WEBVTT - 211. CMV in Pregnancy 0:00:03.680 --> 0:00:06.760 Welcome to the kick Your Expert led podcast, helping you 0:00:06.840 --> 0:00:11.200 explore and learn everything about getting pregnancy, birth, and becoming 0:00:11.280 --> 0:00:11.680 a parent. 0:00:12.000 --> 0:00:15.760 On the podcast and our online pregnancy program grow My Baby, 0:00:15.920 --> 0:00:19.760 we share my experience of helping more than four thousand babies. 0:00:19.360 --> 0:00:21.960 To be born, and our experience of running a women's 0:00:21.960 --> 0:00:23.920 health clinic and parenting for boys. 0:00:24.160 --> 0:00:27.120 We're here to help everyone to feel empowered in pregnancy 0:00:27.280 --> 0:00:30.120 and birth with real life, practical information. 0:00:32.920 --> 0:00:35.280 Welcome everyone. I'm Bridget Maloney. 0:00:34.880 --> 0:00:37.319 And I'm obstetrician doctor Patrick Maloney, and. 0:00:37.280 --> 0:00:39.960 Today we've got an episode that I can't believe we 0:00:40.000 --> 0:00:42.960 haven't done pad on CMV. 0:00:43.800 --> 0:00:45.760 Yeah, definitely time we talked about CMV. 0:00:45.880 --> 0:00:49.640 Yeah, we got a question ages ago about this, oh gosh, 0:00:49.800 --> 0:00:51.960 like years ago, and we did do a couple of 0:00:52.000 --> 0:00:54.760 social media posts on it. But I think there's enough 0:00:54.800 --> 0:00:56.920 information for us to do an episode, and it's such 0:00:56.920 --> 0:00:58.600 an important thing for people to know about. 0:00:59.240 --> 0:01:02.080 Yeah, I think in our in our sort of preparation 0:01:02.160 --> 0:01:04.760 for this episode, one of the most interesting stats is 0:01:04.760 --> 0:01:06.080 that people don't know about. 0:01:06.000 --> 0:01:08.120 Oh that's it. Yeah, so let's go talk about that, 0:01:08.400 --> 0:01:12.119 all right. It's cytomegalovirus if I pronounced that correctly. 0:01:12.120 --> 0:01:13.880 That is right, good, Yeah. 0:01:14.800 --> 0:01:15.560 What is it? Pat? 0:01:16.400 --> 0:01:20.720 So CMV is a virus. It's a common virus in 0:01:20.760 --> 0:01:27.160 our community. It's often spread around by well, it's spread 0:01:27.200 --> 0:01:31.600 it's spread through through close contact and it's often spread 0:01:31.600 --> 0:01:41.120 around by asymptomatic normal children through saliva and close touch 0:01:41.280 --> 0:01:46.920 and urine. And the problem with that is that that's 0:01:46.959 --> 0:01:50.960 what children do and there and that virus is easily 0:01:50.960 --> 0:01:54.160 spread around. Now, the relevance to us is that it 0:01:54.320 --> 0:01:59.600 is an important virus in pregnancy. It can cause significant 0:01:59.680 --> 0:02:05.200 problems for the developing baby. And it's not that rare. 0:02:06.760 --> 0:02:09.800 A little over a baby a day is born in 0:02:09.840 --> 0:02:13.079 Australia with a significant outcome from CMV. 0:02:13.400 --> 0:02:15.160 And we're going to talk about why that is a 0:02:15.200 --> 0:02:19.040 problem in a minute. But I just you've already raised 0:02:19.040 --> 0:02:24.280 so many points there. It's most virulent, isn't it in 0:02:24.480 --> 0:02:25.799 kids under the age of two. 0:02:26.720 --> 0:02:29.680 Yes, So it's bad to get it as a fetus, 0:02:29.919 --> 0:02:33.240 and it's bad to get it as a newborn. But 0:02:34.080 --> 0:02:38.320 and it can cause a significant sort of flu like 0:02:38.400 --> 0:02:43.480 illness in children. But it can also be spread around 0:02:43.600 --> 0:02:49.120 relatively well people in settings like child cares. 0:02:48.840 --> 0:02:52.400 And kindergartens and parents with toddlers that then happen to 0:02:52.400 --> 0:02:52.960 be pregnant. 0:02:53.280 --> 0:02:54.040 That's the problem. 0:02:54.200 --> 0:03:00.000 Yeah, yeah, So it's part of the herpes virus family. 0:03:00.200 --> 0:03:03.960 Yeah, big family of viruses with some similar characteristics. 0:03:04.160 --> 0:03:08.639 And we know that, you know, I have a little 0:03:08.680 --> 0:03:10.760 bit of herpies. Can I say that? You know I 0:03:10.800 --> 0:03:13.280 get my cold sauce every now and then, you know, 0:03:13.360 --> 0:03:16.119 it lies dormant in my system and then just reactivates. 0:03:16.160 --> 0:03:17.839 That's the same thing with CMV, isn't it. 0:03:17.840 --> 0:03:18.679 It can be. Yeah. 0:03:18.760 --> 0:03:20.959 So the classic cold saw picture where you get the 0:03:21.000 --> 0:03:23.600 saw on the corner of your mouth when you're tired, 0:03:23.840 --> 0:03:28.239 run down, burn the candle at both ends it comes 0:03:28.280 --> 0:03:30.920 out again. There is a sort of a version of 0:03:30.919 --> 0:03:35.600 that with CMV. See lots of by the time someone 0:03:35.640 --> 0:03:37.880 gets to the age of having a baby, about half 0:03:37.960 --> 0:03:41.080 the community have already had CMV, and they get some 0:03:41.640 --> 0:03:46.960 lifelong immunity to it, which is a little incomplete in 0:03:47.000 --> 0:03:51.880 that one there is a capacity to be reinfected, so 0:03:52.040 --> 0:03:55.760 you might not have complete immunity. And two there's a 0:03:55.840 --> 0:03:59.920 phenomenon of reactivation where the old CMV virus might have 0:04:00.000 --> 0:04:03.440 been alive in your body but dormant, and it reactivates 0:04:03.440 --> 0:04:07.880 in pregnancy because you're a bit immunosuppressed, possibly due to 0:04:07.920 --> 0:04:10.160 the demands on your body of being pregnant, So you 0:04:10.240 --> 0:04:12.119 might be a little bit in mino suppressed, a little 0:04:12.120 --> 0:04:12.880 bit sleep deprived. 0:04:13.000 --> 0:04:15.320 So farth Yeah, right, I want to add it's not 0:04:15.360 --> 0:04:18.040 relevant actually to CMV, but coswals come when I get 0:04:18.080 --> 0:04:20.239 a sun burnt on my lip too, If anyone also 0:04:20.320 --> 0:04:21.600 has that, then I want to hear from. 0:04:21.520 --> 0:04:23.279 You, because that's definitely a thing. 0:04:23.400 --> 0:04:26.600 Yeah, that's my issue. So I read a study that 0:04:26.800 --> 0:04:30.440 only one in six pregnant people have even ever heard 0:04:30.560 --> 0:04:31.159 of CMV. 0:04:31.839 --> 0:04:36.640 Yeah, and this is this is definitely somewhere where we 0:04:36.720 --> 0:04:40.200 can improve. I've got a theory on this. I think 0:04:40.240 --> 0:04:44.640 one of the reasons why we don't sort of talk 0:04:44.760 --> 0:04:48.279 to people about CMV as much as we should is 0:04:48.320 --> 0:04:52.520 there's a feeling amongst obstetricians, midwives, obstetric care give is 0:04:52.560 --> 0:04:54.200 that there's not tons that can be done about it. 0:04:55.160 --> 0:05:00.279 And firstly, that's not entirely true, because the there is 0:05:00.320 --> 0:05:03.560 some evidence that the preventative things that can stop be 0:05:03.600 --> 0:05:08.479 catching it do work or at least improve the odds 0:05:08.480 --> 0:05:11.839 in your favor. And the other thing is just because 0:05:12.120 --> 0:05:17.160 like for example, there isn't a vaccine, then that doesn't 0:05:17.160 --> 0:05:18.840 mean there's nothing we can do. We're don't throw our 0:05:18.880 --> 0:05:20.920 arms up and say well, we can't do anything about CMV. 0:05:21.680 --> 0:05:25.279 By contrast, if you look at rebella used to be 0:05:25.360 --> 0:05:29.800 a cause of serious infection in pregnancy people in our 0:05:29.839 --> 0:05:35.440 community this day with the natal rebella, blindness, deafness, intellectual disability, 0:05:36.640 --> 0:05:39.920 pretty much fixed by an effective vaccine that really works. 0:05:40.640 --> 0:05:41.720 So vaccinated as. 0:05:41.680 --> 0:05:43.880 A child potentially have a booster before we have a baby, 0:05:44.000 --> 0:05:45.640 you're not going to catch rebella in pregnancy. You'll be 0:05:45.720 --> 0:05:50.120 fine c MV. Unfortunately, we don't have the same we 0:05:50.120 --> 0:05:51.479 don't have the same weapons to fight it. 0:05:52.480 --> 0:05:56.640 And interestingly, I did see a graph that showed people's 0:05:56.839 --> 0:06:00.760 knowledge about the different diseases and things like rebella. Nearly 0:06:00.760 --> 0:06:03.640 one hundred percent of pregnant people know about the impact 0:06:03.720 --> 0:06:06.640 of rebella or why they should even be tested for rebella. Yes, 0:06:06.640 --> 0:06:09.880 but you know, I don't know this. It's interesting why 0:06:10.000 --> 0:06:11.960 I know you said that. It's because we feel like, 0:06:12.120 --> 0:06:14.479 as you know, you feel like as medical people that 0:06:14.520 --> 0:06:18.080 you can't do much about it. But one in six 0:06:18.120 --> 0:06:20.040 people not knowing about it. I find that really a 0:06:20.080 --> 0:06:21.000 shocking statu. 0:06:20.800 --> 0:06:22.920 Yeah, we should be doing better than that. And I think. 0:06:25.160 --> 0:06:27.440 It starts with the fact that it isn't actually one 0:06:27.440 --> 0:06:29.400 of the tests that's recommended in early pregnancy. 0:06:30.160 --> 0:06:34.200 And that's because you know, if. 0:06:34.080 --> 0:06:38.640 Someone's got CMV immunity or they don't, the advice we 0:06:38.680 --> 0:06:43.159 would give them would be the same. It's about preventing transmission. 0:06:43.920 --> 0:06:45.760 That there isn't something special we could do for the 0:06:45.760 --> 0:06:51.080 person who's non immune versus immune. Whereas the person who 0:06:51.800 --> 0:06:55.360 early pregnancy testing shown that they didn't have any rebella immunity, 0:06:55.640 --> 0:06:57.719 we could we give that person a booster before they're 0:06:57.720 --> 0:07:02.360 pregnant again and at least is risk that way. So 0:07:02.920 --> 0:07:05.840 it's it's it's sometimes it is tested for in early 0:07:05.920 --> 0:07:10.280 pregnancy opportunistically, but it's not actually an official recommendation in Australia. 0:07:10.720 --> 0:07:13.360 And I think that's where it's where it's where it 0:07:13.440 --> 0:07:15.160 starts that we don't talk about enough. 0:07:15.320 --> 0:07:20.280 Yeah right, I want to really highlight that CMV is 0:07:20.400 --> 0:07:24.520 the most common infectious cause of disabilities in newborn babies. 0:07:24.880 --> 0:07:28.120 Yeah yeah, yeah, so presumably it came to number one 0:07:28.160 --> 0:07:29.240 as rubella dropped away. 0:07:29.400 --> 0:07:32.800 Yeah, so CMV effects one in one hundred and fifty 0:07:32.840 --> 0:07:38.120 babies down syndrome one in six hundred and sixty, spina 0:07:38.160 --> 0:07:42.680 biffitter six point three in ten thousand, and toxoplasmosis is 0:07:43.320 --> 0:07:47.239 zero point zero one seven in one thousand. Yeah, so interesting, 0:07:47.280 --> 0:07:47.600 isn't it? 0:07:48.200 --> 0:07:51.200 That is interesting data because you know, it's certainly it's 0:07:51.200 --> 0:07:54.840 eurned its place in things we should be discussing. The 0:07:55.800 --> 0:07:58.480 we can get We can talk today easily about about, 0:07:58.520 --> 0:08:03.280 you know, how detection works and so forth. But you know, 0:08:03.320 --> 0:08:05.400 in our preparation for today, the thing I found most 0:08:05.440 --> 0:08:09.040 interesting was that there's quite good data behind the relatively 0:08:09.120 --> 0:08:11.880 simple things that you can do to prevent CMB transmission 0:08:12.200 --> 0:08:14.160 that actually shows that it really does prevent it. 0:08:14.320 --> 0:08:17.520 Yeah. All right, now we've talked about that. We want 0:08:17.560 --> 0:08:21.560 to raise awareness, but let's talk about why, Like why 0:08:21.680 --> 0:08:22.920 is CMV an issue? 0:08:24.560 --> 0:08:26.000 Why is it an issue in pregnancy? 0:08:26.080 --> 0:08:27.000 In pregnancy? 0:08:27.560 --> 0:08:32.840 Well, if the most significant CMV infection in pregnancy would 0:08:32.880 --> 0:08:38.280 be somebody with no previous immunity catching CMV while they're 0:08:38.320 --> 0:08:43.679 pregnant and then having that CMV virus cross the placenta 0:08:43.760 --> 0:08:49.560 into the developing baby, and that's a potentially very serious 0:08:49.600 --> 0:08:53.040 situation where the baby can develop a large number of 0:08:53.280 --> 0:08:57.960 significant abnormalities that could resate, resulting in long term health 0:08:58.000 --> 0:09:04.120 troubles for that baby, long term disability, or even still 0:09:04.160 --> 0:09:05.320 birth or nanatal death. 0:09:06.600 --> 0:09:08.679 I don't want to scare people, but maybe we could 0:09:08.720 --> 0:09:12.560 talk about some of those disabilities that are noted to 0:09:12.640 --> 0:09:13.800 be caused by CMB. 0:09:14.640 --> 0:09:17.280 Yeah, so, I guess in the most serious situation, you 0:09:17.360 --> 0:09:21.400 might get a CMV picture in the in the developing baby. 0:09:21.440 --> 0:09:24.440 That's a very serious and multi system. It can lead 0:09:24.440 --> 0:09:26.840 to a problem in babies called hydrops, which is where 0:09:26.840 --> 0:09:31.160 there's abnormal fluid develops right throughout the the baby's body 0:09:31.200 --> 0:09:33.959 cavities and that and that can be a cause of 0:09:36.840 --> 0:09:43.839 pregnancy loss or nanatal death. And then more subtly, but 0:09:44.160 --> 0:09:49.800 the CMV infection can affect various organs within the baby's body, 0:09:50.559 --> 0:09:53.760 causing you know, potentially very long term dysfunction of those organs. 0:09:54.760 --> 0:10:00.480 And among the more serious outcome scene are problems hearing, 0:10:01.440 --> 0:10:07.400 intellectual disability, learning difficulties, failed to thrive as newborn. 0:10:07.040 --> 0:10:12.000 Those sort of things, and eye diseases, yes, possibly, yeah, 0:10:12.040 --> 0:10:16.240 and it can be a cause of prematurity and growth restriction. 0:10:16.679 --> 0:10:18.760 Yeah, that's right. And these are some of the ways 0:10:18.760 --> 0:10:22.480 that it can be picked up. For example, sometimes it's 0:10:22.559 --> 0:10:26.800 quite obvious the woman has a really severe flu like illness, 0:10:27.120 --> 0:10:31.439 which is sometimes just mistaken for seasonal flu. And then 0:10:31.920 --> 0:10:35.000 but maybe she winds up sick enough for somebody to 0:10:35.040 --> 0:10:38.680 be looking into that she's tested for CMV and it's 0:10:38.720 --> 0:10:42.200 found that she's got a CMV infection at that time, 0:10:43.000 --> 0:10:44.280 and that she didn't used. 0:10:44.160 --> 0:10:45.679 To have any old immunity. 0:10:46.240 --> 0:10:50.000 And then this is somebody who who suddenly has developed 0:10:50.000 --> 0:10:54.480 antibodies for CMV which they didn't previously have, and that 0:10:54.840 --> 0:10:57.160 is and that proves that this is a new infection 0:10:57.400 --> 0:11:00.440 in this person, and that might lead to that being 0:11:00.480 --> 0:11:04.320 referred to a specialist center where with expertise in the 0:11:04.360 --> 0:11:09.040 management of infectious diseases in pregnancy, where her where her 0:11:09.760 --> 0:11:15.000 baby would be monitored for signs of CMV infection in 0:11:15.040 --> 0:11:19.319 the in the fetus, and that's done using ultrasound and 0:11:19.400 --> 0:11:25.880 occasional occasionally MRI and they and an amniosynthesis can be 0:11:25.960 --> 0:11:29.640 taken from the fluid around the baby to also look. 0:11:29.440 --> 0:11:33.079 For evidence of the virus in the water around the baby. 0:11:33.600 --> 0:11:37.320 Can I ask you know you mentioned that the that 0:11:37.440 --> 0:11:41.160 sometimes the woman will feel unwell and that will be 0:11:42.440 --> 0:11:44.440 thought of it that it's just the cold or a flu. 0:11:45.440 --> 0:11:48.880 Would from a patient's perspective, would it be best for 0:11:48.960 --> 0:11:51.600 them to go I would like to be tested for CMV. 0:11:52.120 --> 0:11:55.600 I think that's quite reasonable, especially for someone with a 0:11:55.640 --> 0:11:59.199 significant flu like illness where they were they had a 0:11:59.280 --> 0:12:02.440 vaccine for seasonal flu, which I think would mean it 0:12:02.480 --> 0:12:05.280 was less likely to be seasonal flu. Then a CMV 0:12:05.400 --> 0:12:08.040 test would be quite reasonable. And the other one would 0:12:08.120 --> 0:12:10.800 be a situation where it had features that were more 0:12:10.840 --> 0:12:13.440 in keeping with CMV rather than seasonal flu. For example, 0:12:13.760 --> 0:12:18.319 significant what we call limphat anopathy, big lymph nodes in 0:12:18.480 --> 0:12:22.080 the neck, core, the armpits, or the groin, And you're thinking, 0:12:22.080 --> 0:12:23.520 hang on a minute, this is a bit not very 0:12:23.600 --> 0:12:24.760 much like seasonal flu. 0:12:24.679 --> 0:12:26.240 Could this be CMV. 0:12:26.679 --> 0:12:28.560 When you're go and have those first trimester bloods, when 0:12:28.559 --> 0:12:31.880 you're first pregnant, you have HIV and hepatitis and hemoclover 0:12:31.960 --> 0:12:35.200 and all that are the blood from those that first 0:12:35.240 --> 0:12:37.920 set of bloods, they keep that in the laboratory for 0:12:38.320 --> 0:12:41.640 a year so that if you later developed something that 0:12:41.720 --> 0:12:44.600 might be CMV and they say, yep, you've got some 0:12:44.640 --> 0:12:47.040 CMV antibodies, they can then go back to the stored 0:12:47.040 --> 0:12:49.280 blood from the start of the pregnancy and see whether 0:12:49.280 --> 0:12:50.240 you had antibodies then. 0:12:50.800 --> 0:12:53.040 But would CMV be looked for back then? 0:12:53.720 --> 0:12:55.800 No, but the blood still there, and they just test again. 0:12:55.640 --> 0:12:57.720 Oh they can, Okay, they keep the actual blood. 0:12:57.800 --> 0:13:00.800 Yeah yeah, you big of these storage units, yeah, be big, right, 0:13:00.840 --> 0:13:02.240 And so they keep it. They keep it all for 0:13:02.240 --> 0:13:04.839 a year, so you can go back then and say, 0:13:05.080 --> 0:13:08.960 just find the tube of blood from seven months ago, please, wow, 0:13:09.000 --> 0:13:12.040 and then they'll test that for CMV. And I guess 0:13:12.080 --> 0:13:14.760 the most I guess the most concerning would be that 0:13:14.800 --> 0:13:17.319 there were zero antibodies back then and fresh antibodies now. 0:13:17.440 --> 0:13:17.640 Yeah. 0:13:17.679 --> 0:13:19.200 Yeah, proves that the infections new. 0:13:19.640 --> 0:13:22.720 And that's also called a primary infection. If anyone then 0:13:22.840 --> 0:13:24.439 goes and reads up, yeah, that's. 0:13:24.360 --> 0:13:27.640 That's what's called a primary infection. And then there's also 0:13:27.720 --> 0:13:32.439 secondary infections where you've always had CMV and you've got 0:13:32.440 --> 0:13:36.320 it again. And then there's a reactivation where you've got 0:13:36.360 --> 0:13:38.760 it years ago and it was never quite killed off 0:13:38.800 --> 0:13:41.319 inside your body and it comes back. 0:13:41.520 --> 0:13:44.079 And you're more interested in the primary infection because the 0:13:44.200 --> 0:13:46.360 transmission rate is higher, isn't it. 0:13:46.400 --> 0:13:49.320 The transmission from mother to baby is highest. Yes, that's right, 0:13:50.280 --> 0:13:56.120 but more people have secondary or reactivations, so. 0:13:57.760 --> 0:13:58.839 We're interested in both. 0:13:59.000 --> 0:14:01.920 Yeah, and I want to go back just in case 0:14:01.960 --> 0:14:06.400 anyone's panicking right now, when we said that one in 0:14:06.400 --> 0:14:09.920 one hundred and fifty babies are found with CMV. There's 0:14:09.960 --> 0:14:13.400 some that are infected yep, and there are some that 0:14:13.480 --> 0:14:15.440 are affected exactly. 0:14:15.480 --> 0:14:19.960 So lots of those babies are fine and have no 0:14:20.200 --> 0:14:24.360 problems then and no problems later. Yeah, But the most 0:14:24.720 --> 0:14:28.320 severe scenario is a baby that becomes quite sick inside. 0:14:28.560 --> 0:14:30.920 So when we talk about it as a cause of prematurity, 0:14:30.960 --> 0:14:34.400 some of that prematurity will be caused by us. We'll 0:14:34.400 --> 0:14:36.920 be watching a baby with CMV and thinking this baby 0:14:37.080 --> 0:14:40.000 is not going to make it to full term unless 0:14:40.000 --> 0:14:40.560 we interfere. 0:14:40.640 --> 0:14:44.920 Now, yeah, the old better out than in scenario. 0:14:45.280 --> 0:14:46.280 Sometimes that applies. 0:14:46.400 --> 0:14:50.359 Yeah, Now the baby can also get CMV during delivery 0:14:50.400 --> 0:14:52.760 and post natally through breast milk, is that right? 0:14:53.000 --> 0:14:56.120 Yeah, So that's a significant situation as well. So we 0:14:56.160 --> 0:14:59.800 want to know about mums that are sick with CMV 0:15:00.320 --> 0:15:05.480 even if there's no even if there's no immediately obvious 0:15:05.520 --> 0:15:06.760 evidence of fetal infection. 0:15:07.160 --> 0:15:10.200 You've talked about how we can test for it during pregnancy, 0:15:10.440 --> 0:15:14.120 but if it's suspected after birth, what sort of tests 0:15:14.280 --> 0:15:16.280 would a parent expect for their baby to have. 0:15:17.200 --> 0:15:19.320 So after birth, when we've got the baby right there 0:15:19.320 --> 0:15:22.840 in front of us, we can try and sample and 0:15:22.920 --> 0:15:29.280 culture multiple body fluids, urine, a saliva, pooh, and get 0:15:29.320 --> 0:15:31.640 swabs and viral cultures off the baby to try and 0:15:31.720 --> 0:15:34.880 make a quick diagnosis of whether the baby appears to 0:15:34.880 --> 0:15:38.120 have CMV at birth, because there is a role for 0:15:38.120 --> 0:15:41.160 anti viral medication, but you need to give it quickly, 0:15:41.520 --> 0:15:42.120 So we'd. 0:15:41.960 --> 0:15:44.480 Want to get a diagnosis right at the start, and 0:15:44.520 --> 0:15:48.160 that baby then would be referred to a pediatrician or yeah, 0:15:48.160 --> 0:15:49.760 that's in the hands of a pet isn't it. 0:15:49.840 --> 0:15:52.000 Yes, So the pediatricians would then be looking at that 0:15:52.080 --> 0:15:54.760 baby for any signs of an acute illness. So the 0:15:54.760 --> 0:15:57.960 baby got sick as a newborn, and then long term, 0:15:58.840 --> 0:16:03.120 if CMV was proven for the development of any you know, 0:16:03.320 --> 0:16:09.240 neuro developmental things, vision, hearing, and so forth, it must. 0:16:09.040 --> 0:16:13.440 Be so hard because you know, jaundice is one symptom 0:16:13.480 --> 0:16:16.040 as well, but jaundice can be caused by so many 0:16:16.040 --> 0:16:19.120 different things like it do people say, oh, well, how 0:16:19.160 --> 0:16:21.320 about SAMV? Like, is that what you hear? 0:16:21.480 --> 0:16:21.880 That's right? 0:16:21.960 --> 0:16:25.400 So we rely on these neonatal pediatricians. 0:16:25.400 --> 0:16:26.520 They're pretty clever. 0:16:26.320 --> 0:16:28.880 Men and women, and they and we and we rely 0:16:29.040 --> 0:16:31.960 on them to take a broad look at a newborn. 0:16:32.440 --> 0:16:34.400 And the new one can't tell you what's wrong. It 0:16:34.520 --> 0:16:38.520 must be a really hard job. So they do take 0:16:38.560 --> 0:16:43.120 a really broad look. And sometimes we would say, well, well, 0:16:43.200 --> 0:16:47.280 here's a baby with some significant jaundice, and yet there 0:16:47.320 --> 0:16:51.160 were no real obstetric risk factors for that obstetric for 0:16:51.200 --> 0:16:55.040 that jaundice, like a mismatch between blood groups or anything 0:16:55.120 --> 0:16:58.000 like that, or significant prematurity. Why is this baby joundice? 0:16:58.080 --> 0:17:00.320 And the clever pedatrician will often say, well, let's let's 0:17:00.360 --> 0:17:04.160 rule out infection. So they test the baby for something 0:17:04.160 --> 0:17:09.919 called a torch screen, which is any evidence of infections 0:17:09.920 --> 0:17:11.080 that could be making a baby. 0:17:11.080 --> 0:17:14.720 See right, What about the placenta do they do? The 0:17:14.760 --> 0:17:18.600 peds also say hey, can we hey obstetrician, what do 0:17:18.640 --> 0:17:19.960 you do with the placenta? Can we test it? 0:17:20.080 --> 0:17:20.520 Yeah? They do. 0:17:20.600 --> 0:17:23.119 Yeah, so you can swap the placenter for any signs 0:17:23.119 --> 0:17:26.800 of infection and then for other problems, you can analyze 0:17:26.800 --> 0:17:31.280 the placenta microscopically for any for signs of problems that 0:17:31.320 --> 0:17:34.439 might have led to an unexpected pregnancy outcome. 0:17:35.000 --> 0:17:37.760 All right, so you mentioned that the baby needs you know, 0:17:37.800 --> 0:17:40.399 it's best if they get their antiviral treatments within twenty 0:17:40.440 --> 0:17:46.000 one days. That's that's a pretty tight frame, isn't it. 0:17:46.440 --> 0:17:46.680 Yeah. 0:17:47.040 --> 0:17:49.960 I think I think that's the important thing we need 0:17:49.960 --> 0:17:53.960 to have about CMV is an index of suspicion. 0:17:54.040 --> 0:17:55.840 Could this be cmp and. 0:17:57.480 --> 0:18:00.320 The opportunities for early treatment might be lost by that 0:18:00.560 --> 0:18:04.480 just not being thought of. But if we're on the 0:18:04.520 --> 0:18:08.280 ball about CMV, then then you know there's a there's 0:18:08.520 --> 0:18:12.000 a clear protocol of of how to a manager suspected 0:18:12.040 --> 0:18:12.880 their natal infection. 0:18:14.119 --> 0:18:18.080 I imagine that in one in six people knowing about CMV 0:18:18.680 --> 0:18:22.040 listening to this podcast will be kind of shocking and 0:18:22.119 --> 0:18:23.560 it will be kind of terrifying. 0:18:24.000 --> 0:18:26.520 Yeah, that's that's sort of the risk, isn't it, Because 0:18:27.240 --> 0:18:33.440 information is good, but it also worries people potentially. So 0:18:34.480 --> 0:18:37.439 I'm encouraging people, if they're hearing about CMB for the 0:18:37.480 --> 0:18:39.800 first time and have never heard of it, to talk 0:18:39.840 --> 0:18:42.600 to their cares and say what can I do to 0:18:42.720 --> 0:18:46.240 prevent this? Is there any value in me being tested. 0:18:47.680 --> 0:18:49.520 I had a shock and flu like illness a month 0:18:49.520 --> 0:18:51.960 ago which is passed. Is there any chance that was CMV? 0:18:52.600 --> 0:18:54.919 And encouraged discussion of it. 0:18:56.760 --> 0:18:59.800 Hopefully our next portion of the podcast, we're really going 0:18:59.880 --> 0:19:03.760 to hone in on how to prevent getting CMV. So 0:19:04.280 --> 0:19:06.120 everyone take a big breath, because that's. 0:19:06.080 --> 0:19:07.960 That I think is the most is the best way 0:19:08.000 --> 0:19:12.919 to respond. If this is causing people anxiety, we'll say, right, 0:19:13.400 --> 0:19:16.320 what can what can we do? What's been shown to 0:19:16.440 --> 0:19:17.760 help reduce transmission? 0:19:18.480 --> 0:19:21.199 Let's do that, all right, what has been shown to 0:19:21.280 --> 0:19:25.720 help stop transmission? Yeah, you asked your own question. 0:19:25.760 --> 0:19:29.040 Then look, I think you might get it off your 0:19:29.040 --> 0:19:33.640 own children who are older and two or three year old, 0:19:34.160 --> 0:19:39.040 say in daycare or kindergarten or something. And you won't 0:19:39.119 --> 0:19:42.040 get it from just giving that child a hug or 0:19:42.280 --> 0:19:45.240 just usual parenting care, but you could get it from 0:19:45.280 --> 0:19:46.120 sharing saliva. 0:19:46.960 --> 0:19:49.200 So there are a couple. 0:19:48.880 --> 0:19:52.000 Of things that parents do that maybe we shouldn't if 0:19:52.000 --> 0:19:54.359 we knew about CMV. And one is that if a 0:19:54.440 --> 0:19:58.280 todler drops their dummy on the ground, I've done this, 0:19:58.480 --> 0:20:01.400 I've done this, We pick it up up and there's 0:20:01.440 --> 0:20:03.639 no tap or anything around. So we put in our 0:20:03.680 --> 0:20:05.639 own mouth to wash the dirt off, and then we 0:20:05.680 --> 0:20:08.159 put back in the baby's mouth, and that's probably a 0:20:08.240 --> 0:20:10.920 high risk activity for CMV transmission. 0:20:12.359 --> 0:20:16.679 And then you know, the other thing that it's. 0:20:16.640 --> 0:20:18.400 Nice to do when you've got when you've got really 0:20:18.400 --> 0:20:20.359 little ones, is you want to kiss them all the time. 0:20:20.960 --> 0:20:23.640 But it's presumably a lot safer to kiss a baby 0:20:23.640 --> 0:20:28.719 anywhere but on the mouth, and that's something that people 0:20:28.760 --> 0:20:32.480 could consider. And the other thing is contact with urine, 0:20:32.880 --> 0:20:38.520 so the virus is spread heavily in urine. There's a 0:20:38.560 --> 0:20:41.679 lot of virus in the urine. So when you have 0:20:41.720 --> 0:20:45.960 to clean up we your baby or somebody else's that, 0:20:46.400 --> 0:20:49.200 you know, proper hand wash afterwards. 0:20:49.800 --> 0:20:54.120 I want to further explore where we might share saliva 0:20:54.200 --> 0:20:58.760 with our children. I remember being on holidays and one 0:20:58.760 --> 0:21:03.520 of the kids has forgotten toothbrush, and I've loaned my toothbrush, 0:21:03.560 --> 0:21:05.119 which in hindsight is disgusting. 0:21:05.640 --> 0:21:08.160 But also that's why I'm hesitating, because it all sounds 0:21:08.200 --> 0:21:10.200 a bit gross, But when it's your baby, doesn't feel gross. 0:21:10.400 --> 0:21:11.120 Kissing a little. 0:21:10.920 --> 0:21:12.520 Baby on the male You think it's other people baby 0:21:12.560 --> 0:21:13.840 on the mouth, but you Mike's your own baby in 0:21:13.880 --> 0:21:15.359 the mouth and there. 0:21:15.359 --> 0:21:18.720 They might kiss you like you know, the the open 0:21:18.760 --> 0:21:22.879 mouth kiss of a six month old is hilarious. 0:21:22.440 --> 0:21:25.960 Hilarious, And but they've definitely got saliva aging out there. 0:21:26.119 --> 0:21:32.200 And then and then you know, things like contact with urine. 0:21:33.040 --> 0:21:35.360 You would wash your hands if you if you had 0:21:35.960 --> 0:21:41.399 just cleaned up somebody else's urine, but we had, but 0:21:41.840 --> 0:21:43.960 with our own children in our own household, we're probably 0:21:44.000 --> 0:21:44.480 a bit slack. 0:21:44.680 --> 0:21:48.000 Yeah, so it's back to That's one thing COVID did 0:21:48.000 --> 0:21:51.280 teach us his proper hand washing routine, which is good. 0:21:52.240 --> 0:21:57.560 I'm stuck on the saliva sorry. But toddlers their slobbery people, 0:21:58.280 --> 0:22:00.879 so they sobber over everything, So you know, you've got 0:22:00.920 --> 0:22:05.920 to make sure you're cleaning their toys properly. Sometimes you 0:22:05.960 --> 0:22:09.679 want to feed your baby off your own utensils, you know, 0:22:09.840 --> 0:22:13.040 put a mouthful in their mouth and then back in yours. 0:22:13.520 --> 0:22:15.160 Or do what I used to do and take food 0:22:15.160 --> 0:22:15.600 from their. 0:22:15.560 --> 0:22:17.760 Play Yeah, you're a shocker at doing that. That is 0:22:17.800 --> 0:22:18.200 so bad. 0:22:18.400 --> 0:22:20.280 Used to go what are you doing? Yeah, yeah, that 0:22:20.320 --> 0:22:21.679