Cardiac function in newborns with cerebral ischemia born to mothers experiencing exacerbation of cytomegalovirus infection in the second trimester of pregnancy

Introduction. Cytomegalovirus (CMV) infection in pregnant women is deemed significant in affecting the cardiovascular system of their newborns. Despite the well-known cardiotropism of this pathogen, the characteristics of cardiac function in neonates with perinatal central nervous system (CNS) injury, whose mothers experienced reactivation of chronic CMV infection during pregnancy, have not been investigated to date.

Aim. To assess the state of cardiac function in newborns with cerebral ischemia, born to mothers with exacerbation of chronic CMV infection in the second trimester of pregnancy.

Materials and methods. The functional state of the heart was studied in 42 newborns from mothers with an uncomplicated pregnancy (control group) and in 67 newborns with perinatal brain damage from mothers who had exacerbation of chronic CMV infection in the second trimester of pregnancy (main group). Of these 67 newborns, 36 had grade I cerebral ischemia (first subgroup) and 31 had grade II cerebral ischemia (second subgroup).

Results. Compared to the control group, newborns in the first subgroup had lower Apgar scores at 1 minute (p < 0.001) and at 5 minutes (p < 0.001), as well as lower birth weight (p < 0.01). Although no significant differences were noted in the main clinical and functional parameters of the cardiovascular system, isolated cases of sinus arrhythmia and ST segment depression in leads V2 and V6 were observed. In the second subgroup, compared to both the control group and the first subgroup, Apgar scores at 1 minute (p < 0.001) and at 5 minutes (p < 0.001) were lower, as was birth weight (p < 0.01 and p < 0.001, respectively). In the second subgroup, when compared with the first, pallor (χ² = 3.99; p < 0.05), circumoral cyanosis (χ² = 3.96; p < 0.05), systolic murmur (χ² = 9.49; p < 0.01), tachycardia (χ² = 4.37; p < 0.05), incomplete right bundle branch block (χ² = 3.90; p < 0.05), moderate metabolic changes in the myocardium (χ² = 5.08; p < 0.05), and increased load on the right atrium (χ² = 4.66; p < 0.05) were more frequent.

Conclusion. In newborns with grade II cerebral ischemia born to mothers with exacerbation of chronic CMV infection in the second trimester of pregnancy, compared to newborns with grade I cerebral ischemia whose antenatal history was complicated by chronic CMV reactivation in the same gestational period, there is a more frequent occurrence of peripheral circulatory disorders, hypoxia, and cardiac dysfunction, increasing the load on the right atrium. These changes in clinical and functional features reflect the negative impact of the severity of perinatal brain injury on the conduction system and contractile function of the myocardium in newborns from mothers with CMV reactivation in the second trimester of pregnancy.  

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