Klin Padiatr 2018; 230(05): 257-262
DOI: 10.1055/a-0598-4748
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Prevalence of Congenital CMV Infection and Antiviral Therapy in Very-Low-Birth-Weight Infants: Observations of the German Neonatal Network

Prävalenz der kongenitalen CMV Infektion und antivirale Therapie in Very-Low-Birth-Weight Infants: Beobachtungen aus dem German Neonatal Network
Alexander Humberg
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
,
Viola Leienbach
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
,
Mats I. Fortmann
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
,
Tanja K. Rausch
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
4  Institute of Medical Biometry and Statistics, University of Lübeck, University Medical Center of Schleswig-Holstein, Campus Lübeck, Germany
,
Horst Buxmann
2  Pediatrics, JW Goethe University Hospital, Germany
,
Andreas Müller
3  Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany
,
Egbert Herting
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
,
Christoph Härtel
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
,
Wolfgang Göpel
1  Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 April 2018 (online)

Abstract

Background To determine the prevalence of congenital CMV infection (cCMV) in very-low-birth-weight infants (VLBWI) and to evaluate epidemiological characteristics of VLBWI with antiviral therapy (AT).

Methods CMV-specific PCR in umbilical cord tissue was performed (n=3330). Univariate analyses and logistic regression models were used to identify associations with outcome.

Results 22/3330 VLBWI received AT (0.66%). 4 of these (0.12%) were PCR positive, with 2 VLBWI showing pathological screening for hearing loss. VLBWI with AT and negative PCR had significantly reduced mean birth weight (BW) and higher rates of small-for-gestational-age (SGA). Clinical sepsis, bronchopulmonary dysplasia (BPD), use of reserve antibiotics (RA) and treatment for retinopathy of prematurity were significantly increased. We further observed a higher need of transfusion of red blood cells (RBC), fresh frozen plasma and platelets. Logistic regression (controlled for gender, gestational age, SGA and BW) showed associations for AT and BPD (OR 3.4 [1.2–10.1], p=0.024), RA (OR 20.4 [4.2–98.9], p≤0.001), transfusions of RBC (OR 11.9 [1.3–105.7], p=0.026) and platelets (OR 8.7 [2.9–26.4], p≤0.001).

Discussion All VLBWI with positive PCR received AT. We hypothesize from our data by assuming a postnatal aquired CMV infection in VLBWI with AT and negative PCR that VLBWI born SGA have a different risk profile.

Conclusion Further prospective studies concerning postnatal transmission should take VLBWI born SGA into account and should study the impact of infection on short- and long-term complications in this supposed vulnerable group.

Zusammenfassung

Hintergrund Bestimmung der Prävalenz kongenitaler CMV-Infektion und Evaluierung epidemiologischer Charakteristika bei very-low-birth-weight infants (VLBWI) mit antiviraler Therapie (AT).

Methoden CMV-spezifische DNA wurde per PCR in Nabelschnurgewebe (n=3330) bestimmt. Univariate und logistische Regressionsanalysen wurden zur Identifizierung von Assoziationen und Outcome herangezogen.

Ergebnisse 22/3330 VLBWI (0,66%) erhielten AT. Ein positiver CMV Nachweis ergab sich bei 4 dieser Kinder (0,12%). 2 davon zeigten ein pathologisches Hörscreening. VLBWI mit AT und negativer PCR zeigten ein signifikant reduziertes mittleres Geburtsgewicht (GG) und höhere Raten an small-for-gestational-age (SGA). Klinische Sepsis, Bronchopulmonale Dysplasie (BPD), Gebrauch von Reserveantibiotika (RA) und Behandlung einer Retinopathia praematorum waren signifikant erhöht. Weiter beobachteten wir erhöhte Transfusionsraten für Erythrozytenkonzentrate (EK), fresh frozen plasma und Thrombozyten (THR). In der logistischen Regression (kontrolliert für Geschlecht, Gestationsalter, SGA und GG) zeigten sich Assoziationen für AT und BPD (OR 3,4 [1,2–10,1], p=0,024), RA (OR 20,4 [4,2–98,9], p≤0,001), Transfusionen von EK (OR 11,9 [1,3–105,7], p=0,026) und THR (OR 8,7 [2,9–26,4], p≤0,001).

Diskussion Alle VLBWI mit positiver PCR erhielten AT. Bei vermutlich postnatal CMV infizierten VLBWI (AT und negative PCR) vermuten wir aus der Analyse unserer Daten ein besonderes Risikoprofil bei SGA Kindern.

Schlussfolgerung Weitere prospektive Studien bezüglich postnataler Transmission sollten VLBWI mit SGA in den Fokus nehmen und den Einfluss auf Kurz- und Langzeiteffekte besonders in dieser Kohorte untersuchen.