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Published on: July 6, 2013
Symptomatic Postnatal Cytomegalovirus Infection in Less than 32-Week Preterm Infants: 13-Year Retrospective
Sarah Jane Corpuz Tapawan1,2, Barbara Bajuk3, Ju Lee Oei4,5
1Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia, janesa0301@gmail.com.
Insights
Symptomatic postnatal cytomegalovirus (pCMV) infection significantly increases chronic lung disease (CLD) risk in extremely preterm infants. Ganciclovir treatment showed no benefit, highlighting the need for screening and treatment studies.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Pediatric Pulmonology
Background:
- Postnatal cytomegalovirus (pCMV) infection impacts neonatal outcomes in preterm infants, yet management guidelines are lacking.
- Preterm infants, especially those born before 32 weeks gestation, are vulnerable to infections like pCMV.
Purpose of the Study:
- To determine the association between symptomatic pCMV infection and chronic lung disease (CLD) in preterm infants (<32 weeks gestation).
- To investigate the impact of symptomatic pCMV infection on mortality in this vulnerable population.
Main Methods:
- A prospective, population-based data registry from 10 neonatal units in New South Wales, Australia, was utilized.
- Data from 40,933 infants were analyzed, identifying 172 infants with symptomatic pCMV infection (<32 weeks gestation) matched with controls.
Main Results:
- Symptomatic pCMV infection increased the likelihood of developing CLD by 2.7 times and prolonged hospital stay by 25.2 days.
- Seventy-five percent of affected infants were extremely preterm (<28 weeks). Ganciclovir treatment did not reduce CLD or mortality.
- CLD was a significant predictor of death in infants with symptomatic pCMV infection, though pCMV did not directly influence mortality or neurologic impairment.
Conclusions:
- Symptomatic pCMV infection is a modifiable factor significantly impacting CLD in extremely preterm infants.
- Further prospective studies on screening and treatment are warranted to explore potential benefits for high-risk preterm infants.
Introduction:
Reports on the influence of postnatal cytomegalovirus (pCMV) infection in neonatal outcomes of preterm babies vary while guidance on management including screening is lacking. We aim to determine the association between symptomatic pCMV infection and chronic lung disease (CLD) and mortality in preterm infants born less than 32 weeks gestation.
Methods:
We used data from the Neonatal Intensive Care Units' (NICUS) population-based prospective data registry of infants in 10 neonatal units in New South Wales and the Australian Capital Territory, Australia. De-identified perinatal and neonatal outcome data for 40,933 infants were examined. We identified 172 infants <32 weeks gestation with symptomatic pCMV infection. Each was matched with one control infant.
Results:
Infants with symptomatic pCMV infection were 2.7 times more likely to develop CLD (OR 2.7, 95% CI: 1.7-4.5) and spend 25.2 days more in hospital (95% CI: 15.2-35.2). Seventy-five percent (129/172) of infants with symptomatic pCMV were extremely preterm (<28 weeks). The mean age of symptomatic pCMV diagnosis was 62.5 ± 20.5 days or 34.7 ± 3.6 weeks-corrected gestational age. Ganciclovir treatment did not decrease CLD and death. CLD was 5.5 times predictive of death in patients with symptomatic pCMV infection. Symptomatic pCMV infection did not influence mortality nor increase neurologic impairment.
Conclusion:
Symptomatic pCMV is a modifiable factor affecting extreme preterm infants with significant impact on CLD. Prospective study on screening and treatment will help unveil potential benefits in our already at-risk preterm infants.
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