WEBVTT - 116. CMV in pregnancy: Why is no one talking about this? 0:00:00.080 --> 0:00:03.560 The information in this podcast is provided for education and 0:00:03.600 --> 0:00:07.560 research information only. It is not a substitute for professional 0:00:07.600 --> 0:00:08.280 health advice. 0:00:12.960 --> 0:00:15.400 If you're trying to get pregnant, or you are pregnant 0:00:15.480 --> 0:00:17.680 and you feel a little bit overwhelmed by all you 0:00:17.760 --> 0:00:20.840 need to know, then this is the right podcast for you. 0:00:21.400 --> 0:00:24.000 Welcome to the show. I'm Bridget Maloney. 0:00:23.720 --> 0:00:27.000 And I'm obstetrician doctor Patrick Maloney, and this is the 0:00:27.120 --> 0:00:31.280 kick your expert led podcast that delivers the essentials of 0:00:31.320 --> 0:00:34.360 growing a baby. Make sure you head to our website 0:00:34.440 --> 0:00:37.519 grown mybaby dot com dot au to get some moreesome 0:00:37.560 --> 0:00:40.879 free tools like our pregnancy knowledge checker to help you 0:00:40.960 --> 0:00:42.040 feel like you got this. 0:00:44.040 --> 0:00:46.320 Welcome everyone, I'm Bridget Maloney. 0:00:46.000 --> 0:00:48.239 And I'm obstetrician doctor Patrick Maloney. 0:00:48.280 --> 0:00:50.960 And today we've got an episode that I can't believe 0:00:51.000 --> 0:00:54.080 we haven't done PAM on CMV. 0:00:54.920 --> 0:00:56.880 Yeah, definitely time we talked about CMV. 0:00:57.000 --> 0:01:00.760 Yeah, we got a question ages ago about this, oh gosh, 0:01:00.920 --> 0:01:03.080 like years ago, and we did do a couple of 0:01:03.120 --> 0:01:05.880 social media posts on it. But I think there's enough 0:01:05.920 --> 0:01:08.039 information for us to do an episode, and it's such 0:01:08.040 --> 0:01:09.679 an important thing for people to know about. 0:01:10.400 --> 0:01:12.720 Yeah, and I think in our in our sort of 0:01:12.720 --> 0:01:15.720 preparation for this episode, one of the most interesting stats 0:01:15.800 --> 0:01:17.200 is that people don't know about. 0:01:17.120 --> 0:01:19.240 Oh that's it. Yeah, so let's go talk about that. 0:01:19.520 --> 0:01:23.240 All right, it's cyto megalovirus. If I pronounced that correctly, 0:01:23.240 --> 0:01:23.840 that is right? 0:01:23.959 --> 0:01:24.240 Good? 0:01:24.600 --> 0:01:26.360 Yeah, what is it? 0:01:26.400 --> 0:01:31.840 Pat? So CMV is a virus. It's common virus in 0:01:31.880 --> 0:01:38.280 our community. It's often spread around by well, it's spread 0:01:38.319 --> 0:01:42.720 it's spread through through close contact, and it's often spread 0:01:42.720 --> 0:01:52.240 around by asymptomatic normal children through saliva and close touch 0:01:52.400 --> 0:01:58.040 and urine. And the problem with that is that that's 0:01:58.080 --> 0:02:03.000 what children do, and that virus is easily spread around. Now, 0:02:03.000 --> 0:02:06.840 the relevance to us is that it is an important 0:02:07.560 --> 0:02:11.880 virus in pregnancy. It can cause significant problems for the 0:02:12.000 --> 0:02:18.440 developing baby. And it's not that rare. A little over 0:02:19.120 --> 0:02:22.720 a baby a day is born in Australia with a 0:02:22.720 --> 0:02:24.200 significant outcome from CMV. 0:02:24.520 --> 0:02:26.280 And we're going to talk about why that is a 0:02:26.320 --> 0:02:30.160 problem in a minute. But I just you've already raised 0:02:30.200 --> 0:02:35.400 so many points there. It's most virulent, isn't it in 0:02:35.600 --> 0:02:36.919 kids under the age of two? 0:02:37.840 --> 0:02:40.800 Yes, So it's bad to get it as a fetus, 0:02:41.040 --> 0:02:44.360 and it's bad to get it as a newborn. But 0:02:45.200 --> 0:02:49.440 and it can cause a significant sort of flu like 0:02:49.520 --> 0:02:54.600 illness in children. But it can also be spread around 0:02:54.720 --> 0:03:00.160 relatively well people in settings like child cares. 0:03:00.200 --> 0:03:04.079 Kindergartens and parents with toddlers that then happen to be pregnant. 0:03:04.400 --> 0:03:05.160 That's the problem. 0:03:05.320 --> 0:03:11.160 Yeah, Yeah, So it's part of the herpes virus family. 0:03:11.320 --> 0:03:14.920 Yeah, big family of viruses with some similar characteristics. 0:03:15.280 --> 0:03:19.760 And we know that, you know, I have a little 0:03:19.800 --> 0:03:21.880 bit of herpes. Can I say that? You know I 0:03:21.919 --> 0:03:24.400 get my cold sauce every now and then you know 0:03:24.480 --> 0:03:27.239 it lies dormant in my system and then just reactivates. 0:03:27.280 --> 0:03:28.959 That's the same thing with CMV, isn't it. 0:03:28.960 --> 0:03:31.640 It can be. Yeah. So the classic cold saw picture, 0:03:31.639 --> 0:03:33.040 where you get the saw on the corner of your 0:03:33.040 --> 0:03:38.480 mouth when you're tired, run down, burn the candle at 0:03:38.520 --> 0:03:41.360 both ends it comes out again. There is a sort 0:03:41.360 --> 0:03:45.600 of a version of that with CMV. See lots of 0:03:46.000 --> 0:03:47.600 by the time someone gets to the age of having 0:03:47.640 --> 0:03:50.920 a baby, about half the community have already had CMV, 0:03:51.520 --> 0:03:56.280 and they get some lifelong immunity to it, which is 0:03:56.320 --> 0:04:01.280 a little incomplete. In that one. There is a capacity 0:04:01.360 --> 0:04:04.680 to be reinfected, so you might not have complete immunity. 0:04:05.280 --> 0:04:09.280 And two there's there's a phenomenon of reactivation where the 0:04:09.320 --> 0:04:12.280 old CMV virus might have been alive in your body 0:04:12.280 --> 0:04:16.719 but dormant, and it reactivates in pregnancy because you're a 0:04:16.720 --> 0:04:19.920 bit immunosuppressed. Yea, possibly due to the demands on your 0:04:19.960 --> 0:04:21.960 body of being pregnant. So you might be a little 0:04:22.000 --> 0:04:24.000 bit I mino suppressed, a little bit sleep deprived. 0:04:24.120 --> 0:04:26.440 So farth Yeah right, I want to add it's not 0:04:26.480 --> 0:04:29.160 relevant actually to CMV, but costs come when I get 0:04:29.200 --> 0:04:31.359 a sun burnt on my lip too. If anyone also 0:04:31.440 --> 0:04:32.720 has that, then I want to hear from. 0:04:32.640 --> 0:04:34.400 You, because yeah, that's definitely a thing. 0:04:34.520 --> 0:04:37.720 Yeah, that's my issue. So I read a study that 0:04:37.920 --> 0:04:41.599 only one in six pregnant people have even ever heard 0:04:41.680 --> 0:04:42.279 of CMV. 0:04:42.960 --> 0:04:47.760 Yeah, and this is this is definitely somewhere where we 0:04:47.839 --> 0:04:51.080 can improve. I've got a theory on this. I think. 0:04:51.080 --> 0:04:53.640 I think one of the reasons why we don't sort 0:04:53.640 --> 0:04:58.000 of talk to people about CMV as much as we 0:04:58.080 --> 0:05:03.200 should is there's a fear feeling amongst obstetricians, midwives, obstetric 0:05:03.200 --> 0:05:04.760 care give is that there's not tons that can be 0:05:04.760 --> 0:05:10.640 done about it, and Firstly, that's not entirely true, because 0:05:10.720 --> 0:05:14.280 there is some evidence that the preventative things that can 0:05:14.320 --> 0:05:19.240 stop be catching it do work or at least improve 0:05:19.240 --> 0:05:22.520 the odds in your favor. And the other thing is 0:05:22.560 --> 0:05:27.719 just because like for example, there isn't a vaccine, then 0:05:27.920 --> 0:05:29.640 that doesn't mean there's nothing we can do. We're don't 0:05:29.680 --> 0:05:31.080 throw our arms up and say, well, we can't do 0:05:31.080 --> 0:05:35.279 anything about CMV. By contrast, if you look at rebella 0:05:35.960 --> 0:05:39.560 used to be a cause of serious infection in pregnancy 0:05:40.360 --> 0:05:45.200 people in our community this day with the natal rebella, blindness, deafness, 0:05:45.440 --> 0:05:50.400 intellectual disability, pretty much fixed by an effective vaccine that 0:05:50.440 --> 0:05:53.840 really works. So vaccinated as a child, potentially have a 0:05:53.880 --> 0:05:55.520 booster before you have a baby, you're not going to 0:05:55.600 --> 0:05:58.760 catch rebella in pregnancy. You'll be fine c MV. Unfortunately, 0:05:58.760 --> 0:06:01.800 we don't have the same we don't have the same 0:06:01.839 --> 0:06:02.599 weapons to fight it. 0:06:03.640 --> 0:06:07.760 And interestingly, I did see a graph that showed people's 0:06:07.960 --> 0:06:11.880 knowledge about the different diseases and things like rebella. Nearly 0:06:11.880 --> 0:06:14.760 one hundred percent of pregnant people know about the impact 0:06:14.839 --> 0:06:17.760 of rebella or why they should even be tested for rebella. Yes, 0:06:17.760 --> 0:06:21.000 but you know, I don't know this. It's interesting why 0:06:21.120 --> 0:06:23.080 I know you said that. It's because we feel like, 0:06:23.240 --> 0:06:25.599 as you know, you feel like as medical people that 0:06:25.640 --> 0:06:29.200 you can't do much about it. But one in six 0:06:29.240 --> 0:06:31.160 people not knowing about it. I find that really a 0:06:31.200 --> 0:06:32.120 shocking statu. 0:06:31.920 --> 0:06:33.520 Yeah, we should be doing better than that. And I 0:06:33.560 --> 0:06:38.400 think it starts with the fact that it isn't actually 0:06:38.400 --> 0:06:41.320 one of the tests that's recommended in early pregnancy. And 0:06:41.920 --> 0:06:47.640 that's because you know, if someone's got CMV immunity or 0:06:47.680 --> 0:06:50.800 they don't, the advice we would give them would be 0:06:50.880 --> 0:06:55.919 the same. It's about preventing transmission. That there isn't something 0:06:55.920 --> 0:06:58.360 special we could do for the person who's non immune 0:06:58.440 --> 0:07:03.880 versus immune. Yeah, whereas the person who early pregnancy testing 0:07:03.880 --> 0:07:07.560 shown they didn't have any rubella immunity, we could we 0:07:07.600 --> 0:07:10.120 give that person a booster before they're pregnant again and 0:07:10.200 --> 0:07:15.160 at least reduce risk that way. So it's it's it's 0:07:15.240 --> 0:07:18.880 sometimes it is tested for in early pregnancy opportunistically, but 0:07:18.960 --> 0:07:22.080 it's not actually an official recommendation in Australia, and I 0:07:22.120 --> 0:07:25.200 think that's where it's where it's where it starts, that 0:07:25.240 --> 0:07:26.280 we don't talk about enough. 0:07:26.440 --> 0:07:31.400 Yeah, right, I want to really highlight that CMV is 0:07:31.520 --> 0:07:35.640 the most common infectious cause of disabilities in newborn babies. 0:07:36.000 --> 0:07:39.240 Yeah, yeah, yeah, so presumably it came to number one 0:07:39.280 --> 0:07:40.360 as rubella dropped away. 0:07:40.520 --> 0:07:43.920 Yeah, so CMV effects one in one hundred and fifty 0:07:43.960 --> 0:07:49.240 babies down, syndrome one in six hundred and sixty, spina 0:07:49.280 --> 0:07:53.800 biffitter six point three in ten thousand, and toxoplasmosis is 0:07:54.440 --> 0:07:58.360 zero point zero one seven in one thousand. Yeah, So interesting, 0:07:58.400 --> 0:07:58.720 isn't it? 0:07:58.960 --> 0:08:02.320 That is interesting data because you know, it's certainly it's 0:08:02.320 --> 0:08:05.960 turned its place in things we should be discussing. The 0:08:06.920 --> 0:08:09.600 we can get We can talk today easily about about 0:08:09.640 --> 0:08:13.040 you know, how how detection works and so forth. But 0:08:14.160 --> 0:08:16.000 you know, in our preparation for today, the thing I 0:08:16.000 --> 0:08:18.679 found most interesting was that there's quite good data behind 0:08:19.160 --> 0:08:21.800 the relatively simple things that you can do to prevent 0:08:21.880 --> 0:08:25.360 CMV transmission that actually shows that it really does prevent it. 0:08:26.560 --> 0:08:28.760 All. Right, now, we've talked about that we want to 0:08:28.960 --> 0:08:32.839 raise awareness, but let's talk about why, Like why is 0:08:32.920 --> 0:08:34.040 CMV an issue? 0:08:35.679 --> 0:08:38.920 Why is it an issue in pregnancy? In pregnancy, Well, 0:08:39.640 --> 0:08:43.960 if if the most significant CMV infection in pregnancy would 0:08:44.000 --> 0:08:49.840 be somebody with no previous immunity catching CMV while they're pregnant, 0:08:50.880 --> 0:08:54.760 and then having that c MV virus cross the placenta 0:08:54.880 --> 0:09:00.680 into the developing baby. And that's a potentially very serious 0:09:00.720 --> 0:09:04.160 situation where the baby can develop a large number of 0:09:04.400 --> 0:09:09.040 significant abnormalities that could resate result in long term health 0:09:09.120 --> 0:09:15.240 troubles for that baby, long term disability, or even still 0:09:15.280 --> 0:09:16.440 birth or nanatal death. 0:09:17.720 --> 0:09:19.800 I don't want to scare people, but maybe we could 0:09:19.840 --> 0:09:23.680 talk about some of those disabilities that are noted to 0:09:23.760 --> 0:09:24.920 be caused by CMB. 0:09:25.760 --> 0:09:28.400 Yeah, so I guess in the most serious situation, you 0:09:28.480 --> 0:09:32.760 might get a CMV picture in the developing baby. That's 0:09:32.800 --> 0:09:35.640 a very serious and multi system. It can lead to 0:09:35.640 --> 0:09:38.160 a problem in babies called hydrops, which is where there's 0:09:38.280 --> 0:09:42.760 abnormal fluid develops right throughout the the baby's body cavities 0:09:43.160 --> 0:09:48.440 and that and that can be a cause of pregnancy 0:09:48.480 --> 0:09:55.360 loss or nanatal death. And then more subtly, but the 0:09:55.440 --> 0:10:00.920 CMV infection can affect various organs within the baby's body, 0:10:01.679 --> 0:10:04.880 causing you know, potentially very long term dysfunction of those organs. 0:10:05.880 --> 0:10:11.120 And among the more serious outcomes scene our problems with 0:10:11.240 --> 0:10:18.160 hearing intellectual disability, learning difficulties, have failed to thrive as newborn, 0:10:18.200 --> 0:10:18.680 those sort. 0:10:18.520 --> 0:10:23.400 Of things, and eye diseases, yes, possibly, yeah, And it 0:10:23.440 --> 0:10:27.360 can be a cause of prematurity and growth restriction. 0:10:27.800 --> 0:10:29.880 Yeah, that's right. And these are some of the ways 0:10:29.880 --> 0:10:33.400 that it can be picked up. For example, sometimes it's 0:10:33.480 --> 0:10:37.120 it's quite obvious the woman has a really severe flu 0:10:37.400 --> 0:10:41.280 like illness, which is sometimes just mistaken for seasonal flu. 0:10:41.800 --> 0:10:45.680 And then but maybe she winds up sick enough for 0:10:45.720 --> 0:10:48.679 somebody to be looking into that she's tested for CMV 0:10:49.440 --> 0:10:52.760 and it's found that she's got a CMV infection at 0:10:52.760 --> 0:10:55.720 that time, and that she didn't used to have any 0:10:56.000 --> 0:11:00.400 old immunity. And then this is somebody who who suddenly 0:11:00.559 --> 0:11:04.439 has developed antibodies for CMV which they didn't previously have, 0:11:05.160 --> 0:11:07.560 and that is and that proves that this is a 0:11:07.640 --> 0:11:10.880 new infection in this person, and that might lead to 0:11:10.880 --> 0:11:14.440 that woman being referred to a specialist center where with 0:11:14.640 --> 0:11:20.000 expertise in the management of infectious diseases in pregnancy, where 0:11:20.040 --> 0:11:25.720 her baby would be monitored for signs of CMV infection 0:11:26.040 --> 0:11:30.319 in the in the fetus, and that's done using ultrasound 0:11:30.400 --> 0:11:36.840 and occasional occasionally MRI and they and an amniosynthesis can 0:11:36.920 --> 0:11:40.240 be taken from the fluid around the baby to also 0:11:40.280 --> 0:11:43.720 look for evidence of the virus in the water around 0:11:43.720 --> 0:11:44.199 the baby. 0:11:44.720 --> 0:11:48.440 Can I ask you know you mentioned that the that 0:11:48.559 --> 0:11:52.280 sometimes the woman will feel unwell and that will be 0:11:53.559 --> 0:11:55.560 thought of it that it's just the cold or a flu. 0:11:56.559 --> 0:12:00.040 Would from a patient's perspective, would it be best for 0:12:00.160 --> 0:12:02.760 them to go I would like to be tested for CMV. 0:12:03.240 --> 0:12:06.720 I think that's quite reasonable, especially for someone with a 0:12:06.760 --> 0:12:10.880 significant flu like illness where they had had a vaccine 0:12:10.920 --> 0:12:13.640 for seasonal flu, which I think would mean it was 0:12:13.720 --> 0:12:16.679 less likely to be seasonal flu, then a CMV test 0:12:16.760 --> 0:12:19.400 would be quite reasonable. And the other one would be 0:12:19.559 --> 0:12:22.040 a situation where it had features that were more in 0:12:22.120 --> 0:12:25.640 keeping with CMV rather than seasonal flu. For example, significant 0:12:25.679 --> 0:12:29.439 what we call limp hat anopathy, big lymph nodes in 0:12:29.600 --> 0:12:33.200 the neck core, the armpits or the groin, and you're thinking, 0:12:33.200 --> 0:12:34.640 hang on a minute, this is a bit not very 0:12:34.720 --> 0:12:38.120 much like seasonal flu. Could this be CMV? When you're 0:12:38.160 --> 0:12:40.400 go and have those first trimester bloods, when you're first pregnant, 0:12:40.400 --> 0:12:43.440 you have HIV and hepatitis and hemoclover and all that 0:12:44.200 --> 0:12:47.000 are the blood from those that first set of bloods. 0:12:47.040 --> 0:12:50.719 They keep that in the laboratory for a year so 0:12:50.760 --> 0:12:53.520 that if you later developed something that might be CMV 0:12:53.679 --> 0:12:56.880 and they say, yep, you've got some CMV antibodies, they 0:12:56.880 --> 0:12:58.679 can then go back to the stored blood from the 0:12:58.720 --> 0:13:01.360 start of the pregnancy, see whether you had antibodies then. 0:13:01.920 --> 0:13:04.160 But would CMV be looked for back then? 0:13:04.840 --> 0:13:06.920 No, but the blood still there, and they just test again. 0:13:06.760 --> 0:13:09.560 Oh they can, Okay, they keep the actual blood. Yeah, yeah, 0:13:09.679 --> 0:13:10.880 how big of these storage units? 0:13:10.920 --> 0:13:12.680 Yeah, it must be big, right, and so they keep it. 0:13:12.679 --> 0:13:15.080 They keep it all for a year, so you can 0:13:15.120 --> 0:13:17.199 go back then and say, just find the tube of 0:13:17.240 --> 0:13:20.720 blood from seven months ago, plase, wow, and then they'll 0:13:20.720 --> 0:13:24.040 test that for CMV. And I guess the most I 0:13:24.040 --> 0:13:26.360 guess the most concerning would be that there were zero 0:13:26.440 --> 0:13:28.439 antibodies back then and fresh antibodies now. 0:13:28.559 --> 0:13:28.760 Yeah. 0:13:28.800 --> 0:13:30.360 Yeah, proves that the infections new. 0:13:30.760 --> 0:13:33.880 And that's also called a primary infection. If anyone then 0:13:33.960 --> 0:13:35.640 goes and reads up, yeah, that's. 0:13:35.480 --> 0:13:38.760 That's what's called a primary infection. And then there's also 0:13:38.840 --> 0:13:43.559 secondary infections where you've always had CMV and you've got 0:13:43.559 --> 0:13:47.440 it again, And then there's a reactivation where you've got 0:13:47.480 --> 0:13:49.920 it years ago and it was never quite killed off 0:13:49.920 --> 0:13:52.400 inside your body and it comes. 0:13:52.160 --> 0:13:55.160 Back, and you're more interested in their primary infection because 0:13:55.160 --> 0:13:57.480 the transmission rate is higher, isn't it. 0:13:57.559 --> 0:14:00.400 The transmission from mother to baby is highest. Yes, that right, 0:14:01.440 --> 0:14:09.520 But more people have secondary or reactivations, so we're interested 0:14:09.559 --> 0:14:09.959 in both. 0:14:10.120 --> 0:14:13.040 Yeah, And I want to go back just in case 0:14:13.080 --> 0:14:17.520 anyone's panicking right now, when we said that one in 0:14:17.520 --> 0:14:21.040 one hundred and fifty babies are found with CMV. There's 0:14:21.080 --> 0:14:24.520 some that are infected. Yep, And there are some that 0:14:24.600 --> 0:14:26.560 are affected exactly. 0:14:26.600 --> 0:14:31.080 So lots of those babies are fine and have no 0:14:31.320 --> 0:14:35.480 problems then and no problems later. Yeah, But the most 0:14:35.840 --> 0:14:39.479 severe scenario is a baby that becomes quite sick inside. 0:14:39.680 --> 0:14:42.040 So when we talk about it as a cause of prematurity, 0:14:42.080 --> 0:14:45.520 some of that prematurity will be caused by us. We'll 0:14:45.520 --> 0:14:48.040 be watching a baby with CMV and thinking, this baby 0:14:48.200 --> 0:14:51.120 is not going to make it to full term unless 0:14:51.120 --> 0:14:51.680 we interfere. 0:14:51.760 --> 0:14:56.040 Now, yeah, the old better out than in scenario. 0:14:56.400 --> 0:14:57.400 Sometimes that applies. 0:14:57.520 --> 0:15:01.640 Yeah. Now, the baby can also get during delivery and 0:15:01.720 --> 0:15:03.880 post natally through breast milk, is that right? 0:15:04.120 --> 0:15:07.240 Yeah, So that's a significant situation as well, So we 0:15:07.280 --> 0:15:10.920 want to know about mums that are sick with CMV 0:15:11.440 --> 0:15:16.600 even if there's no Even if there's no immediately obvious 0:15:16.640 --> 0:15:17.880 evidence of fetal infection. 0:15:18.280 --> 0:15:21.320 You've talked about how we can test for it during pregnancy, 0:15:21.560 --> 0:15:25.240 but if it's suspected after birth, what sort of tests 0:15:25.400 --> 0:15:27.400 would a parent expect for their baby to have. 0:15:28.320 --> 0:15:30.440 So after birth, when we've got the baby right there 0:15:30.440 --> 0:15:33.960 in front of us, we can try and sample and 0:15:34.040 --> 0:15:40.400 culture multiple body fluids, urine, a saliva, pooh, and get 0:15:40.480 --> 0:15:42.840 swabs and viral cultures off the baby to try and 0:15:42.840 --> 0:15:46.000 make a quick diagnosis of whether the baby appears to 0:15:46.000 --> 0:15:49.240 have CMV at birth, because there is a role for 0:15:49.240 --> 0:15:52.320 anti viral medication, but you need to give it quickly, 0:15:52.640 --> 0:15:53.240 So we'd. 0:15:53.080 --> 0:15:55.600 Want to get a diagnosis right at the start, and 0:15:55.640 --> 0:15:59.280 that baby then would be referred to a pedutrition or yeah, 0:15:59.280 --> 0:16:00.880 that's in the hand of aped, isn't it. 0:16:00.960 --> 0:16:03.120 Yes, So the pediatricians would then be looking at that 0:16:03.200 --> 0:16:05.840 baby for any signs of an acute illness. So the 0:16:05.880 --> 0:16:09.040 baby got sick as a newborn, and then long term, 0:16:09.520 --> 0:16:14.240 if CMV was proven for the development of any you know, 0:16:14.440 --> 0:16:19.720 neurodevelopmental things vision, hearing, and so forth. 0:16:19.840 --> 0:16:22.880 It must be so hard because you know, jaundice is 0:16:22.920 --> 0:16:26.720 one symptom as well, but jaundice can be caused by 0:16:26.760 --> 0:16:30.120 so many different things like it do people say, well, 0:16:30.120 --> 0:16:32.440 how about CMV? Like is that what you hear? 0:16:32.600 --> 0:16:36.680 That's right? So we rely on these neonatal pediatricians. They're 0:16:36.680 --> 0:16:39.240 pretty clever men and women, and they and we and 0:16:39.520 --> 0:16:42.480 we rely on them to take a broad look at 0:16:42.480 --> 0:16:45.080 a newborn. And the new one can't tell you what's wrong. 0:16:45.440 --> 0:16:49.360 It must be a really hard job. So they do 0:16:49.480 --> 0:16:54.200 take a really broad look. And sometimes we would say, well, well, 0:16:54.320 --> 0:16:58.400 here's a baby with some significant jaundice, and yet there 0:16:58.440 --> 0:17:02.280 were no real obstetric risk factors for that obstetric for 0:17:02.320 --> 0:17:06.159 that jaundice, like a mismatch between blood groups or anything 0:17:06.240 --> 0:17:09.040 like that, or significant prematurity. Why is this baby jaundice? 0:17:09.200 --> 0:17:11.440 And the clever pedutrition will often say, well, let's let's 0:17:11.480 --> 0:17:15.280 rule out infection, So they test the baby for something 0:17:15.280 --> 0:17:21.040 called a torch screen, which is any evidence of infections 0:17:21.040 --> 0:17:22.200 that could be making a baby. 0:17:22.200 --> 0:17:25.840 See right, What about the placenta do they do? The 0:17:25.880 --> 0:17:29.720 peds also say hey, can we hey, obstetrician, what do 0:17:29.760 --> 0:17:31.080 you do with the placenta. Can we test it? 0:17:31.200 --> 0:17:33.160 Yeah? They do. Yeah, so you can swap the placenta 0:17:33.280 --> 0:17:36.920 for any signs of infection and then for other problems. 0:17:36.960 --> 0:17:41.920 You can analyze the placenta microscopically for any for signs 0:17:41.920 --> 0:17:45.560 of problems that might have led to an unexpected pregnancy outcome. 0:17:46.119 --> 0:17:48.879 All right, so you mentioned that the baby needs you know, 0:17:48.920 --> 0:17:51.520 it's best if they get their antiviral treatments within twenty 0:17:51.560 --> 0:17:57.119 one days. That's that's a pretty tight frame, isn't it. 0:17:57.560 --> 0:18:00.760 Yeah. I think I think that's the The important thing 0:18:00.800 --> 0:18:05.040 we need to have about CMV is an index of suspicion. 0:18:05.160 --> 0:18:10.200 Could this be CMV? And the opportunities for early treatment 0:18:10.320 --> 0:18:13.879 might be lost by just not being thought of. But 0:18:14.760 --> 0:18:18.720 if we're on the ball about CMV, then then you 0:18:18.720 --> 0:18:21.520 know there's a there's a clear protocol of of how 0:18:21.560 --> 0:18:24.000 to a manager suspected their natal infection. 0:18:25.240 --> 0:18:29.160 I imagine that in one in six people knowing about CMV, 0:18:29.800 --> 0:18:33.160 listening to this podcast will be kind of shocking and 0:18:33.240 --> 0:18:34.680 it will be kind of terrifying. 0:18:35.119 --> 0:18:37.640 Yeah, that's that's sort of the risk, isn't it, Because 0:18:38.359 --> 0:18:44.560 information is good, but it also worries people potentially So 0:18:45.600 --> 0:18:48.560 I'm encouraging people, if they're hearing about CMB for the 0:18:48.600 --> 0:18:50.920 first time and have never heard of it, to talk 0:18:50.960 --> 0:18:53.720 to their cares and say, what can I do to 0:18:53.840 --> 0:18:57.360 prevent this? Is there any value in me being tested? 0:18:58.800 --> 0:19:00.640 I had a shock and flu like illness a month 0:19:00.640 --> 0:19:03.080 ago which is pasted. Is there any chance that was CMV? 0:19:03.720 --> 0:19:06.040 And encourage discussion of it. 0:19:07.880 --> 0:19:11.000 Hopefully, our next portion of the podcast, we're really going 0:19:11.040 --> 0:19:14.879 to hone in on how to prevent getting CMV. So 0:19:15.400 --> 0:19:16.520 everyone take a big breath. 0:19:16.760 --> 0:19:18.880 Because that I think is the most is the best 0:19:18.880 --> 0:19:24.080 way to respond. If this is causing people anxiety, We'll say, right, 0:19:24.520 --> 0:19:27.800 what what can we do? What's been shown to help 0:19:27.880 --> 0:19:28.879 reduce transmission? 0:19:29.600 --> 0:19:32.320 Let's do that, all right? What has been shown to 0:19:32.400 --> 0:19:36.840 help stop transmission? Yeah, you asked your own question. 0:19:36.880 --> 0:19:40.160 Then look, I think you might get it off your 0:19:40.160 --> 0:19:44.879 own children who are older and two or three year old, 0:19:45.280 --> 0:19:50.159 say in daycare or kindergarten or something, And you won't 0:19:50.240 --> 0:19:53.159 get it from just giving that child a hug or 0:19:53.400 --> 0:19:56.360 just usual parenting care, but you could get it from 0:19:56.400 --> 0:20:00.720 sharing saliva. So there are a couple of things that 0:20:00.800 --> 0:20:03.119 parents do that that maybe we shouldn't if we if 0:20:03.119 --> 0:20:05.480 we knew about CMV. And one is that if a 0:20:05.560 --> 0:20:09.520 toddler drops their dummy on the ground, I've done. 0:20:09.320 --> 0:20:10.120 This, I've done this. 0:20:10.520 --> 0:20:13.840 We pick it up and there's no tap or anything around, 0:20:14.040 --> 0:20:16.159 so we put in our own mouth to wash the 0:20:16.160 --> 0:20:17.840 dirt off, and then we put back in the baby's mouth. 0:20:18.320 --> 0:20:22.040 And that's probably a high risk activity for CMV transmission. 0:20:23.480 --> 0:20:27.640 And then you know, the other thing that that it's 0:20:27.760 --> 0:20:29.520 nice to do when you've got when you've got really 0:20:29.520 --> 0:20:31.480 little ones, is you want to kiss them all the time. 0:20:32.080 --> 0:20:34.760 But it's presumably a lot safer to kiss the baby 0:20:34.760 --> 0:20:39.399 anywhere but on the mouth, and and that's something that 0:20:39.480 --> 0:20:43.600 people could consider. And the other thing is contact with urine. 0:20:44.000 --> 0:20:49.639 So the virus is spread heavily in urine. There's a 0:20:49.680 --> 0:20:52.800 lot of virus in the urine. So when you have 0:20:52.840 --> 0:20:57.080 to clean up we your baby or somebody else's that, 0:20:57.520 --> 0:21:00.680 you know, proper hand wash towards. 0:21:00.920 --> 0:21:05.240 I want to further explore where we might share saliva 0:21:05.320 --> 0:21:09.880 with our children. I remember being on holidays and one 0:21:09.880 --> 0:21:14.040 of the kids has forgotten their toothbrush, and I've loaned 0:21:14.040 --> 0:21:16.760 my toothbrush, which in hindsight is disgusting. 0:21:16.760 --> 0:21:19.280 But also that's why I'm hesitating because it all sounds 0:21:19.320 --> 0:21:21.320 a bit gross, But when it's your baby, doesn't feel gross. 0:21:21.520 --> 0:21:23.040 Kissing a little baby on the math you think it's 0:21:23.040 --> 0:21:24.560 other people baby on the mouth, but you mike's your 0:21:24.560 --> 0:21:26.960 own baby in the mouth and there they might. 0:21:26.840 --> 0:21:30.480 Kiss you like you know, the the open mouth kiss 0:21:30.520 --> 0:21:34.000 of a six month old is hilarious. 0:21:33.560 --> 0:21:37.080 Hilarious, and but they've definitely got saliva again out there 0:21:37.240 --> 0:21:43.320 and then and then you know, things like contact with urine. 0:21:44.160 --> 0:21:47.639 You would wash your hands if you had just cleaned 0:21:47.720 --> 0:21:53.280 up somebody else's urine, but we had, But with our 0:21:53.280 --> 0:21:55.600 own children in our own household, we're probably a bit slack. 0:21:55.800 --> 0:21:59.120 Yeah, so it's back to That's one thing COVID did 0:21:59.119 --> 0:22:02.400 teach us is proper and washing routine, which is good. 0:22:03.359 --> 0:22:08.679 I'm stuck on the saliva sorry. But toddlers their slobbery people, 0:22:09.400 --> 0:22:12.040 so they sobber over everything, so you know you've got 0:22:12.040 --> 0:22:17.040 to make sure you're cleaning their toys properly. Sometimes you 0:22:17.080 --> 0:22:20.800 want to feed your baby off your own utensils, you know, 0:22:20.960 --> 0:22:24.159 put a mouthful in their mouth and then back in yours. 0:22:24.640 --> 0:22:26.280 Or do what I used to do and take food 0:22:26.280 --> 0:22:26.720 from their. 0:22:26.680 --> 0:22:28.879 Play Yeah, you're a shocker at doing that. That is 0:22:28.920 --> 0:22:29.320 so bad. 0:22:29.520 --> 0:22:31.399 Used to go what are you doing? Yeah, yeah, that 0:22:31.440 --> 0:22:32.800 would have been like, no, they just left it them 0:22:32.800 --> 0:22:33.720 and you're like, we'll come to what. 0:22:33.960 --> 0:22:37.200 I'm back now, slob it all over it. 0:22:37.440 --> 0:22:42.560 Yeah, So this is I'm serious, like like we should 0:22:42.600 --> 0:22:47.040 be we should be rethinking these behaviors, and I guess 0:22:47.119 --> 0:22:49.880 things that we can do to reduce cm FEA transmission 0:22:50.240 --> 0:22:53.760