Postnatal Cytomegalovirus Infection in a Neonatal Intensive Care Unit: A Retrospective Study

Postnatal cytomegalovirus (pCMV) infection is a relevant cause of morbidity in preterm infants, particularly those born extremely preterm or with very low birth weight. This study aimed to describe the clinical manifestations, management, and outcomes of neonates with pCMV infection admitted to a neonatal intensive care unit (NICU).

We conducted a retrospective case series of 12 neonates diagnosed with pCMV infection between 2013 and 2024 in a level III NICU. Congenital cytomegalovirus (CMV) infection was excluded by negative urine testing within the first two weeks of life. Clinical, laboratory, and follow-up data were extracted from medical records.

Median gestational age was 25.0 weeks, and median birth weight was 699.5 grams. All infants were breastfed prior to infection, with the first positive CMV sample detected at a median of 52 days of life. Hematological abnormalities were frequent, including neutropenia in 9/11 (81.8%) and thrombocytopenia in 7/12 (58.3%). Respiratory complications were common, with bronchopulmonary dysplasia in all cases, and intraventricular hemorrhage (IVH) occurred in eight (66.7%). Antiviral therapy was administered in 9/11 (75%) patients, achieving viral clearance in 8/9 (88.9%) treated infants. Overall mortality was 25%.

pCMV infection in extremely preterm infants is associated with significant morbidity, frequent hematological and respiratory complications, and high mortality. Although antiviral therapy achieved viral clearance in most treated infants, long-term neurodevelopmental impairment was common. Distinguishing sequelae attributable to pCMV from those related to extreme prematurity remains challenging, underscoring the need for prospective studies to better guide management and assess long-term outcomes.