Newborn With Asymptomatic Congenital Cytomegalovirus: To MRI or Not to MRI? And What Next?

Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, presenting with a wide clinical spectrum ranging from asymptomatic newborns to severe neurologic sequelae. The use of brain magnetic resonance imaging (MRI) in asymptomatic cCMV-infected neonates poses a diagnostic and therapeutic challenge. Although MRI is more sensitive than cranial ultrasound in detecting subclinical brain abnormalities, the prognostic significance of mild findings, such as isolated white matter abnormalities, remains unclear. Current guidelines recommend antiviral therapy primarily for symptomatic neonates, for those with persistent isolated thrombocytopenia or hepatomegaly, and for neonates with sensorineural hearing loss, while treatment for asymptomatic infants with radiologic abnormalities is controversial. This case report describes an asymptomatic infant with cCMV and isolated white matter abnormalities on brain MRI, raising the dilemma of treating or not these lesions, but also the retrospective discussion of whether an MRI was indeed needed. This case highlights the urgent need for prospective studies to better define the role of MRI and antiviral therapy in asymptomatic newborns with neuroradiological abnormalities, balancing benefits, risks, costs and psychologic impact on families.