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Acquired cytomegalovirus infection and blood transfusion in preterm infants
1Department of Pediatrics, Kobe University School of Medicine, Japan.
Abstract:
The urinary excretion of cytomegalovirus (CMV) DNA, amplified by polymerase chain reaction using two pairs of primers for late antigen (LA) and major immediate-early antigen (MIE), and serum CMV IgM were examined in 85 pre-term infants (birth-weight less than 2000 g) on admission and monthly until 6 months after birth. Of these 85 infants, 27 had blood exchange transfusions (BET) and 28 had bolus blood transfusions two to nine times. Fifteen of 27 infants underwent BET with blood that had been filtered through Pall RC100 leukocyte removal filter; the other 12 with unfiltered blood. Neither urinary CMV DNA nor serum CMV-specific IgM was detected at birth in any of the 85 pre-term infants; during the first 6 months after birth urinary CMV DNA, for both MIE and LA, appeared in 22 of the 85 infants (25.9%) and CMV IgM was positive in 14 of the 85 (16.5%). Nine of the 12 (75%) infants who received BET of unfiltered blood showed a significantly higher prevalence of urinary CMV DNA compared to the infants in the other three groups (i.e., those who received no blood transfusion, those who had bolus blood transfusions, or those who received BET of filtered blood; P < 0.01 in each instance). In a logistic regression model, CMV DNA urinary excretion was significantly associated with the mode of blood transfusion (unfiltered BET), and the Odds ratio was 38.9 (95% confidence interval, 9.4-160). There was no significant association with other independent variables such as gender, mother's seropositivity, gestational age, birth-weight or delivery mode.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Unfiltered blood exchange transfusions (BET) significantly increased cytomegalovirus (CMV) DNA excretion in preterm infants. Leukocyte filtration of blood may reduce CMV transmission risk in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Virology
- Transfusion Medicine
Background:
- Cytomegalovirus (CMV) infection is a significant concern in preterm infants.
- Blood transfusions are common in preterm infants and may pose a risk for CMV transmission.
- The role of blood filtration in preventing CMV transmission during transfusions requires further investigation.
Purpose of the Study:
- To investigate the incidence of cytomegalovirus (CMV) DNA and IgM in preterm infants.
- To determine the association between blood transfusion methods and CMV shedding.
- To evaluate the efficacy of leukocyte filtration in reducing CMV transmission via blood exchange transfusions (BET).
Main Methods:
- Urinary CMV DNA and serum CMV IgM were monitored in 85 preterm infants over 6 months.
- Infants received no transfusions, bolus transfusions, filtered BET, or unfiltered BET.
- Polymerase chain reaction (PCR) and serological assays were used for CMV detection.
Main Results:
- CMV DNA was detected in 25.9% and CMV IgM in 16.5% of infants during the study period.
- Infants receiving unfiltered BET showed a significantly higher prevalence of urinary CMV DNA (75%) compared to other groups (P < 0.01).
- Unfiltered BET was strongly associated with CMV DNA excretion (Odds Ratio = 38.9).
Conclusions:
- Unfiltered blood exchange transfusions are a significant risk factor for CMV DNA shedding in preterm infants.
- Leukocyte removal filters may reduce CMV transmission during BET.
- Further research is warranted to confirm the protective effect of filtered blood transfusions against CMV in high-risk neonatal populations.