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Value of targeted testing for cytomegalovirus in preterm infants: 7 years' experience at a tertiary London hospital
Helen Payne1,2, Rebecca Faber3, Ravi D Mistry4
1Paediatric Infectious Disease, Imperial College London, London, UK helen.payne@imperial.ac.uk.
Insights
Targeted cytomegalovirus (CMV) testing in preterm infants aids early diagnosis of congenital CMV (cCMV) and postnatal CMV (pCMV). This study highlights CMV
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) poses a significant health risk to preterm infants.
- Distinguishing between congenital CMV (cCMV) and postnatal CMV (pCMV) is crucial for appropriate management.
- Current diagnostic strategies involve targeted testing in high-risk neonatal populations.
Purpose of the Study:
- To audit the effectiveness of targeted CMV testing in preterm infants (<30 weeks gestation).
- To determine the incidence of congenital CMV (cCMV) and postnatal CMV (pCMV) in this cohort.
- To evaluate the clinical presentation and outcomes associated with CMV infection in preterm neonates.
Main Methods:
- Retrospective data collection on CMV testing from 2016 to 2023.
- Inclusion criteria: infants born <30 weeks gestation admitted to a tertiary London neonatal center.
- Analysis of testing timing, CMV infection status (cCMV vs. pCMV), clinical symptoms, treatment, and outcomes.
Main Results:
- 77% of infants underwent CMV testing, with 74.6% tested within 21 days of birth.
- CMV infection was confirmed in 58 infants: 4 cCMV (0.4%) and 54 pCMV (6.0%).
- Symptomatic disease occurred in 6% of tested infants; mortality was 16.7%, with 42.6% discharged on home oxygen.
Conclusions:
- CMV infection represents a substantial disease burden in preterm infants (<30 weeks gestation).
- Targeted testing is feasible and valuable for diagnosing cCMV and identifying pCMV.
- Consideration of targeted birth testing for cCMV in infants <30 weeks gestation is recommended in the absence of universal screening.
Background:
Targeted testing for cytomegalovirus (CMV) in preterm infants <21 days has two benefits: timely congenital CMV (cCMV) diagnosis, and differentiation between cCMV and postnatal CMV (pCMV). We present an audit of targeted testing for cCMV alongside rates of clinically suspected pCMV in preterm infants.
Methods:
We collected data on CMV testing from 2016 to 2023 in infants born <30 weeks gestation during admission to a tertiary London neonatal centre.
Results:
Of all infants, 77% (899/1162) were tested for CMV during their admission with 74.6% tested <21 days of age. CMV infection was confirmed in 58 infants, 4 cases of cCMV (0.4%) and 54 cases of pCMV (6.0%). One infant with cCMV died, and all were symptomatic: microcephaly, thrombocytopenia, leucopenia, white matter hyperintensity on brain imaging, but none had hearing loss. Most pCMV cases (92.6%) were symptomatic, with bone-marrow suppression (92.6%), sepsis-like syndrome (50%), respiratory (31.5%) and gastrointestinal symptoms (29.6%). All infants with cCMV and 38.9% of infants with pCMV received treatment. Overall, 6% (54/899) had symptomatic CMV disease, 16.7% of infants with CMV died during their neonatal intensive care unit admission, and 42.6% were discharged on home oxygen.
Conclusions:
CMV causes a substantial disease burden in infants born <30 weeks gestation, whereby 6% have symptomatic CMV disease. We show the feasibility and value of targeted cCMV and opportunistic pCMV testing. In the absence of universal screening, targeted birth testing for cCMV in infants <30 weeks gestational age should be considered.
