, there was no increase in prevalence with age in white subjects, but the percentage of individuals with antibody increased with age among nonwhite subjects. It is of obvious concern that a large proportion of white women entering childbearing years lack CMV antibody.

Adolescent↗
PubMed1988

Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants.

In this longitudinal study of cytomegalovirus in 4578 pregnant women of middle/upper socioeconomic status in Houston, 52% had cytomegalovirus antibody when enrolled, and 48% were serologically susceptible. Studies were completed on 3899 mothers and their infants; 2.2% of these women experienced primary cytomegalovirus during pregnancy and 24% of those with primary infection transmitted cytomegalovirus to their infants. Of 22 cytomegalovirus-infected infants, 2 had disease at birth and 20 were asymptomatic. One symptomatic infant (primary maternal infection) has developmental delay. The other (immunocompromised mother with cytomegalovirus antibody before pregnancy) had hepatitis but has no symptoms at 1 year of age. On follow-up, 4 of 16 infants asymptomatic at birth have sequelae (hearing loss in 3, developmental delay in 1). All four were born to mothers with primary cytomegalovirus infection. Infant outcome was not related to trimester of maternal infection.

Antibodies, Viral↗
PubMed1988

Factors predictive of cytomegalovirus immune status in pregnant women.

We performed serological tests for antibody to cytomegalovirus on 1989 pregnant women of middle-to-upper socioeconomic status at the time of their first obstetric visit. Fifty percent of the women had antibody to cytomegalovirus. Analysis with a stepwise logistic regression model revealed that seropositivity was independently correlated with nonwhite race, less than 16 years of education, being breast-fed as an infant, the presence of children five to 18 years of age in the home, and maternal age greater than or equal to 30 years. Conversely, women not possessing these risk factors were more likely to be seronegative; 69% of the women without any of the five factors lacked antibody to cytomegalovirus. Serological screening for antibody would be more useful in obstetric practices where the majority of patients lack these risk factors.

Adolescent↗
PubMed1988

DNA hybridization assay for congenital cytomegalovirus infection.

An in vitro DNA hybridization assay was used to test 281 newborns for congenital infection with cytomegalovirus. The assay utilized an abbreviated method for DNA preparation and a dot blot assay that provided good sensitivity (100%) and specificity (98.9%) when compared with standard tissue culture, yet substantially reduced the total time of analysis. This assay would be a useful adjunct to tissue culture to diagnose newborns with congenital infection with cytomegalovirus.

Cytomegalovirus Infections↗
PubMed1987

Acquisition of cytomegalovirus infection from birth to 10 years: a longitudinal serologic study.

We performed serial serologic tests for cytomegalovirus (CMV) antibody in 177 children born to low- and middle-income families in Houston from 1975 to 1983. Mean duration of participation in the study was 4.8 years (range 1 to 9.6 years). Most rapid acquisition of antibody occurred during the first and second years of life, 13.6% and 12%, respectively; thereafter, annual acquisition varied from 1.5% to 4.6%, up to 10 years. Overall, 59 (33%) of the group were known to seroconvert by age 10 years. This was a minimal figure because of loss to follow-up. Analysis by the Kaplan-Meier method indicated that the probability of remaining seronegative was 65% at age 6 years, and 58% at age 8 years. Variables positively related to seroconversion by multivariate analysis were order of birth, seroconversion in a family member, and breast-feeding. During the first year of life, acquisition of CMV antibody was related to the seroimmune status of the mother. The variables of socioeconomic status, race, age of the mother, and attendance in a day care center did not appear to be related to seroconversion in these children.

Analysis of Variance↗
PubMed1987

Nosocomial cytomegalovirus infections within two hospitals caring for infants and children.

Using serology, virology, and molecular epidemiology, we investigated nosocomial transmission of cytomegalovirus (CMV) over a two-year period in two contrasting environments: a crowded, busy pediatric chronic care unit (337 patients, 43 nurses, and 76 therapists; average prevalence of CMV excretion in patients, 16%) and a small neonatal unit (293 patients and 69 nurses; average prevalence, 0.7%). In the chronic care unit no nurse or therapist acquired CMV, but two pairs of infants were infected with homologous strains of CMV, and patient-to-patient transmission was proven in one pair. In the neonatal unit no patients acquired CMV in the hospital, but two nurses seroconverted, with a nonoccupational source proven for one. Transmission from CMV-infected caretaker to patient did not occur in either environment. CMV was isolated from diapers as well as hands of patients and personnel but not from other environmental surfaces.

Adult↗
PubMed1986

Congenital cytomegalovirus infection and maternal systemic lupus erythematosus: a case report.

We describe an infant with symptomatic congenital cytomegalovirus infection, who was born to a mother with active systemic lupus erythematosus. Infection in the child resulted from reactivation of maternal cytomegalovirus infection. The mother's use of prednisone may have contributed to the reactivation. The role of maternal immunosuppression in the acquisition of congenital viral infection by the neonate is discussed.

Adult↗
PubMed1985

Acquisition of cytomegaloviral infections in families with young children: a serological study.

Acquisition of cytomegalovirus (CMV) infection in families with young children was investigated with serial serological tests for antibody to CMV by using ELISA and anti-complement immunoflourescence. Members of 68 Houston families were studied for a mean of 3.5 years. Seroconversion occurred in one or more members of 37 (53%) of 68 families studied. The mean annual seroconversion rate was 10% for fathers, 10.6% for mothers, and 10.3% for children. The attack rate for susceptible family members (including the index case) was 54%. The index case was the child in 10 instances, the father in 2, and the mother in 2. The index case could not be identified in 23 families. This Houston study indicates that the family with young children is a high-risk setting for CMV infection. This is an important concern regarding risks for mothers in their childbearing and child-rearing years.

Adolescent↗