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The Effect of Postnatal Cytomegalovirus Infection on (Micro)structural Cerebral Development in Very Preterm Infants
Yasmin Pellkofer1, Marlene Hammerl1, Elke Griesmaier1
1Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Postnatal cytomegalovirus (CMV) infection did not significantly impact brain injury or microstructural development in very preterm infants. Further research is needed to understand long-term neurodevelopmental outcomes.
Area of Science:
- Neonatal neurology
- Infectious diseases in neonates
- Neuroimaging
Background:
- Postnatal cytomegalovirus (CMV) infection is suspected to negatively affect neurodevelopment in preterm infants.
- Cerebral imaging correlates of CMV-induced neurodevelopmental changes in preterm infants are not well understood.
Purpose of the Study:
- To investigate the effect of postnatal CMV infection on brain injury incidence.
- To assess microstructural brain maturation in very preterm infants at term-equivalent age.
Main Methods:
- Cerebral MRI with diffusion-weighted imaging was performed at term-equivalent age in infants born before 32 weeks gestational age.
- Postnatal CMV infection was identified via urine/saliva screening, with infection confirmed if samples turned positive after 5 postnatal days.
- Brain injury rates and microstructural parameters (fractional anisotropy, apparent diffusion coefficient) were compared between infected and non-infected infants.
Main Results:
- Of 401 eligible infants, 18 (4.5%) acquired postnatal CMV infection.
- No significant differences in brain injury rates or microstructural brain development were observed between infants with and without postnatal CMV infection.
- This finding held true even for the subgroup of infants born before 28 weeks gestational age.
Conclusions:
- Despite being born more immature and experiencing more complications, infants with postnatal CMV infection did not show increased preterm brain injury.
- Postnatal CMV infection did not lead to disadvantageous alterations in microstructural brain maturation at term-equivalent age.
- The study suggests that postnatal CMV infection may not have the detrimental effects on brain structure previously hypothesized.
Introduction:
There are some data indicating a negative impact of postnatal cytomegalovirus (CMV) infection on long-term neurodevelopmental outcome of preterm infants. So far, there is only little knowledge about a cerebral imaging correlate of these neurodevelopmental alterations induced by postnatal CMV infection in preterm infants. The aim of the current study was to investigate the effect of postnatal CMV infection on the incidence of brain injury and on microstructural brain maturation in very preterm infants at term-equivalent age.
Methods:
Infants <32 gestational weeks (02/2011-11/2018) received cerebral MRI including axial diffusion-weighted images at term-equivalent age. All infants were screened for CMV infection using urine/saliva samples, and infection was regarded as acquired postnatal if a sample became positive >5 postnatal days. We compared brain injury as well as fractional anisotropy and apparent diffusion coefficient in 14 defined cerebral regions between infants with and without postnatal CMV infection.
Results:
401 infants were eligible, of whom 18 (4.5%) infants had a postnatal CMV infection. There were no significant differences in rates of brain injury or in microstructural brain development between both groups. This applied equally to the subgroup of infants <28 gestational weeks.
Conclusion:
Although infants with postnatal CMV infection were born more immature and more frequently suffered from complications related to immaturity, we neither observed a higher rate of preterm brain injury nor disadvantageous alterations in microstructural brain maturation at term-equivalent age.
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