perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2017-62-1-10-18perinatology-446Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSВрожденная цитомегаловирусная инфекция: диагностика, лечение и профилактикаCongenital cytomegalovirus infection: Diagnosis, treatment, and preventionКарповаА. Л.KarpovaA. L.

к.м.н., зам. главного врача по детству Перинатального центра Калужской областной клинической больницы, ассистент кафедры поликлинической терапии и клинической лабораторной диагностики с курсом общей врачебной практики Института последипломного образования Ярославского государственного медицинского университета 248007 Калуга, ул. Вишневского, д. 1

НароганМ. В.NaroganM. V.

д.м.н., вед. научн. сотр. Научного центра акушерства, гинекологии и перинатологии им. академика В.И. Кулакова, профессор кафедры неонатологии 1 МГМУ имени М.И. Сеченова. 117997 Москва, ул. Академика Опарина, д. 4

КарповН. Ю.KarpovN. Yu.

зав. акушерским отделением Тутаевской ЦРБ 150000 Ярославль, ул. Революционная, д. 5

ГБУЗ Калужской области «Калужская областная клиническая больница», Калуга ГБОУ ВПО «Ярославский государственный медицинский университет» Минздрава РФРоссияKaluga Reginal Clinical Hospital Yaroslavl State Medical University, Ministry of Health of the Russian FederationRussian FederationФГБУ «Научный центр акушерства, гинекологии и перинатологии им. академика В.И.Кулакова» Минздрава РФ Первый Московский государственный медицинский университет имени М.И.СеченоваРоссияAcademician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation I.M. Sechenov First Moscow State Medical UniversityRussian FederationГБУЗ Ярославской области «Тутаевская ЦРБ»РоссияTutaev Central District Hospital, TutaevRussian Federation2017060420176211018Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20172017Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/446

Врожденная цитомегаловирусная инфекция – инфекционное заболевание, развивающееся в результате антенатального трансплацентарного заражения плода цитомегаловирусом. Указанный вирус является наиболее распространенной причиной врожденных инфекций во всем мире. Врожденная цитомегаловирусная инфекция может развиваться как после первичного заражения серонегативной беременной женщины (primary), так и за счет реактивации вируса или реинфекции другими штаммами во время беременности (non-primary). В неонатальном периоде у 85–90% детей, инфицированных внутриутробно, наблюдается бессимптомное или субклиническое течение болезни. В остальных случаях клиническая картина характеризуется поражением различных органов и нередко вовлечением ЦНС. При тяжелом течении заболевания проводится медикаментозное лечение противовирусными препаратами, относящимися до сих пор к группе «off-label». У детей, инфицированных цитомегаловирусом внутриутробно, даже при отсутствии симптомов в неонатальном периоде, могут развиваться отдаленные последствия, наиболее часто – тугоухость. Для своевременного лечения и реабилитации отдаленных проявлений врожденной цитомегаловирусной инфекции рекомендуется проводить контроль слуха, офтальмологическое и неврологическое наблюдение до школьного возраста. Важной стратегией снижения частоты врожденной цитомегаловирусной инфекции является профилактика заболевания у беременных женщин путем распространения информации о заболевании в общедоступных источниках и обучения несложным гигиеническим мероприятиям.

Congenital cytomegalovirus infection is an infectious disease that results from antenatal transplacental transmission of cytomegalovirus to a fetus. The above virus is the most common cause of congenital infections worldwide. Congenital cytomegalovirus infection may develop both after primary infection of a seronegative pregnant women (primary) and due to reactivation of the virus or reinfection with other virus strains during pregnancy (non-primary). In the neonatal period, 85-90% of children infected in utero are observed to have an asymptomatic or subclinical course of the disease. In other cases, the clinical picture is characterized by lesions of various organs and by frequent CNS involvement. In its severe course, the disease is treated with antiviral drugs that are so far referred to as an “off-label” group. Even in the absence of symptoms in the neonatal period, the babies infected with CMV in utero may develop late sequels, with hearing loss being most common. Preschool hearing control and ophthalmologic and neurologic monitoring are recommended for the timely treatment and rehabilitation of late manifestations of congenital cytomegalovirus infection. The important strategy to reduce the incidence of congenital cytomegalovirus infection is its prevention in pregnant women, by disseminating information about the disease in the publicly accessible sources of information and by teaching simple hygienic practices.

детиврожденная цитомегаловирусная инфекцияЦНСслуххориоретинитганцикловирвалганцикловирchildrencongenital cytomegalovirus infectioncentral nervous systemhearingchorioretinitisganciclovirvalganciclovirReferencesSwanson E.C., Schleiss M.R. Congenital Cytomegalovirus Infection: New Prospects for Prevention and Therapy. Pediatr Clin North Am 2013; 60: (2): 335–349.Swanson E.C., Schleiss M.R. Congenital Cytomegalovirus Infection: New Prospects for Prevention and Therapy. Pediatr Clin North Am 2013; 60: (2): 335–349.Halwachs-Baumann G. (Ed.). Congenital Cytomegalovirus Infection. Epidemiology, Diagnosis, Therapy. SpringerWien-NewYork, 2011; 149.Halwachs-Baumann G. (Ed.). Congenital Cytomegalovirus Infection. Epidemiology, Diagnosis, Therapy. SpringerWien-NewYork, 2011; 149.Никонов А.П., Асцатурова О.Р. Цитомегаловирусная инфекция. Педиатрия. Приложение к журналу Consilium Medicum 2009; (1): 7–10. [Nikonov A.P., Ascaturova O.R. Cytomegalovirus Infection. Pediatriya. Supplement to the journal Consilium Medicum 2009; (1): 7–10. (in Russ)]Никонов А.П., Асцатурова О.Р. Цитомегаловирусная инфекция. Педиатрия. Приложение к журналу Consilium Medicum 2009; (1): 7–10. [Nikonov A.P., Ascaturova O.R. Cytomegalovirus Infection. Pediatriya. Supplement to the journal Consilium Medicum 2009; (1): 7–10. (in Russ)]Volpe J.J. Neurology of the newborn. 5th edition. Saunders Elsevier, 2008; 1094.Volpe J.J. Neurology of the newborn. 5th edition. Saunders Elsevier, 2008; 1094.Gomella T.L. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. McGraw-Hill, 2013; 698.Gomella T.L. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. McGraw-Hill, 2013; 698.Reddehase M. J. (Ed.). Cytomegaloviruses From Molecular Pathogenesis to Intervention. Norfolk, UK: Caister Academic Press, 2013; 539.Reddehase M. J. (Ed.). Cytomegaloviruses From Molecular Pathogenesis to Intervention. Norfolk, UK: Caister Academic Press, 2013; 539.Cannon M.J., Griffiths P.D., Aston V., Rawlinson W.D. Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit? Rev Med Virol 2014; (24): 291–307.Cannon M.J., Griffiths P.D., Aston V., Rawlinson W.D. Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit? Rev Med Virol 2014; (24): 291–307.Williams E.J., Kadambari S., Berrington J.E. et al. Feasibility and acceptability of targeted screening for congenital CMVrelated hearing loss. Arch Dis Child Fetal Neonatal Ed 2014; 99: F230–F236.Williams E.J., Kadambari S., Berrington J.E. et al. Feasibility and acceptability of targeted screening for congenital CMVrelated hearing loss. Arch Dis Child Fetal Neonatal Ed 2014; 99: F230–F236.Lanzieri T.M., Dollard S.C., Bialek S.R., Grosse S.D. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis 2014; (22): 44–48.Lanzieri T.M., Dollard S.C., Bialek S.R., Grosse S.D. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis 2014; (22): 44–48.Mussi-Pinhata M.M., Yamamoto A.Y., Britt R.M. et al. Birth prevalence and natural history of congenital cytomegalovirus infection in a highly seroimmune population. Clin Infect Dis 2009; (15): 522–528.Mussi-Pinhata M.M., Yamamoto A.Y., Britt R.M. et al. Birth prevalence and natural history of congenital cytomegalovirus infection in a highly seroimmune population. Clin Infect Dis 2009; (15): 522–528.Townsend C.L., Forsgren M., Ahlfors K., Ivarsson S.A., Tookey P.A., Peckham C.S. Long- term Outcomes of Congenital Cytomegalovirus Infection in Sweden and the United Kingdom. Clinical Infectious Diseases 2013; 56: (9): 1232–1239. DOI: 10.1093/cid/cit018.Townsend C.L., Forsgren M., Ahlfors K., Ivarsson S.A., Tookey P.A., Peckham C.S. Long- term Outcomes of Congenital Cytomegalovirus Infection in Sweden and the United Kingdom. Clinical Infectious Diseases 2013; 56: (9): 1232–1239. DOI: 10.1093/cid/cit018.Manicklal S., Emery V.C., Lazzarotto T., Boppana S.B., Gupta R.K. The «Silent» Global Burden of Congenital Cytomegalovirus. Clin Microbiol Rev 2013; 26: (1): 86–102. DOI: 10.1128/CMR.00062–12.Manicklal S., Emery V.C., Lazzarotto T., Boppana S.B., Gupta R.K. The «Silent» Global Burden of Congenital Cytomegalovirus. Clin Microbiol Rev 2013; 26: (1): 86–102. DOI: 10.1128/CMR.00062–12.Yamamoto A.Y., Mussi-Pinhata M.M., Boppana S.B., Novak Z., Wagatsuma V.M., Oliveira P.F. et al. Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. Am J Obstet Gynecol 2010; 202: (3): 297.e1-8. DOI: 10.1016/j.ajog.2009.11.018.Yamamoto A.Y., Mussi-Pinhata M.M., Boppana S.B., Novak Z., Wagatsuma V.M., Oliveira P.F. et al. Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. Am J Obstet Gynecol 2010; 202: (3): 297.e1-8. DOI: 10.1016/j.ajog.2009.11.018.Boppana S.B., Ross S.A., Fowler K.B. Congenital Cytomegalovirus Infection: Clinical Outcome. Clin Infect Dis 2013; 57: S4: S178–181. DOI: 10.1093/cid/cit629.Boppana S.B., Ross S.A., Fowler K.B. Congenital Cytomegalovirus Infection: Clinical Outcome. Clin Infect Dis 2013; 57: S4: S178–181. DOI: 10.1093/cid/cit629.Buonsenso D., Serranti D., Gargiullo L., Ceccarelli M., Ranno O., Valentini P. Congenital cytomegalovirus infection: current strategies and future perspectives. Eur Rev Med Pharmacol Sci 2012; (16): 919–935.Buonsenso D., Serranti D., Gargiullo L., Ceccarelli M., Ranno O., Valentini P. Congenital cytomegalovirus infection: current strategies and future perspectives. Eur Rev Med Pharmacol Sci 2012; (16): 919–935.Fox G., Hoque N., Watts T. (Ed.) Oxford handbook of neonatology. New York: Oxford university press, 2010; 523.Fox G., Hoque N., Watts T. (Ed.) Oxford handbook of neonatology. New York: Oxford university press, 2010; 523.Ghekiere S., Allegaert K., Cossey V., Van Ranst M., Cassiman C., Casteels I. Ophthalmological Findings in Congenital Cytomegalovirus Infection: When to Screen, When to Treat? J Pediatr Ophthalmol Strabismus 2012; (49): 274–282. DOI: 10.3928/01913913-20120710-03.Ghekiere S., Allegaert K., Cossey V., Van Ranst M., Cassiman C., Casteels I. Ophthalmological Findings in Congenital Cytomegalovirus Infection: When to Screen, When to Treat? J Pediatr Ophthalmol Strabismus 2012; (49): 274–282. DOI: 10.3928/01913913-20120710-03.Hayakawa J., Kawakami Y., Takeda S., Ozawa H, Fukazawa R., Takase M., Fukunaga Yu. A neonate with reduced cytomegalovirus DNA copy number and marked improvement of hearing in the treatment of congenital cytomegalovirus infection. J Nippon Med Sch 2012; (79): 471–477.Hayakawa J., Kawakami Y., Takeda S., Ozawa H, Fukazawa R., Takase M., Fukunaga Yu. A neonate with reduced cytomegalovirus DNA copy number and marked improvement of hearing in the treatment of congenital cytomegalovirus infection. J Nippon Med Sch 2012; (79): 471–477.Nigro G., Adler S.P. Hyperimmunoglobulin for Prevention of Congenital Cytomegalovirus Disease. Clin Infect Dis 2013; 57: S4: 193–195.Nigro G., Adler S.P. Hyperimmunoglobulin for Prevention of Congenital Cytomegalovirus Disease. Clin Infect Dis 2013; 57: S4: 193–195.Nigro G. Maternal–fetal cytomegalovirus infection: From diagnosis to therapy. J Matern Fetal Neonatal Med 2009; 22: (2): 169–174. DOI: 10.1080/14767050802609767.Nigro G. Maternal–fetal cytomegalovirus infection: From diagnosis to therapy. J Matern Fetal Neonatal Med 2009; 22: (2): 169–174. DOI: 10.1080/14767050802609767.Picone O., Teissier N., Cordier A.G. Vauloup-Fellous C., Adle-Biassette H., Martinovic J. et al. Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection. Prenat Diagn 2014; (34): 1–7. DOI: 10.1002/pd.4340.Picone O., Teissier N., Cordier A.G. Vauloup-Fellous C., Adle-Biassette H., Martinovic J. et al. Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection. Prenat Diagn 2014; (34): 1–7. DOI: 10.1002/pd.4340.Irizarry K., Honigbaum S., Demmler-Harrison G., Rippel S., Wilsey M.Jr. Successful Treatment with Oral Valganciclovir of Primary CMV Enterocolitis in a Congenitally Infected Infant. Fetal Pediatr Pathol 2011; (30): 437–441. DOI: 10.3109/15513815.2011.587501.Irizarry K., Honigbaum S., Demmler-Harrison G., Rippel S., Wilsey M.Jr. Successful Treatment with Oral Valganciclovir of Primary CMV Enterocolitis in a Congenitally Infected Infant. Fetal Pediatr Pathol 2011; (30): 437–441. DOI: 10.3109/15513815.2011.587501.Bar-Meir M., Farrow K.N., Melin-Aldana H., Chadwick E.G. Cytomegalovirus Enterocolitis Mimicking Necrotizing Enterocolitis: Case Report and Review of the Literature. J Ped Infect Dis 2013; 2: (1): 71–75.Bar-Meir M., Farrow K.N., Melin-Aldana H., Chadwick E.G. Cytomegalovirus Enterocolitis Mimicking Necrotizing Enterocolitis: Case Report and Review of the Literature. J Ped Infect Dis 2013; 2: (1): 71–75.Khan R., Ranganathan M., Mondal T. Congenital Cytomegalovirus ( Cmv) Infection and Ascending Aorta Dilation. J Cardiol Curr Res 2015; 4: (1): 00130. DOI: 10.15406/jccr.2015.04.00130.Khan R., Ranganathan M., Mondal T. Congenital Cytomegalovirus ( Cmv) Infection and Ascending Aorta Dilation. J Cardiol Curr Res 2015; 4: (1): 00130. DOI: 10.15406/jccr.2015.04.00130.Alarcon A., Martinez-Biarge M., Cabanas F., Hernanz A., Quero J., Garcia-Alix A. Clinical, Biochemical, and Neuroimaging Findings Predict Long-Term Neurodevelopmental Outcome in Symptomatic Congenital Cytomegalovirus Infection. J Pediatr 2013; 163: 828-834. DOI: 10.1016/j.jpeds.2013.03.014.Alarcon A., Martinez-Biarge M., Cabanas F., Hernanz A., Quero J., Garcia-Alix A. Clinical, Biochemical, and Neuroimaging Findings Predict Long-Term Neurodevelopmental Outcome in Symptomatic Congenital Cytomegalovirus Infection. J Pediatr 2013; 163: 828-834. DOI: 10.1016/j.jpeds.2013.03.014.Nishida K., Morioka I., Nakamachi Y., Kobayashi Y., Imanishi T., Kawano S. et al. Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment. Brain Dev 2015, http://dx.DOI:.org/10.1016/j.braindev.2015.08.003.Nishida K., Morioka I., Nakamachi Y., Kobayashi Y., Imanishi T., Kawano S. et al. Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment. Brain Dev 2015, http://dx.DOI:.org/10.1016/j.braindev.2015.08.003.Capretti M.G., Lanari M., Tani G., Ancora G., Sciutti R., Marsico C. et al. Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection. Brain Dev 2014; (36): 203–211. DOI: 10.1016/j.braindev.2013.04.001.Capretti M.G., Lanari M., Tani G., Ancora G., Sciutti R., Marsico C. et al. Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection. Brain Dev 2014; (36): 203–211. DOI: 10.1016/j.braindev.2013.04.001.Полин Р.А., Спитцер А.Р. Секреты неонатологии и перинатологии. Пер.с англ. Москва: БИНОМ, 2011; 622.Полин Р.А., Спитцер А.Р. Секреты неонатологии и перинатологии. Пер.с англ. Москва: БИНОМ, 2011; 622.[Polin R.A., Spitcer A.R. Secrets of Neonatology and Perinatology. Translation from English. Moscow: BINOM, 2011; 622. (in Russ)][Polin R.A., Spitcer A.R. Secrets of Neonatology and Perinatology. Translation from English. Moscow: BINOM, 2011; 622. (in Russ)]Adler S.P., Nigro G. Fetal infections: Cytomegalovirus, Herpes simplex, and Varicella. In: Neonatology. A practical approach to neonatal diseases. G. Buonocore, R. Bracci, M. Weindling (Eds). Springer-Verlag, Italia, 2012; 869–879.Adler S.P., Nigro G. Fetal infections: Cytomegalovirus, Herpes simplex, and Varicella. In: Neonatology. A practical approach to neonatal diseases. G. Buonocore, R. Bracci, M. Weindling (Eds). Springer-Verlag, Italia, 2012; 869–879.Bernard S., Wiener-Vacher S., Abbeele T.V.D., Teissier N. Disorders in Children With Congenital Cytomegalovirus Infection. Pediatrics 2015; 136: (4): e887–895.Bernard S., Wiener-Vacher S., Abbeele T.V.D., Teissier N. Disorders in Children With Congenital Cytomegalovirus Infection. Pediatrics 2015; 136: (4): e887–895.Turner K.M., Lee H.C., Boppana S.B., Carlo W.A., Randolph D.A. Incidence and Impact of CMV Infection in Very Low Birth Weight Infants. Pediatrics 2014; 133: e609–e615. DOI: 10.1542/peds.2013–2217.Turner K.M., Lee H.C., Boppana S.B., Carlo W.A., Randolph D.A. Incidence and Impact of CMV Infection in Very Low Birth Weight Infants. Pediatrics 2014; 133: e609–e615. DOI: 10.1542/peds.2013–2217.Duval M., Park A.H. Congenital cytomegalovirus: what the otolaryngologist should know. Curr Opin Otolaryngol Head Neck Surg 2014; (22): 495–500.Duval M., Park A.H. Congenital cytomegalovirus: what the otolaryngologist should know. Curr Opin Otolaryngol Head Neck Surg 2014; (22): 495–500.Павлова М.В., Федорова Н.Е., Гаджиева З.С., Адиева А.А., Евстигнеева Ж.В., Щербо С.Н. и др. Алгоритм лабораторной диагностики врожденной цитомегаловирусной инфекции у недоношенных детей и влияние терапии вифероном на течение внутриутробных инфекций. Педиатрия 2009; 87: (2): 55 – 62. [Pavlova M.V., Fedorova N.E., Gadzhieva Z.S., Adieva A.A., Evstigneeva Zh.V., Shherbo S.N. et al. Algorithm of laboratory diagnosis of congenital cytomegalovirus infection in preterm infants and the effect of therapy with viferon intrauterine infections. Pediatrija 2009; 87: (2): 55–62. (in Russ)]Павлова М.В., Федорова Н.Е., Гаджиева З.С., Адиева А.А., Евстигнеева Ж.В., Щербо С.Н. и др. Алгоритм лабораторной диагностики врожденной цитомегаловирусной инфекции у недоношенных детей и влияние терапии вифероном на течение внутриутробных инфекций. Педиатрия 2009; 87: (2): 55 – 62. [Pavlova M.V., Fedorova N.E., Gadzhieva Z.S., Adieva A.A., Evstigneeva Zh.V., Shherbo S.N. et al. Algorithm of laboratory diagnosis of congenital cytomegalovirus infection in preterm infants and the effect of therapy with viferon intrauterine infections. Pediatrija 2009; 87: (2): 55–62. (in Russ)]Ross S.A., Ahmed A., Palmer A.L., Michaels M.G., Sánchez P.J., Bernstein D.I. et al. Detection of Congenital Cytomegalovirus Infection by Real-Time Polymerase Chain Reaction Analysis of Saliva or Urine Specimens. The Journal of Infectious Diseases 2014; (210): 1415–1418. DOI: 10.1093/infdis/jiu263.Ross S.A., Ahmed A., Palmer A.L., Michaels M.G., Sánchez P.J., Bernstein D.I. et al. Detection of Congenital Cytomegalovirus Infection by Real-Time Polymerase Chain Reaction Analysis of Saliva or Urine Specimens. The Journal of Infectious Diseases 2014; (210): 1415–1418. DOI: 10.1093/infdis/jiu263.Boppana S.B., Ross S.A., Shimamura M., Palmer A.L., Ahmed A., Michaels M.G. et al. Saliva polymerase-chain-reaction assay for cytomegalovirus screening in newborns. N Engl J Med 2011; (364): 2111–2118. DOI: 10.1056/NEJMoa1006561.Boppana S.B., Ross S.A., Shimamura M., Palmer A.L., Ahmed A., Michaels M.G. et al. Saliva polymerase-chain-reaction assay for cytomegalovirus screening in newborns. N Engl J Med 2011; (364): 2111–2118. DOI: 10.1056/NEJMoa1006561.Lanary M., Lazzarotto T., Venturi V., Papa I., Gabrielli L., Guerra B. et al. Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and symptomatic congenitally infected newborns. Pediatrics 2006; 117: e76–83.Lanary M., Lazzarotto T., Venturi V., Papa I., Gabrielli L., Guerra B. et al. Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and symptomatic congenitally infected newborns. Pediatrics 2006; 117: e76–83.Boppana S.B., Fowler K.B., Pass R.F., Rivera L.B., Bradford R.D., Lakeman F.D., Britt W.J. Congenital cytomegalovirus infection: The association between virus burden in infancy and hearing loss. J Pediatr 2005; (146): 817–823.Boppana S.B., Fowler K.B., Pass R.F., Rivera L.B., Bradford R.D., Lakeman F.D., Britt W.J. Congenital cytomegalovirus infection: The association between virus burden in infancy and hearing loss. J Pediatr 2005; (146): 817–823.Walter S., Atkinson C., Sharland M., Rice P., Raglan E., Emery V.C., Griffiths P.D. Congenital cytomegalovirus: association between dried blood spot viral load and hearing loss. Arch Dis Child Fetal Neonatal Ed 2008; 93: F280–F285.Walter S., Atkinson C., Sharland M., Rice P., Raglan E., Emery V.C., Griffiths P.D. Congenital cytomegalovirus: association between dried blood spot viral load and hearing loss. Arch Dis Child Fetal Neonatal Ed 2008; 93: F280–F285.Запорожан В.Н., Старец Е.А., Дубковская М.В. Особенности нервно-психического развития и слуха у детей с внутриутробной трансмиссией цитомегаловируса. Перинатология и педиатрия 2013; (2): (54): 44–46. [Zaporozhan V.N., Starec E.A., Dubkovskaya M.V. Features of mental development, and hearing in children with intrauterine transmission of cytomegalovirus. Perinatologija i pediatrija 2013; (2): (54): 44–46. (in Russ)]Запорожан В.Н., Старец Е.А., Дубковская М.В. Особенности нервно-психического развития и слуха у детей с внутриутробной трансмиссией цитомегаловируса. Перинатология и педиатрия 2013; (2): (54): 44–46. [Zaporozhan V.N., Starec E.A., Dubkovskaya M.V. Features of mental development, and hearing in children with intrauterine transmission of cytomegalovirus. Perinatologija i pediatrija 2013; (2): (54): 44–46. (in Russ)]Forner G., Abate D., Mengoli C., Palù G., Gussetti N. High Cytomegalovirus (CMV) DNAemia Predicts CMV Sequelae in Asymptomatic Congenitally Infected Newborns Born to Women With Primary Infection During Pregnancy. J Infect Dis 2015; (212): 67–71. DOI: 10.1093/infdis/jiu627.Forner G., Abate D., Mengoli C., Palù G., Gussetti N. High Cytomegalovirus (CMV) DNAemia Predicts CMV Sequelae in Asymptomatic Congenitally Infected Newborns Born to Women With Primary Infection During Pregnancy. J Infect Dis 2015; (212): 67–71. DOI: 10.1093/infdis/jiu627.Ross S.A., Novak Z., Fowler K.B., Arora N., Britt W.J., Boppana S.B. Cytomegalovirus blood viral load and hearing loss in young children with congenital infection. Pediatr Infect Dis J2009; (28): 588–592. DOI: 10.1097/INF.0b013e3181979a27.Ross S.A., Novak Z., Fowler K.B., Arora N., Britt W.J., Boppana S.B. Cytomegalovirus blood viral load and hearing loss in young children with congenital infection. Pediatr Infect Dis J2009; (28): 588–592. DOI: 10.1097/INF.0b013e3181979a27.Park A.H., Mann D., Error M., Miller M., Firpo M.A., Wang Y. et al. Comparative analysis of detection methods for congenital cytomegalovirus infection in a guinea pig model. JAMA Otolaryngol Head Neck Surg 2013; (139): 82–86. DOI: 10.1001/jamaoto.2013.1090.Park A.H., Mann D., Error M., Miller M., Firpo M.A., Wang Y. et al. Comparative analysis of detection methods for congenital cytomegalovirus infection in a guinea pig model. JAMA Otolaryngol Head Neck Surg 2013; (139): 82–86. DOI: 10.1001/jamaoto.2013.1090.Hashaw J.B., Dudgeon J.A., Marshall W.C. Viral diseases of the fetus and newborn. Philadelphia: Saunders, 1985; 335.Hashaw J.B., Dudgeon J.A., Marshall W.C. Viral diseases of the fetus and newborn. Philadelphia: Saunders, 1985; 335.Dreher A.M., Arora N., Fowler K.B., Novak Z., Britt W.J., Boppana S.B., Ross S.A. Spectrum of Disease and Outcome in Children with Symptomatic Congenital Cytomegalovirus Infection. J Pediatr 2014; 164: (4): 855-859. DOI: 10.1016/j.jpeds.2013.12.007.Dreher A.M., Arora N., Fowler K.B., Novak Z., Britt W.J., Boppana S.B., Ross S.A. Spectrum of Disease and Outcome in Children with Symptomatic Congenital Cytomegalovirus Infection. J Pediatr 2014; 164: (4): 855-859. DOI: 10.1016/j.jpeds.2013.12.007.Goderis J., De Leenheer E., Smets K., Van Hoecke H., Keymeulen A., Dhooge I. Hearing loss and congenital CMV infection: a systematic review. Pediatrics 2014; 134: (5): 972-982. DOI: 10.1542/peds.2014–1173.Goderis J., De Leenheer E., Smets K., Van Hoecke H., Keymeulen A., Dhooge I. Hearing loss and congenital CMV infection: a systematic review. Pediatrics 2014; 134: (5): 972-982. DOI: 10.1542/peds.2014–1173.Kimberlin D.W., Jester P.M., Sanchez P.J., Ahmed A., Arav-Boger R., Michaels M.G. et al. Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease. N Engl J Med 2015; (372): 933–943. DOI: 10.1056/NEJMoa1404599.Kimberlin D.W., Jester P.M., Sanchez P.J., Ahmed A., Arav-Boger R., Michaels M.G. et al. Valganciclovir for Symptomatic Congenital Cytomegalovirus Disease. N Engl J Med 2015; (372): 933–943. DOI: 10.1056/NEJMoa1404599.Kimberlin D.W., Lin C.Y., Sanchez P.J., Demmler G.J., Dankner W., Shelton M. et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: A randomized, controlled trial. J Pediatr 2003; (143): 16–25.Kimberlin D.W., Lin C.Y., Sanchez P.J., Demmler G.J., Dankner W., Shelton M. et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: A randomized, controlled trial. J Pediatr 2003; (143): 16–25.Oschman A., Murthy V., Kollipara R., Kenneth Lord R., Oluola O. Intravitreal Ganciclovir for Neonatal Cytomegalovirus-Associated Retinitis: A Case Report. J Perinatol 2013; (33): 329–331. DOI: 10.1038/jp.2012.139.Oschman A., Murthy V., Kollipara R., Kenneth Lord R., Oluola O. Intravitreal Ganciclovir for Neonatal Cytomegalovirus-Associated Retinitis: A Case Report. J Perinatol 2013; (33): 329–331. DOI: 10.1038/jp.2012.139.Tawse K.L., Baumal C.R. Intravitreal foscarnet for recurring CMV retinitis in a congenitally infected premature infant. J AAPOS 2014; 18: (1): 78–80.Tawse K.L., Baumal C.R. Intravitreal foscarnet for recurring CMV retinitis in a congenitally infected premature infant. J AAPOS 2014; 18: (1): 78–80.Lacker A., Acham A., Alborno T., Moser M., Engele H., Raggam R.B. et al. Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up. J Laryngol Otol 2008; (30): 1–6. DOI: 10.1017/S0022215108003162.Lacker A., Acham A., Alborno T., Moser M., Engele H., Raggam R.B. et al. Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up. J Laryngol Otol 2008; (30): 1–6. DOI: 10.1017/S0022215108003162.Nassetta L, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies. J Antimicrob Chemother 2009; 63: (5): 862–867.Nassetta L, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies. J Antimicrob Chemother 2009; 63: (5): 862–867.Luck S.E., Emery V.C., Atkinson C., Sharland M., Griffiths P.D. Compartmentalized dynamics of cytomegalovirus replication in treated congenital infection. J Clin Virol 2016; (82): 152– 158. DOI: 10.1016/j.jcv.2016.07.018. Epub 2016 Jul 27.Luck S.E., Emery V.C., Atkinson C., Sharland M., Griffiths P.D. Compartmentalized dynamics of cytomegalovirus replication in treated congenital infection. J Clin Virol 2016; (82): 152– 158. DOI: 10.1016/j.jcv.2016.07.018. Epub 2016 Jul 27.Erice A. Resistance of Human Cytomegalovirus to Antiviral Drugs Clin Microbiol Rev 1999; 12: (2): 286–297.Erice A. Resistance of Human Cytomegalovirus to Antiviral Drugs Clin Microbiol Rev 1999; 12: (2): 286–297.Choi K.Y., Sharon B., Balfour Jr., Belani K., Pozos T.C., Schleiss M.R. Emergence of antiviral resistance during oral valganciclovir treatment of an infant with congenital cytomegalovirus (CMV) infection. J Clin Virol 2013; 57: (4): 356–360. DOI: 10.1016/j.jcv.2013.04.004.Choi K.Y., Sharon B., Balfour Jr., Belani K., Pozos T.C., Schleiss M.R. Emergence of antiviral resistance during oral valganciclovir treatment of an infant with congenital cytomegalovirus (CMV) infection. J Clin Virol 2013; 57: (4): 356–360. DOI: 10.1016/j.jcv.2013.04.004.Hughes B.L., Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM). Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016; 214: (6): B5–B11.Hughes B.L., Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM). Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016; 214: (6): B5–B11.Weng Y.H., Chu S.M., Lien R.I., Chou Y.H., Lin T.Y. Clinical experience with ganciclovir and anti-cytomegalovirus immunoglobulin treatment for a severe case of congenital cytomegalovirus infection. Chang Gung Med J 2003; 26: (2): 128–132.Weng Y.H., Chu S.M., Lien R.I., Chou Y.H., Lin T.Y. Clinical experience with ganciclovir and anti-cytomegalovirus immunoglobulin treatment for a severe case of congenital cytomegalovirus infection. Chang Gung Med J 2003; 26: (2): 128–132.Aslam M., Anderson J.L., Guglietti D., Cardwell D. CMV-induced neonatal thrombocytopenia: a case report and review of the literature. Am J Perinatol 2007; 24: (7): 429–434.Aslam M., Anderson J.L., Guglietti D., Cardwell D. CMV-induced neonatal thrombocytopenia: a case report and review of the literature. Am J Perinatol 2007; 24: (7): 429–434.Cekinović D., Golemac M., Pugel E.P., Tomac J., Cicin-Sain L., Slavuljica I. et al. Passive immunization reduces murine cytomegalovirus-induced brain pathology in newborn mice. J Virol 2008; 82: (24): 12172–12180. DOI: 10.1128/JVI.01214–08.Cekinović D., Golemac M., Pugel E.P., Tomac J., Cicin-Sain L., Slavuljica I. et al. Passive immunization reduces murine cytomegalovirus-induced brain pathology in newborn mice. J Virol 2008; 82: (24): 12172–12180. DOI: 10.1128/JVI.01214–08.Дубковская М.В. Анализ факторов, связанных с тяжестью течения врожденной цитомегаловирусной инфекции. Перинатология и педиатрия 2011; (1): (45): 116–120. [Dubkovskaya M.V. Analysis of factors associated with the severity of congenital cytomegalovirus infection. Perinatologija i pediatrija 2011; (1): (45): 116–120. (in Russ)]Дубковская М.В. Анализ факторов, связанных с тяжестью течения врожденной цитомегаловирусной инфекции. Перинатология и педиатрия 2011; (1): (45): 116–120. [Dubkovskaya M.V. Analysis of factors associated with the severity of congenital cytomegalovirus infection. Perinatologija i pediatrija 2011; (1): (45): 116–120. (in Russ)]Cannon M.J., Stowell J.D., Clark R., Dollard P.R., Johnson D., Mask K. et al. Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children. BMC Infect Dis. 2014; 14: 569. DOI: 10.1186/s12879-014-0569-1.Cannon M.J., Stowell J.D., Clark R., Dollard P.R., Johnson D., Mask K. et al. Repeated measures study of weekly and daily cytomegalovirus shedding patterns in saliva and urine of healthy cytomegalovirus-seropositive children. BMC Infect Dis. 2014; 14: 569. DOI: 10.1186/s12879-014-0569-1.Ross E.S., Dollard S.C., Victor M., Sumartojo E., Cannon M.J. The epidemiology and prevention of congenital cytomegalovirus infection and disease: Activities of the Centers For Disease Control and Prevention Workgroup. J Women’s Health 2006; 15: (3): 224–229.Ross E.S., Dollard S.C., Victor M., Sumartojo E., Cannon M.J. The epidemiology and prevention of congenital cytomegalovirus infection and disease: Activities of the Centers For Disease Control and Prevention Workgroup. J Women’s Health 2006; 15: (3): 224–229.Van Zuylen W.J., Hamilton S.T., Naing Z., Hall B., Shand A., Rawlinson W.D. Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention. Obstet Med 2014; (7): (4): 140–146. DOI: 10.1177/1753495X14552719.Van Zuylen W.J., Hamilton S.T., Naing Z., Hall B., Shand A., Rawlinson W.D. Congenital cytomegalovirus infection: Clinical presentation, epidemiology, diagnosis and prevention. Obstet Med 2014; (7): (4): 140–146. DOI: 10.1177/1753495X14552719.http://www.cdc.gov/cmv/clinical/features.html. Page last updated: June 17, 2016.http://www.cdc.gov/cmv/clinical/features.html. Page last updated: June 17, 2016.Cannon M.J., Westbrook K., Levis D., Schleiss M.R., Thackeray R., Pass R.F. Awareness of and behaviors related to childto- mother transmission of cytomegalovirus. Prev Med 2012; 54: (5): 351–357. DOI: 10.1016/j.ypmed.2012.03.009.Cannon M.J., Westbrook K., Levis D., Schleiss M.R., Thackeray R., Pass R.F. Awareness of and behaviors related to childto- mother transmission of cytomegalovirus. Prev Med 2012; 54: (5): 351–357. DOI: 10.1016/j.ypmed.2012.03.009.Jeon J., Victor M., Adler S., Arwady A., Demmler G., Fowler K. et al. Knowledge and awareness of congenital cytomegalovirus among women. Infect Dis Obstet Gynecol 2006; (2006): 1–7.Jeon J., Victor M., Adler S., Arwady A., Demmler G., Fowler K. et al. Knowledge and awareness of congenital cytomegalovirus among women. Infect Dis Obstet Gynecol 2006; (2006): 1–7.

The authors declare that there are no conflicts of interest present.