“At 18 months, she’s perfect!” my MD friend exclaimed. “So many times in my career, I’ve seen it go the other way.”
We were talking about one of her favorite patients: a tiny tot infected with cytomegalovirus while still in her mother’s womb. The name may be new, but the scourge is common. In fact, CMV is the U.S.’s leading congenital infection.
Transmitted in multiple ways (infected humans can shed virus in saliva, blood, and sexual secretions, among other fluids), CMV produces mild-to-moderate illness in most people. It wreaks far worse damage, however, in babies whose mothers are acutely infected during pregnancy.
But back to Dr. Chris Mink, one amazing pediatrician. On top of practicing “routine” pediatric infectious diseases at Harbor-UCLA Medical Center for more than 20 years, Mink’s work has spanned FDA vaccine reviews to treatment of HIV-infected children to caring for foster kids and international adoptees.
Mink has also cared for many CMV victims, needless to say. In most developed countries, CMV afflicts roughly 1 in 250 live births. Ten percent of infected newborns have telltale signs right away; without treatment, many of them develop mental retardation, cerebral palsy, hearing loss or visual impairment. Other babies infected at birth seem well at first but reveal damage later on.
Here’s another shocking fact. Experts currently estimate that CMV in newborns causes more permanent disability than either Down or fetal alcohol syndrome.
The good news? An estimated 50 to 80 percent of American women of child-bearing age are already immune to CMV, which virtually eliminates their chance of infecting their babies in utero.
In some newborns promptly diagnosed, there’s also treatment: an intravenous antiviral called ganciclovir. (Current data suggest that ganciclovir lessens CMV-induced hearing loss and other developmental impairments in congenitally-infected babies.)
But first doctors have to suspect the infection, prove the diagnosis, then treat in hospital for six weeks while supporting the babies (who are usually premature and underweight) in other ways.
In the case of Mink’s patient, the situation was especially poignant.
Although treated with ganciclovir, the little girl was born to a mom who didn’t want to keep her.
“How many strikes can you have against you?” Mink said. “Unwanted, no love and attention. At first she had a really hard time eating.”
Then a wonderful thing happened. A devoted foster parent took her home, and the child born with CMV began to thrive.
“She bonded with her new mom, started growing, and hasn’t stopped,” my friend enthused. “She’s now walking and talking and has already passed several milestones, like putting words together.”
Because saliva-based CMV tests have recently become available, some experts believe all newborn babies should be screened. Another strategy? Screening pregnant women. Once diagnosed with active CMV, in some cases, they can be treated before they deliver.
Education and prevention are also key. In particular, pregnant women who work in day care (a major site of CMV transmission) should be extremely conscientious about hand-washing and other hygiene measures.
Sometimes it’s good to reflect on how far we’ve come. Twenty-five years ago, another MD friend and his wife celebrated the birth of their first son.
Sadly, within months, it became clear their little boy had severe congenital CMV. Today, he resides permanently on a farm for developmentally disabled adults.
In 2011, many CMV-infected newborns can avoid a similar fate. In fact, Chris Mink predicts a far different future for her patient.
“It’s as if she has a little light inside her,” she told me. “I believe she is destined for great things.”