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Original Investigation
December 2, 2019

Association of Adverse Hearing, Growth, and Discharge Age Outcomes With Postnatal Cytomegalovirus Infection in Infants With Very Low Birth Weight

Author Affiliations
  • 1Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
  • 2Mednax, Sunrise, Florida
  • 3Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
JAMA Pediatr. Published online December 2, 2019. doi:10.1001/jamapediatrics.2019.4532
Key Points

Question  What morbidities are associated with postnatal cytomegalovirus infection at discharge in infants with very low birth weight?

Findings  In this multicenter cohort study of 304 infants with very low birth weight and postnatal cytomegalovirus infection, increased risks were found for failed hearing screen and bronchopulmonary dysplasia, an increased postnatal age at discharge, and decreased weight for length at discharge compared with control infants without infection.

Meaning  These findings suggest that postnatal cytomegalovirus infection is associated with significant morbidity at discharge; prospective, long-term studies are needed to determine the full effects of postnatal cytomegalovirus infection.

Abstract

Importance  Studies suggest that postnatal cytomegalovirus (CMV) infection can lead to long-term morbidity in infants with very low birth weight (VLBW; <1500 g), including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and neurodevelopmental impairment. However, to date, the association of postnatal CMV with hearing, growth, and length of stay among VLBW infants is unknown.

Objectives  To determine the risk for failed hearing screen, increased postnatal age at discharge, or decreased growth at discharge in VLBW infants with postnatal CMV infection compared with CMV-uninfected infants and to compare the risk for other major outcomes of prematurity, including BPD and NEC, in infants with and without postnatal CMV infection.

Participants  This multicenter retrospective cohort study included VLBW infants from 302 neonatal intensive care units managed by the Pediatrix Medical Group from January 1, 2002, through December 31, 2016. Infants hospitalized on postnatal day 21 with a diagnosis of postnatal CMV and hearing screen results after a postmenstrual age of 34 weeks were included in the study population. Data were analyzed from December 11, 2017, to June 14, 2019.

Main Outcomes and Measures  Infants with and without postnatal CMV infection were matched using propensity scores. Poisson and linear regression were used to examine the association between postnatal CMV and the risk of failed hearing screen, postnatal age at discharge, growth, BPD, and NEC.

Results  A total of 304 infants with postnatal CMV were identified, and 273 of these infants (89.8%; 155 boys [56.8%]) were matched with 273 infants without postnatal CMV (148 boys [54.2%]). Hearing screen failure occurred in 45 of 273 infants (16.5%) with postnatal CMV compared with 25 of 273 infants (9.2%) without postnatal CMV (risk ratio [RR], 1.80; 95% CI, 1.14 to 2.85; P = .01). Postnatal CMV was also associated with an increased postnatal age at discharge of 11.89 days (95% CI, 6.72 to 17.06 days; P < .001) and lower weight-for-age z score (−0.23; 95% CI, −0.39 to −0.07; P = .005). Analysis confirmed an increased risk of BPD (RR, 1.30; 95% CI, 1.17 to 1.44; P < .001), previously reported on infants from this cohort from 1997 to 2012, but not an increased risk of NEC after postnatal day 21 (RR, 2.00; 95% CI, 0.18 to 22.06; P = .57).

Conclusions and Relevance  These data suggest that postnatal CMV infection is associated with lasting sequelae in the hearing and growth status of VLBW infants and with prolonged hospitalization. Prospective studies are needed to determine the full effects of postnatal CMV infection and whether antiviral treatment reduces the associated morbidity.

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