Related Experiment Video
Updated: Dec 12, 2025
Intracerebroventricular and Intravascular Injection of Viral Particles and Fluorescent Microbeads into the Neonatal Brain
Published on: July 24, 2016
Refractory Ileal Perforations in a Cytomegalovirus-Infected Premature Neonate Resolved After Ganciclovir Therapy
Mari Morimoto1, Hirofumi Sawada1,2, Noriko Yodoya1
1Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan.
Insights
Cytomegalovirus (CMV) infection may cause severe gastrointestinal disease in premature infants. Antiviral therapy with ganciclovir showed promising results in resolving symptoms and clearing CMV-DNA in a preterm infant.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Gastroenterology
Background:
- Severe gastrointestinal diseases, including necrotizing enterocolitis and intestinal perforation, are leading causes of mortality in preterm infants.
- Cytomegalovirus (CMV) infection is a known concern in neonates, but its specific role in severe gastrointestinal conditions in premature infants remains unclear.
Observation:
- A preterm infant born at 26 weeks gestation developed progressive abdominal distention and required two emergent surgeries for recurrent ileal perforation.
- Pathological examination revealed Cytomegalovirus (CMV) inclusion bodies in the resected intestinal tissue.
- CMV-DNA was detected in blood, urine, and the umbilical cord, confirming systemic CMV infection.
Findings:
- Intravenous ganciclovir treatment led to the resolution of the infant's gastrointestinal symptoms and a decrease in CMV-DNA levels.
- Post-treatment, pathological findings characteristic of CMV were absent in subsequent intestinal tissue samples.
Implications:
- These findings suggest that antiviral therapy may be beneficial for preterm infants suffering from severe gastrointestinal diseases associated with Cytomegalovirus (CMV).
- Further research is warranted to elucidate the pathogenic role, diagnostic methods, and optimal treatment strategies for CMV in this vulnerable population.
Abstract:
Severe neonatal gastrointestinal diseases such as necrotizing enterocolitis or spontaneous intestinal perforation are potentially lethal conditions which predominantly occur in preterm infants. Cytomegalovirus (CMV), which is known to cause congenital and acquired infections in the newborns, has also been implicated in such severe gastrointestinal diseases in premature infants. However, the pathogenic role of CMV and effect of antiviral therapy in severe gastrointestinal disease in premature neonates is currently unclear. We present an infant, born at 26-weeks' gestation, presented with progressive dyspepsia and abdominal distention after the closure of the symptomatic patent ductus arteriosus at the day of life (DOL) 4, requiring the emergent surgery for ileal perforation at the DOL8. After the surgery, abdominal symptoms persisted and the second emergent surgery was performed for the recurrent ileal perforation at DOL17. Even then the abdominal symptoms prolonged and pathological examination in the affected intestine at the second surgery showed CMV inclusion body. Immunoreactivity for CMV antigen was detected in the specimen at the first surgery on DOL8. Blood and urinary CMV-DNA were detected at DOL28. CMV-DNA was also detected in the dried umbilical cord which was obtained within a week from birth. A 6-week course of intravenous ganciclovir (12 mg/kg/day) was started at DOL34 and then symptoms resolved along with decreasing blood CMV-DNA. Pathological findings characteristic of CMV were not detected in the resection specimen at the ileostomy closure at DOL94. These observations indicate that anti-CMV therapy may be beneficial for some premature infants with severe CMV-associated gastrointestinal diseases and warrants further studies focusing on pathogenic role, diagnosis, treatment and prevention of this underrecognized etiology of severe gastrointestinal diseases particularly in premature neonates.
