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Ascites and Enterocolitis in a Preterm Infant with Acquired CMV Infection: A Case Study and Review of the Literature

Keren Nathan1,2, Ellen Bamberger1,2, Daniel Dubin2,3

  • 1Department of Pediatric Infectious Disease, Bnai Zion Medical Center, Haifa 3339419, Israel.

Journal of Clinical Medicine
|August 28, 2025
PubMed

Insights

Postnatal cytomegalovirus (pCMV) infection is a serious risk for very preterm infants, often transmitted via breast milk. Early recognition and treatment are crucial for managing severe symptoms like ascites.

Area of Science:

  • Neonatology
  • Infectious Diseases
  • Pediatric Gastroenterology

Background:

  • Postnatal cytomegalovirus (pCMV) infection poses significant risks to very preterm and very low birth weight (VLBW) infants.
  • Transmission primarily occurs through breast milk from seropositive mothers.
  • While often asymptomatic in term infants, pCMV can lead to severe illness in vulnerable neonates.

Purpose of the Study:

  • To present a case of severe pCMV infection with ascites in a preterm infant.
  • To review clinical manifestations, focusing on gastrointestinal involvement.
  • To outline current guidelines for pCMV treatment and prevention in high-risk infants.

Main Methods:

  • Case report of a 29-week preterm infant with symptomatic pCMV infection.
  • Management included ganciclovir (GCV), intravenous immunoglobulins (IVIG), and ascites drainage.
  • Literature review of pCMV clinical presentations, gastrointestinal manifestations, and treatment strategies.

Main Results:

  • The presented infant, diagnosed at day of life 50, experienced respiratory compromise and massive ascites.
  • Treatment with GCV, IVIG, and drainage led to gradual improvement and successful discharge.
  • The review highlights ascites as a less recognized gastrointestinal manifestation of pCMV.

Conclusions:

  • Clinicians should consider pCMV in VLBW and extremely premature infants with symptoms like thrombocytopenia, colitis, or ascites.
  • Prompt diagnosis and management are vital for improving outcomes in these high-risk infants.
  • Awareness of pCMV's gastrointestinal manifestations is crucial for timely intervention.

Keywords:
ascitesgastrointestinal complicationspostnatal cytomegalovirus (CMV)very low birth weight (VLBW)

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