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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Pediatrics · Congenital Cytomegalovirus

Fetal & Newborn Symptoms of CMV

At a Glance

While 85% to 90% of babies with congenital CMV are born without symptoms, some may show ultrasound markers like brain calcifications or newborn signs like a rash and jaundice. All babies with cCMV require a diagnostic ABR hearing test and continuous monitoring for late-onset hearing loss.

Understanding how CMV affects a developing baby involves looking at both the biological “path” the virus takes and the physical signs it may leave behind. While every case is unique, knowing the range of possibilities can help you prepare for the conversations ahead with your medical team.

How CMV Affects Development

When the virus crosses the placenta, it can enter the baby’s bloodstream and travel to various organs [1]. Biologically, the virus can disrupt the way cells grow and move into place, particularly in the brain and the inner ear [2][3].

  • In the Brain: CMV can interfere with neuronal migration, which is the process where brain cells move to their correct locations during development [3]. This can lead to structural changes or “bright spots” known as calcifications [4].
  • In the Inner Ear: The virus often targets the stria vascularis, a part of the inner ear responsible for maintaining the chemical balance needed for hearing [5]. This damage is what leads to sensorineural hearing loss (SNHL) [6].

Signs to Look For

Doctors use imaging and physical exams to look for signs of CMV. These are often categorized as “symptomatic” or “asymptomatic.”

Fetal Markers (on Ultrasound or MRI)

If these findings are seen, it is completely natural to feel alarmed. However, remember that 85% to 90% of babies with cCMV are born completely asymptomatic and never show these severe markers [7][1].

  • Intracranial Calcifications: Small, bright spots in the brain [4].
  • Ventriculomegaly: Enlargement of the fluid-filled spaces in the brain [8].
  • Echogenic Bowel: The baby’s bowel appearing brighter than usual on ultrasound [9].
  • Microcephaly: A measurement showing the baby’s head is significantly smaller than expected for their age [10].

Newborn Symptoms

At birth, a “symptomatic” baby may show clinical signs such as:

  • Petechiae: Small red or purple spots on the skin caused by minor bleeding [10].
  • Hepatosplenomegaly: An enlarged liver and spleen [10].
  • Jaundice: A yellowing of the skin and eyes [10].

Asymptomatic vs. Symptomatic

It is important to understand the difference between these two categories, as they guide follow-up care:

  1. Symptomatic (approx. 10-15% of cases): These babies show physical signs of the virus at birth [10]. They are at a higher risk for long-term challenges, such as developmental delays or cerebral palsy [11][6].
  2. Asymptomatic (approx. 85-90% of cases): These babies appear completely healthy at birth and pass their physical exams [12][13].

The Critical Need for ABR Hearing Tests: The standard newborn hearing screen (an OAE test) can easily miss mild or high-frequency hearing loss that is already present at birth. Therefore, babies with cCMV require a diagnostic ABR (Auditory Brainstem Response) test for accurate evaluation [14][15]. Even if a baby passes an ABR test initially, they are still at a 7% to 15% risk for late-onset sensorineural hearing loss throughout childhood, making continuous monitoring essential [13][12].

Common questions in this guide

What are the signs of congenital CMV on a fetal ultrasound?
Doctors may see markers such as intracranial calcifications, an enlarged bowel, or microcephaly on a fetal ultrasound or MRI. However, it is important to remember that many babies with CMV have completely normal imaging.
What is the difference between symptomatic and asymptomatic cCMV?
Symptomatic babies show physical signs of the virus at birth, such as a spotty rash, an enlarged liver, or a smaller head size. Asymptomatic babies appear completely healthy at birth, which accounts for 85 to 90 percent of all cases.
Why does my baby need an ABR hearing test instead of the standard screen?
Standard newborn hearing screens can easily miss the mild or high-frequency hearing loss commonly caused by CMV. A diagnostic Auditory Brainstem Response (ABR) test provides a much more accurate evaluation of your baby's hearing pathways.
Can my baby develop hearing loss later if they pass their first hearing test?
Yes, even if a baby with CMV passes their initial ABR hearing test, they have a 7 to 15 percent risk of developing late-onset hearing loss during childhood. Because of this, continuous audiology monitoring is essential as your child grows.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is my baby considered 'symptomatic' or 'asymptomatic,' and why?
  2. 2.What specific findings on the ultrasound or MRI should we be concerned about?
  3. 3.How does the virus affect the inner ear, and why could hearing loss develop later even if my baby passes the first screen?
  4. 4.If my baby has an enlarged liver or spleen, what are the long-term implications?
  5. 5.Can we ensure my baby gets a diagnostic ABR hearing test, rather than just the standard newborn screen?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (15)
  1. 1

    Maternal cytomegalovirus immune status and hearing loss outcomes in congenital cytomegalovirus-infected offspring.

    Demmler-Harrison GJ, Miller JA,

    PloS one 2020; (15(10)):e0240172 doi:10.1371/journal.pone.0240172.

    PMID: 33035237
  2. 2

    High Incidence of Hippocampal Abnormalities in Pediatric Patients with Congenital Cytomegalovirus Infection.

    Natsume T, Inaba Y, Osawa Y, Fukuyama T

    Neuropediatrics 2022; (53(4)):239-245 doi:10.1055/a-1754-1142.

    PMID: 35098496
  3. 3

    Cytomegalovirus-induced pathology in human temporal bones with congenital and acquired infection.

    Tsuprun V, Keskin N, Schleiss MR, et al.

    American journal of otolaryngology 2019; (40(6)):102270 doi:10.1016/j.amjoto.2019.08.001.

    PMID: 31402062
  4. 4

    Results of Routine Antenatal Screening for Cytomegalovirus at a Tertiary Center.

    Tugrul Ersak D, Ozgurluk I, Bastemur AG, et al.

    Medeniyet medical journal 2023; (38(3)):167-171 doi:10.4274/MMJ.galenos.2023.84042.

    PMID: 37766584
  5. 5

    Hearing loss caused by CMV infection is correlated with reduced endocochlear potentials caused by strial damage in murine models.

    Yu Y, Shi K, Nielson C, et al.

    Hearing research 2022; (417()):108454 doi:10.1016/j.heares.2022.108454.

    PMID: 35131579
  6. 6

    The association between congenital cytomegalovirus infection and cerebral palsy: A systematic review and meta-analysis.

    Ong LT, Fan SWD

    Journal of paediatrics and child health 2022; (58(12)):2156-2162 doi:10.1111/jpc.16244.

    PMID: 36250689
  7. 7

    Secondary cytomegalovirus infections: How much do we still not know? Comparison of children with symptomatic congenital cytomegalovirus born to mothers with primary and secondary infection.

    Scaramuzzino F, Di Pastena M, Chiurchiu S, et al.

    Frontiers in pediatrics 2022; (10()):885926 doi:10.3389/fped.2022.885926.

    PMID: 35928677
  8. 8

    Diagnostic challenges in congenital cytomegalovirus infection in pregnancy: A case report.

    Mathias CR, Joung SJS

    Case reports in women's health 2019; (22()):e00119 doi:10.1016/j.crwh.2019.e00119.

    PMID: 31192993
  9. 9

    Cranial Ultrasound Findings in Infants With Congenital Cytomegalovirus Infection in a Universal Newborn Screening Study in Minnesota.

    Kruc RM, Osterholm EA, Holm T, et al.

    Journal of the Pediatric Infectious Diseases Society 2024; (13(8)):413-420 doi:10.1093/jpids/piae059.

    PMID: 38847778
  10. 10

    Brain MRI findings in newborns with congenital cytomegalovirus infection: results from a large cohort study.

    Vande Walle C, Keymeulen A, Schiettecatte E, et al.

    European radiology 2021; (31(10)):8001-8010 doi:10.1007/s00330-021-07776-2.

    PMID: 33787973
  11. 11

    Long-term impairment attributable to congenital cytomegalovirus infection: a retrospective cohort study.

    Korndewal MJ, Oudesluys-Murphy AM, Kroes ACM, et al.

    Developmental medicine and child neurology 2017; (59(12)):1261-1268 doi:10.1111/dmcn.13556.

    PMID: 28990181
  12. 12

    Usefulness of a flow chart for targeted screening of congenital cytomegalovirus-related hearing loss.

    Ciccia M, Monari C, Vitagliano G, et al.

    Journal of neonatal-perinatal medicine 2018; (11(3)):339-343 doi:10.3233/NPM-17110.

    PMID: 30040746
  13. 13

    Congenital cytomegalovirus infection diagnostics and management.

    Pinninti S, Boppana S

    Current opinion in infectious diseases 2022; (35(5)):436-441 doi:10.1097/QCO.0000000000000874.

    PMID: 35984001
  14. 14

    Congenital Cytomegalovirus-Associated Sensorineural Hearing Loss in Children: Identification Following Universal Newborn Hearing Screening, Effect of Antiviral Treatment, and Long-Term Hearing Outcomes.

    Rohren L, Shanley R, Smith M, et al.

    Ear and hearing 2024; (45(1)):198-206 doi:10.1097/AUD.0000000000001411.

    PMID: 37563758
  15. 15

    A Targeted Approach for Congenital Cytomegalovirus Screening Within Newborn Hearing Screening.

    Fowler KB, McCollister FP, Sabo DL, et al.

    Pediatrics 2017; (139(2)) doi:10.1542/peds.2016-2128.

    PMID: 28049114

This page explains fetal and newborn signs of congenital CMV for educational purposes. Your pediatrician, audiologist, and maternal-fetal medicine specialist are the best sources for evaluating your baby's specific health.

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