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Sequelae of acquired cytomegalovirus infection in premature and sick term infants
Insights
Acquired cytomegalovirus (CMV) infection in premature infants can increase the risk of long-term neurologic sequelae, especially with early onset of CMV excretion. Late excretion did not show increased risks in this study.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Developmental Pediatrics
Background:
- Cytomegalovirus (CMV) is a common congenital infection with potential for long-term sequelae.
- Premature and sick term infants are particularly vulnerable to severe outcomes from CMV infection.
- Understanding the specific risks associated with CMV in this population is crucial for early intervention.
Purpose of the Study:
- To evaluate the risk of long-term neurological and hearing sequelae in premature and sick term infants following acquired cytomegalovirus (CMV) infection.
- To identify factors associated with increased risk of handicaps in CMV-infected infants.
Main Methods:
- A prospective study matching 55 CMV-infected infants with 55 control infants.
- Evaluation at 3 years of age, assessing sensorineural hearing loss and neurological sequelae (EEG, developmental quotient, handicaps).
- Analysis of risk factors including birth weight, onset of CMV excretion, and severity of cardiopulmonary disease.
Main Results:
- No increased incidence of neurological sequelae in CMV-infected infants with birth weight >2000 gm.
- Among infants with birth weight <2001 gm, moderately abnormal EEGs and severe handicaps were more frequent in the CMV group.
- Severe handicaps in premature infants were significantly associated with early CMV excretion (<8 weeks) and severe cardiopulmonary disease.
Conclusions:
- The risk of neurologic sequelae and handicap appears increased in premature infants with early-onset CMV excretion (within the first 2 months of life).
- Late CMV excretion (≥8 weeks) was not associated with increased neurologic sequelae in premature infants.
- Early identification and management of CMV in high-risk premature infants may be critical to mitigate long-term adverse outcomes.
Abstract:
To assess the risk of long-term sequelae after acquired cytomegalovirus (CMV) infection in premature and sick term infants, 55 CMV infected patients were matched prospectively with 55 control patients and these matched pairs were evaluated at 3 years of age. Sensorineural hearing losses were present in four of 43 CMV infected patients (all mild-moderate) and in two of 43 controls (one severe). The incidence of neurologic sequelae was not increased in CMV infected patients with birth weight greater than 2000 gm. Among patients with birth weight less than 2001 gm, moderately abnormal EEGs were found in four (17%) of 23 CMV infected patients and in one (4%) of 23 controls, and severe handicaps occurred in four (14%) of 29 CMV infected patients and in two (7%) of 29 controls. Severe handicaps in premature infants were significantly (P less than 0.05) associated with early onset of CMV excretion (less than 8 weeks of age) and severe cardiopulmonary disease. Among the premature infants who were documented early excretors, three of 13 had severe neuromuscular impairment, four of 13 had severe handicaps (DQ less than 70, severe neuromuscular impairment, or profound loss of vision or hearing), and an additional four had DQs of 70 to 79. Among their matched control subjects, none of 13 had severe neuromuscular impairment, two of 13 had severe handicaps, and an additional two had DQs between 70 and 79. None of the premature infants who were documented late excretors (greater than or equal to 8 weeks of age) had any neurologic sequelae. The risk of neurologic sequelae and handicap may be increased in premature infants with onset of CMV excretion in the first 2 months of life.