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Guo X, Ma D, Li R, Zhang R, Guo Y, Yu Z, Chen C. Association between viral infection and bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:2965-2981. [PMID: 38634889 PMCID: PMC11192663 DOI: 10.1007/s00431-024-05565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common serious complication of very preterm infants (VPI) or very low birth weight (VLBW) infants. Studies implicate viral infections in etiopathogenesis. The aim of this study was to summarize the relationship between viral infections and BPD through a systematic review and meta-analysis. We searched PubMed, Embase, the Web of Science Core Collection, and the Cochrane Database on December 19, 2023. We included observational studies that examined the association between viral infections and BPD in preterm infants. We extracted data on study methods, participant characteristics, exposure assessment, and outcome measures. We assessed study risk of bias using the Newcastle-Ottawa Scale (NOS). We included 17 and 15 studies in the qualitative review and meta-analysis, respectively. The meta-analysis showed a significant association between viral infection and BPD diagnosed at 36 weeks postmenstrual age (odds ratio (OR): 2.42, 95% confidence interval: 1.89-3.09, 13 studies, very low certainty of evidence). In a subgroup analysis of specific viruses, cytomegalovirus (CMV) proved to be significantly associated with BPD diagnosed at 36 weeks postmenstrual age (OR: 2.34, 95% confidence interval: 1.80-3.05, 11 studies). We did not find an association between viral infection and BPD diagnosed on the 28th day of life, probably due to the small sample size of the included prospective studies. Conclusion: Viral infections, especially CMV, are associated with an increased risk of BPD in preterm infants. Methodologically reliable prospective studies with large samples are needed to validate our conclusions, and high-quality randomized controlled studies are needed to explore the effect of prevention or treatment of viral infections on the incidence of BPD. What is Known: • Studies have attempted to identify viral infections and bronchopulmonary dysplasia in preterm infants; however, results have been inconsistent. What is New: • Systematic demonstration that viral infections, particularly cytomegalovirus, are positively associated with bronchopulmonary dysplasia diagnosed in preterm infants at the 36th week of postmenstrual age. • The importance of screening for viral infections in preterm infants, especially cytomegalovirus. More high-quality studies should be produced in the future to investigate the causal relationship between viral infections and bronchopulmonary dysplasia.
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Affiliation(s)
- Xin Guo
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Defei Ma
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Rui Li
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China
| | - Ruolin Zhang
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, 518067, Guangdong, China
| | - Yanping Guo
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, 518000, Guangdong, China.
| | - Cheng Chen
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, 518172, Guangdong, China.
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2
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Titchiner D, Hornik C, Benjamin R, Tolia V, Smith PB, Greenberg RG. Insulin for Treatment of Neonatal Hyperglycemia in Premature Infants: Prevalence over Time and Association with Outcomes. Am J Perinatol 2024; 41:e1008-e1014. [PMID: 36356594 DOI: 10.1055/a-1976-2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our objective was to determine the prevalence of insulin treatment in premature infants with hyperglycemia and evaluate the association of length of treatment with outcomes. STUDY DESIGN The study included cohort of 29,974 infants 22 to 32 weeks gestational age (GA) admitted to over 300 neonatal intensive care unit (NICU) from 1997 to 2018 and diagnosed with hyperglycemia. RESULTS Use of insulin significantly decreased during the study period (p = 0.002) among studied NICUs. The percentage of hyperglycemic infants exposed to insulin ranged from 0 to 81%. Infants who received insulin were more likely to have lower GA, birth weight, 5-minute Apgar score, longer duration of stay, and require mechanical ventilation. After adjustment for GA, infants requiring insulin for >14 days were more likely to have treated retinopathy of prematurity (ROP) and develop chronic lung disease (CLD). Insulin treatment of 1 to 7 days had increased odds of death, death/ROP, and death/CLD compared with no exposure. CONCLUSION Insulin use decreased over time, and differing durations of use were associated with adverse outcomes. KEY POINTS · Insulin use decreased over time.. · There is a temporal relation between the duration of treatment and adverse outcomes.. · Further studies are needed to determine the efficacy and safety of insulin use..
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MESH Headings
- Humans
- Infant, Newborn
- Insulin/therapeutic use
- Hyperglycemia/drug therapy
- Hyperglycemia/epidemiology
- Female
- Male
- Intensive Care Units, Neonatal
- Infant, Premature
- Hypoglycemic Agents/therapeutic use
- Gestational Age
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/therapy
- Prevalence
- Retinopathy of Prematurity/epidemiology
- Retinopathy of Prematurity/drug therapy
- Retinopathy of Prematurity/therapy
- Retrospective Studies
- Respiration, Artificial/statistics & numerical data
- Apgar Score
- Length of Stay/statistics & numerical data
- Lung Diseases/drug therapy
- Lung Diseases/epidemiology
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Affiliation(s)
- Daniela Titchiner
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Chi Hornik
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Robert Benjamin
- Division of Endocrinology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Veeral Tolia
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Rachel G Greenberg
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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3
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Friaza V, Rojas P, de la Horra C, García E, Morilla R, Pavón A, de Armas Y, Vallejo-Vaz AJ, Salsoso R, Medrano FJ, Calderón EJ. Fungal microbiota in newborn infants with and without respiratory distress syndrome. PLoS One 2024; 19:e0302027. [PMID: 38598489 PMCID: PMC11006121 DOI: 10.1371/journal.pone.0302027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Pneumocytis jirovecii infection in preterm newborns has recently been associated with neonatal respiratory distress syndrome and bronchopulmonary dysplasia. Changes in the bacterial microbiota of the airways have also been described in infants with bronchopulmonary dysplasia. However, until now there has been no information on the airway mycobiota in newborns. The purpose of this study was to describe the airway mycobiota in term and preterm newborns and its possible association with respiratory distress syndrome. METHODS Twenty-six matched preterm newborns with and without respiratory distress syndrome were studied, as well as 13 term babies. The identification of the fungal microbiota was carried out using molecular procedures in aspirated nasal samples at birth. RESULTS The ascomycota phylum was identified in 89.7% of newborns, while the basidiomycota phylum was found in 33.3%. Cladosporium was the predominant genus in both term and preterm infants 38.4% vs. 73% without statistical differences. Candida sake and Pneumocystis jirovecii were only found in preterm infants, suggesting a potential relationship with the risk of prematurity. CONCLUSIONS This is the first report to describe the fungal microbiota of the airways in term and preterm infants with and without respiratory distress syndrome. Although no differences have been observed, the number of cases analyzed could be small to obtain conclusive results, and more studies are needed to understand the role of the fungal microbiota of the airways in neonatal respiratory pathology.
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Affiliation(s)
- Vicente Friaza
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - Pilar Rojas
- Neonatology Unit, Virgen del Rocío University Children’s Hospital, Seville, Spain
| | - Carmen de la Horra
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - Elisa García
- Neonatology Unit, Virgen del Rocío University Children’s Hospital, Seville, Spain
| | - Rubén Morilla
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
- Departamento de Enfermería, Universidad de Sevilla, Seville, Spain
| | - Antonio Pavón
- Neonatology Unit, Virgen del Rocío University Children’s Hospital, Seville, Spain
| | - Yaxsier de Armas
- Department of Clinical Microbiology Diagnostic, Hospital Center of Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
- Pathology Department, Hospital Center of Institute of Tropical Medicine ʺPedro Kouríʺ, Havana, Cuba
| | - Antonio J. Vallejo-Vaz
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
- Departamento de Medicina, Hospital Universitario Virgen del Rocío, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - Rocío Salsoso
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
| | - Francisco J. Medrano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
- Departamento de Medicina, Hospital Universitario Virgen del Rocío, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
| | - Enrique J. Calderón
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Seville, Spain
- Departamento de Medicina, Hospital Universitario Virgen del Rocío, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
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Gan YZ, Yang P, Liu R, Wang YH, Hu YW, Yang Y. Changes in Spectrum of Respiratory Pathogen Infections and Disease Severity Among Children in Hohhot, China: Impact of COVID-19 Prevention Measures. Med Sci Monit 2024; 30:e942845. [PMID: 38451880 DOI: 10.12659/msm.942845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This retrospective study evaluated the effects of specific COVID-19 preventive measures, including the use of medical masks, nucleic acid testing, and patient isolation, on respiratory infections, disease severity, and seasonal patterns among children in Hohhot, located in northern China. Understanding these alterations is pivotal in developing effective strategies to handle pediatric respiratory infections within the context of continuous public health initiatives. MATERIAL AND METHODS At the First Hospital of Hohhot, throat swabs were collected from 605 children with community-acquired respiratory between January 2022 and March 2023 for pathogen infection spectrum detection using microarray testing. RESULTS Among the patients, 56.03% were male, and their average age was 3.45 years. SARS-CoV-2 infections were highest between October 2022 and January 2023. Influenza A peaked in March 2023, and other pathogens such as respiratory syncytial virus and influenza B virus disappeared after December 2022. The proportion of mixed infections was 41.94% among SARS-CoV-2 patients, while other pathogens had mixed infection rates exceeding 57.14%. Before December 2022, the mean WBC count for Streptococcus pneumoniae and Haemophilus influenzae was 8.83×10⁹/L, CRP was 18.36 mg/L, and PCT was 1.11 ng/ml. After December 2022, these values decreased significantly. Coughing, difficulty breathing, running nose, and lower respiratory tract infection diagnoses decreased in December 2022, except for SARS-CoV-2 infections. CONCLUSIONS SARS-CoV-2 peaked around November 2022, influenza A peaked in March 2023, and other pathogens like respiratory syncytial virus and influenza B virus were greatly reduced after December 2022. Inflammatory markers and respiratory symptoms decreased after December 2022, except for SARS-CoV-2.
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Affiliation(s)
- Yan-Zi Gan
- Child Health Department, The First Hospital of Hohhot, Hohhot, Inner Mongolia, China (mainland)
| | - Peng Yang
- Neurophysiology Department, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Rui Liu
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, Inner Mongolia, China (mainland)
| | - Yan-Hai Wang
- Child Health Department, The First Hospital of Hohhot, Hohhot, Inner Mongolia, China (mainland)
| | - Yu-Wei Hu
- Child Health Department, The First Hospital of Hohhot, Hohhot, Inner Mongolia, China (mainland)
| | - Yang Yang
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, Inner Mongolia, China (mainland)
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5
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Stanford AH, Chatmethakul T, Rios DR, Giesinger RE, Thomas B, Bischoff AR, Weiner L, McNamara PJ. Postnatal cytomegalovirus infection and pulmonary vascular disease in extremely premature infants: A case series. J Neonatal Perinatal Med 2024; 17:275-284. [PMID: 38728205 DOI: 10.3233/npm-230078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pulmonary vascular disease (PVD) is a major determinant of both morbidity and mortality in extremely low birth weight infants. It is biologically plausible that postnatal cytomegalovirus (pCMV) infection may lead to PVD in premature infants secondary to pneumonitis or via derangement of pulmonary vascular development directly through endothelial dysfunction. Uncertainty remains, however, regarding thresholds for intervention in premature infants with cardiorespiratory instability and presumed CMV infection likely secondary to the limited understanding of the natural history of the disease. METHODS/RESULTS We describe four cases of premature infants with clinical and echocardiography features of PVD, in the setting of postnatally acquired CMV. All patients had atypical PVD trajectories, refractory to vasodilator treatment, which improved after initiation of CMV treatment. CONCLUSION We highlight the need to consider postnatally acquired CMV infection in patients with PVD non-responsive to standard pulmonary vasodilator therapies or disease severity which is out of proportion of the usual clinical trajectory. Treatment of extremely premature infants with CMV-associated PVD may have positive impact on cardiorespiratory health, although duration of therapy remains uncertain.
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Affiliation(s)
- A H Stanford
- Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - T Chatmethakul
- Department of Pediatrics, Neonatal-Perinatal Medicine Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - D R Rios
- Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - R E Giesinger
- Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - B Thomas
- Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - A R Bischoff
- Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA
| | - L Weiner
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Iowa, Iowa City, IA, USA
| | - P J McNamara
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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6
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Crowe EP, Goel R, Al-Mozain N, Josephson CD. Neonatal Blood Banking Practices. Clin Perinatol 2023; 50:821-837. [PMID: 37866850 DOI: 10.1016/j.clp.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
There is little formal guidance to direct neonatal blood banking practices and, as a result, practices vary widely across institutions. In this vulnerable patient population with a high transfusion burden, considerations for blood product selection include freshness, extended-storage media, pathogen inactivation, and other modifications. The authors discuss the potential unintended adverse impacts in the neonatal recipient. Concerns such as immunodeficiency, donor exposures, cytomegalovirus transmission, volume overload, transfusion-associated hyperkalemia, and passive hemolysis from ABO incompatibility have driven modifications of blood components to improve safety.
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Affiliation(s)
- Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Room 3081-A, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Corporate Medical Affairs, Vitalant National Office, Scottsdale, AZ, USA; Division of Hematology/Oncology, Department of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, 704 Lismore Lane, Springfield, IL 62704, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nour Al-Mozain
- Hematopathology & Transfusion Medicine, Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, 7652, Riyadh, Riyadh, 12713, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cassandra D Josephson
- Department of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cancer and Blood Disorders Institute, Blood Bank and Transfusion Medicine, Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
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7
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Pellkofer Y, Hammerl M, Griesmaier E, Sappler M, Gizewski ER, Kiechl-Kohlendorfer U, Neubauer V. The Effect of Postnatal Cytomegalovirus Infection on (Micro)structural Cerebral Development in Very Preterm Infants at Term-Equivalent Age. Neonatology 2023; 120:727-735. [PMID: 37634498 DOI: 10.1159/000532084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION There are some data indicating a negative impact of postnatal cytomegalovirus (CMV) infection on long-term neurodevelopmental outcome of preterm infants. So far, there is only little knowledge about a cerebral imaging correlate of these neurodevelopmental alterations induced by postnatal CMV infection in preterm infants. The aim of the current study was to investigate the effect of postnatal CMV infection on the incidence of brain injury and on microstructural brain maturation in very preterm infants at term-equivalent age. METHODS Infants <32 gestational weeks (02/2011-11/2018) received cerebral MRI including axial diffusion-weighted images at term-equivalent age. All infants were screened for CMV infection using urine/saliva samples, and infection was regarded as acquired postnatal if a sample became positive >5 postnatal days. We compared brain injury as well as fractional anisotropy and apparent diffusion coefficient in 14 defined cerebral regions between infants with and without postnatal CMV infection. RESULTS 401 infants were eligible, of whom 18 (4.5%) infants had a postnatal CMV infection. There were no significant differences in rates of brain injury or in microstructural brain development between both groups. This applied equally to the subgroup of infants <28 gestational weeks. CONCLUSION Although infants with postnatal CMV infection were born more immature and more frequently suffered from complications related to immaturity, we neither observed a higher rate of preterm brain injury nor disadvantageous alterations in microstructural brain maturation at term-equivalent age.
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Affiliation(s)
- Yasmin Pellkofer
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlene Hammerl
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Griesmaier
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Sappler
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Vera Neubauer
- Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
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Tapawan SJC, Bajuk B, Oei JL, Palasanthiran P. Symptomatic Postnatal Cytomegalovirus Infection in Less than 32-Week Preterm Infants: 13-Year Retrospective Multicenter Case-Control Study. Neonatology 2023; 120:589-597. [PMID: 37393900 DOI: 10.1159/000529241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/12/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Reports on the influence of postnatal cytomegalovirus (pCMV) infection in neonatal outcomes of preterm babies vary while guidance on management including screening is lacking. We aim to determine the association between symptomatic pCMV infection and chronic lung disease (CLD) and mortality in preterm infants born less than 32 weeks gestation. METHODS We used data from the Neonatal Intensive Care Units' (NICUS) population-based prospective data registry of infants in 10 neonatal units in New South Wales and the Australian Capital Territory, Australia. De-identified perinatal and neonatal outcome data for 40,933 infants were examined. We identified 172 infants <32 weeks gestation with symptomatic pCMV infection. Each was matched with one control infant. RESULTS Infants with symptomatic pCMV infection were 2.7 times more likely to develop CLD (OR 2.7, 95% CI: 1.7-4.5) and spend 25.2 days more in hospital (95% CI: 15.2-35.2). Seventy-five percent (129/172) of infants with symptomatic pCMV were extremely preterm (<28 weeks). The mean age of symptomatic pCMV diagnosis was 62.5 ± 20.5 days or 34.7 ± 3.6 weeks-corrected gestational age. Ganciclovir treatment did not decrease CLD and death. CLD was 5.5 times predictive of death in patients with symptomatic pCMV infection. Symptomatic pCMV infection did not influence mortality nor increase neurologic impairment. CONCLUSION Symptomatic pCMV is a modifiable factor affecting extreme preterm infants with significant impact on CLD. Prospective study on screening and treatment will help unveil potential benefits in our already at-risk preterm infants.
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Affiliation(s)
- Sarah Jane Corpuz Tapawan
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia,
- School of Women's and Children's Heath, University of New South Wales, Kensington, New South Wales, Australia,
| | - Barbara Bajuk
- Critical Care Program, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ju Lee Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
- School of Women's and Children's Heath, University of New South Wales, Kensington, New South Wales, Australia
| | - Pamela Palasanthiran
- School of Women's and Children's Heath, University of New South Wales, Kensington, New South Wales, Australia
- Department of Immunology and Infectious Disease, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
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9
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Kasai R, Toriyabe K, Goto T, Hatano M, Kondo Y, Ohta T, Suyama M, Goto T, Koide W, Maki K, Ushijima K, Ban K. A case of breast milk-acquired cytomegalovirus infection in an extremely low birth weight infant. J Neonatal Perinatal Med 2023:NPM221130. [PMID: 37182845 DOI: 10.3233/npm-221130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Although breast milk is considered the optimal nutrition for infants, it is also the primary cause of postnatal cytomegalovirus (CMV) infection. Preterm infants with postnatal CMV infections are susceptible to a variety of life-threatening conditions. CASE SUMMARY Twin male infants were delivered via emergency caesarian section at 27 weeks' gestation secondary to maternal complete uterine rupture. The Apgar scores at 1 and 5 min were 1 and 1 for the older twin (Twin A) and 0 and 3 for the younger twin (Twin B). Their birth weights were 1203 g (+ 0.65SD) and 495 g (- 3.79SD) respectively. On day 41, laboratory blood test results for Twin B showed a moderate elevation in C-reactive protein (CRP), thrombocytopenia. CMV quantitative polymerase chain reaction (qPCR) tests in Twin B's urine and blood as well as in the mother's breast milk were positive, but stored, dried umbilical cord CMV qPCR tests were negative. Twin B was diagnosed with a postnatal CMV infection secondary to infected breast milk and ganciclovir was commenced on day 52. Treatment was switched to valganciclovir at 74 days of age, but a negative CMV-DNA level in the blood was not achieved. Postnatal CMV infection in this infant led to an exacerbation of pre-existing bronchopulmonary dysplasia (BPD) and he demised at 182 days of age. CONCLUSION Postnatal cytomegalovirus infections may lead to exacerbations of BPD. Early use of raw breast milk in preterm infants should be done with careful consideration of this potential complication.
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Affiliation(s)
- R Kasai
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - K Toriyabe
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Japan
| | - T Goto
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - M Hatano
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - Y Kondo
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - T Ohta
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - M Suyama
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - T Goto
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - W Koide
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - K Maki
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - K Ushijima
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
| | - K Ban
- Department of Pediatrics, Yokkaichi Municipal Hospital, Shibata, Yokkaichi, Japan
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10
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Postnatal CMV Infection and Antiviral Treatment in Extremely Premature Infants: A 12-Year Retrospective Analysis. Pediatr Infect Dis J 2023; 42:159-165. [PMID: 36638404 PMCID: PMC9838607 DOI: 10.1097/inf.0000000000003737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The impact and outcomes of postnatal cytomegalovirus (CMV) infection are not entirely clear. We aimed to determine the associations between treatment outcomes of postnatal CMV infection and its antiviral treatment. METHODS Retrospective study in a tertiary center. Infants of < 29 weeks gestational age who were tested for postnatal CMV infection were included. CMV-infected infants were compared to uninfected infants (control group). CMV-infected infants were either treated with ganciclovir and/or valganciclovir (CMVPT group) or not (CMVPNT group). Demographic, clinical, laboratory, treatment, and outcome data were collected. Primary outcomes were the length of stay, death before discharge and hearing impairment, cognitive and motor development as assessed by the Denver Developmental Screening Test II, and neurologic impairment at the corrected age of 1.5-2 years. RESULTS We included 103 extremely premature infants. The Median (interquartile range [IQR]) length of stay was 94 (69-112) days in control, 85 (70-102) days in CMVPNT, and 100 (88-137) days in the CMVPT group. Mortality before discharge was 6% in control, 3.8% in CMVPNT, and 3.7% in the CMVPT group. Normal hearing at follow-up was found in 30/37 infants in control (81.1%), 13/13 infants in CMVPNT (100%), and 17/20 infants in the CMVPT group (85%). Denver Developmental Screening Test II results did not differ among the three groups. Neurologic impairment was found in 21/37 infants (56.8%) in control, 9/13 infants in CMVPNT (69.2%), and 14/20 infants in CMVPT group (70%). CONCLUSIONS The associations between antiviral treatment of postnatal CMV infection and better treatment outcomes were nonsignificant.
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Dong N, Cao L, Zheng D, Su L, Lu L, Dong Z, Xu M, Xu J. Distribution of CMV envelope glycoprotein B, H and N genotypes in infants with congenital cytomegalovirus symptomatic infection. Front Pediatr 2023; 11:1112645. [PMID: 37009289 PMCID: PMC10057549 DOI: 10.3389/fped.2023.1112645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 04/04/2023] Open
Abstract
Background Cytomegalovirus (CMV) is the leading cause of congenital infections worldwide and contributes to long-term sequelae in neonates and children. CMV envelope glycoproteins play a vital role in virus entry and cell fusion. The association between CMV polymorphisms and clinical outcomes remains controversial. The present study aims to demonstrate the distribution of glycoprotein B (gB), H (gH) and N (gN) genotypes in congenitally CMV (cCMV) infected symptomatic infants and attempts to figure out the association between viral glycoprotein genotypes and clinical outcomes. Methods Genotyping of gB, gH and gN was performed in 42 cCMV symptomatic infants and 149 infants with postnatal CMV (pCMV) infection in Children's hospital of Fudan university. Nested PCR, gene sequencing and phylogenetic analyses were used to identify the genotypes. Results Our study demonstrated that: 1. The CMV gB1, gH1 and gN1 were the predominant genotypes among symptomatic cCMV infected infants, while gB1, gH1 and gN3a were more prevalent in pCMV group. gH1 genotype has a significant association with symptomatic cCMV infection (p = 0.006). 2. No significant correlation was found between CMV genotypes and hearing impairment. However, gH1 was more prevalent among cCMV infected infants with moderate/severe hearing loss although without statistical difference (p = 0.130). 3. gB3 was more prevalent among infants with skin petechiae (p = 0.049) and found to be associated with an increased risk of skin petechiae (OR = 6.563). The gN4a subtype was significantly associated with chorioretinitis due to cCMV infection (p = 0.007). 4. Urine viral loads were not significantly associated with different genotypes or hearing impairment among symptomatic cCMV infected infants. Conclusions Our findings demonstrated the overall distribution of gB, gH and gN genotypes in infants with symptomatic cCMV infection in Shanghai for the first time. The findings in our study may suggest a possible association between gH1 genotype and early infancy hearing loss. gB3 genotype was associated with a 6.5-fold increased risk of petechiae while gN4a strongly correlated with chorioretinitis due to cCMV infection. No significant correlation was found between urine viral loads and CMV genotypes or hearing impairment in cCMV infected infants.
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Affiliation(s)
- Niuniu Dong
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lingfeng Cao
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Danni Zheng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Liyun Su
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lijuan Lu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zuoquan Dong
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Menghua Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Correspondence: Jin Xu
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Carmona AS, Kakkar F, Gantt S. Perinatal Cytomegalovirus Infection. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:395-411. [PMID: 36465883 PMCID: PMC9684878 DOI: 10.1007/s40746-022-00261-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention. RECENT FINDINGS High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods. SUMMARY More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.
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Affiliation(s)
- Alejandra Sandoval Carmona
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
| | - Fatima Kakkar
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
- Centre de Recherche du CHU Sainte-Justine, 3175 Ch. de La Côte-Sainte-Catherine, Montréal, Canada
| | - Soren Gantt
- Department of Pediatrics, 3175 Ch. de La Côte-Sainte-Catherine, Université de Montréal, Montréal, Canada
- Centre de Recherche du CHU Sainte-Justine, 3175 Ch. de La Côte-Sainte-Catherine, Montréal, Canada
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Breast Milk and Saliva for Postnatal Cyto†megalovirus Screening among Very Low Birth Weight Infants. Pediatr Infect Dis J 2022; 41:904-910. [PMID: 36102681 DOI: 10.1097/inf.0000000000003671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal approach to managing postnatal cytomegalovirus disease (pCMV) among very low birth weight (VLBW) infants remains unknown. Methods to facilitate screening are needed. OBJECTIVE Determine whether mother's milk and infant saliva can be used to reliably identify maternal cytomegalovirus (CMV) serostatus and detect infant pCMV acquisition. METHODS This was a single-center, prospective cohort study of VLBW infants, and their mothers, born between 2017 and 2020. Maternal milk samples were tested for CMV immunoglobulin G (IgG) using a CMV glycoprotein B binding enzyme-linked immunosorbent assay and the results were compared with maternal serum CMV IgG results. Biweekly paired saliva and urine samples were collected from infants born to mothers with positive or unknown CMV serostatus. Saliva samples were tested for CMV DNA by quantitative real-time polymerase chain reaction (PCR) and compared with urine CMV qualitative PCR results obtained from a clinical laboratory. RESULTS Among 108 infants without congenital CMV included in the study, 10 (9%) acquired pCMV. Both milk and blood CMV serology results were available for 70 mothers. Maternal milk antibody testing had a sensitivity of 97.2% (95% CI: 85.5-99.9%) and specificity of 91.2% (95% CI: 76.3-98.1%) in establishing CMV serostatus. Paired serially collected saliva and urine samples (n = 203) were available for 66 infants. Saliva PCR had a sensitivity of 30.0% (95% CI: 6.7-65.2%) and specificity of 92.7% (95% CI: 88.1-96.0%) in detecting pCMV acquisition. CONCLUSIONS Maternal breast milk is a reliable alternative sample to determine CMV serostatus. Serial testing of infant saliva was not adequately sensitive for identifying pCMV acquisition in preterm infants.
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Postnatal Cytomegalovirus Infection: Is it Important? A 10-Year Retrospective Case-control Study of Characteristics and Outcomes in Very Preterm and Very Low Birth Weight Infants. Pediatr Infect Dis J 2022; 41:579-586. [PMID: 35389941 DOI: 10.1097/inf.0000000000003531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the characteristics and outcomes of postnatal cytomegalovirus (pCMV) infection in preterm infants in a neonatal intensive care unit (NICU). METHODS A retrospective, matched case-control study in a tertiary NICU. Infants born between January 2009 and December 2019, <32 weeks' gestational age (GA) and/or birth weight (BW) <1500 g with pCMV infection were matched 1:1 with cytomegalovirus-(CMV)-negative infants by year of admission, gender, GA and BW. Primary outcome was death ≤36 weeks' postmenstrual age or bronchopulmonary dysplasia (BPD). Secondary outcomes were length of ventilation (LOV), length of stay (LOS) and neurodevelopmental impairment (NDI) at corrected age 1 and 2 years. RESULTS Forty-eight pCMV-positive infants (median GA 25.3 weeks, BW 695 g, age 58 days) were identified from 1659 infants (incidence 2.9%). The most common symptoms of pCMV infection were abdominal distension (43.8%), sepsis-like syndrome (29.2%), thrombocytopenia (60.5%) and conjugated hyperbilirubinemia (60.9%). Compared with controls, there were no significant differences in the composite outcome of death or BPD (56.3% vs. 37.5%; P = 0.1) or NDI at 1 and 2 years (51.9% vs. 44%; P = 0.8; 71.4% vs. 50%; P = 0.4). pCMV-positive infants had a significantly longer median LOV (23.5 vs. 12 days)* and LOS (140 vs. 110.5 days)*. Eleven (22.9%) infants received antivirals. Ten improved and 1 died. Two untreated infants died (1 from pCMV infection). CONCLUSIONS Clinically identifiable pCMV infections are significant and associated with increased respiratory support and prolonged hospital stay in vulnerable infants. pCMV screening and preventive measures against transmission merit consideration.*P < 0.05.
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Postnatal Cytomegalovirus Infection of Preterm and Very-low-birth-weight Infants Through Maternal Breast Milk: Does It Matter? Pediatr Infect Dis J 2022; 41:343-351. [PMID: 34840311 DOI: 10.1097/inf.0000000000003400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postnatal infection with cytomegalovirus (CMV) in very-preterm and very-low-birth-weight infants, transmitted through breast milk (BM), is potentially associated with adverse outcomes. This study aimed to investigate the incidence and clinical significance of postnatal CMV infection in a tertiary neonatal intensive care unit. METHODS Infants of CMV-seropositive mothers born in a neonatal intensive care unit in Melbourne, Australia, were observed for 14 weeks from birth in a prospective cohort study. Maternal BM and infant urine were tested weekly for CMV by culture and polymerase chain reaction, respectively. Clinical and laboratory data were collected and analyzed in relation to the infants' CMV infection status. RESULTS Data from 65 infants of 56 CMV-seropositive mothers were available for analysis. Of these mothers, 88% (49/56) shed CMV in their BM. Of the 58 infants exposed to CMV-positive BM, 27 (47%) became urine polymerase chain reaction CMV-positive. There was no significant difference in gestational age, birth weight, incidence of bronchopulmonary dysplasia, or necrotizing enterocolitis between the CMV-positive and CMV-negative groups. However, CMV-positive infants had a longer length of hospital stay and more episodes of prolonged neutropenia. Of the CMV-positive infants, 30% (8/27) remained asymptomatic, 48% (13/27) had symptoms categorized as mild and 22% (6/27) as severe. CONCLUSIONS About half of preterm and very-low-birth-weight infants exposed to CMV-positive BM become infected, and a fifth develop significant clinical symptoms. Future studies should address the maternal and neonatal factors that determine the risk of mother-to-infant CMV transmission, as well as those leading to clinical deterioration and long-term sequelae.
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Cadena-Mota S, Muñoz-Escalante JC, Martínez-Rodríguez LE, Bernal-Silva S, Tello-Martínez N, de la Torre-Rodríguez I, Hernández-Sánchez PG, Castillo-Martínez F, Escalante-Padrón F, Lima-Rogel V, González-Ortiz AM, Noyola DE. Incidence of congenital and postnatal cytomegalovirus infection during the first year of life in Mexican preterm infants. J Med Virol 2022; 94:3349-3358. [PMID: 35261048 DOI: 10.1002/jmv.27705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022]
Abstract
Cytomegalovirus infection occurs commonly during infancy. Postnatal infection in term infants is usually asymptomatic; however, infection in preterm infants can be associated with clinical manifestations during the neonatal period. Nevertheless, few studies to assess the frequency of cytomegalovirus infection in preterm infants have been performed outside of high-income countries. We analyzed the incidence of congenital and postnatal cytomegalovirus infection in a cohort of preterm infants. Cytomegalovirus infection was detected during the neonatal period in four of 178 infants; in three of them the virus was detected during the first three weeks of life and, therefore, congenital infection was confirmed (1.7% incidence). Postnatal infection was detected in 44 (36.4%) of 121 infants who were assessed after discharge from the neonatal intensive care unit. Cytomegalovirus infection was significantly associated to duration of breast feeding. In addition, we characterized cytomegalovirus strains detected in infants together with sequences available at GenBank, based on sequences of the UL18 gene. Cytomegalovirus UL18-sequences clustered in five distinct clades (A-E), and sequences obtained from infants in our study were distributed in four of the five clades; 44.4% of these sequences were included in clade E. Breastfeeding duration was shorter in average (5.6 months) in infants with sequences in clade E compared to infants with sequences in the other three clades (8.2 months; P=0.07). In conclusion, we provide information regarding the high incidence of cytomegalovirus infection in preterm infants. Further studies are warranted to assess if cytomegalovirus strain characteristics are associated with the risk of infection acquisition during infancy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sandra Cadena-Mota
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Juan Carlos Muñoz-Escalante
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Luz E Martínez-Rodríguez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Sofía Bernal-Silva
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Nallely Tello-Martínez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Pedro G Hernández-Sánchez
- Viral and Human Genomics Laboratory, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Fernanda Castillo-Martínez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Victoria Lima-Rogel
- Neonatology Department, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México
| | - Ana María González-Ortiz
- Pediatrics Department, Hospital del Niño y la Mujer "Dr. Alberto López Hermosa", San Luis Potosí, México
| | - Daniel E Noyola
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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Jiang W, Chen S, Xu L, Xu X, Huang L, Wang Y, Hao C. Presence of Cytomegalovirus Infection Is Associated With an Unfavorable Outcome in Immunocompetent Infants With Pertussis. Front Cell Infect Microbiol 2022; 12:800452. [PMID: 35252027 PMCID: PMC8895427 DOI: 10.3389/fcimb.2022.800452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background We aimed to examine cytomegalovirus (CMV) infection in immunocompetent infants with pertussis, based on polymerase chain reaction in plasma and broncho alveolar lavage (BAL), and to assess the clinical characteristics and outcomes for these patients. Methods We performed a prospective observational cohort study of consecutive infants with pertussis in Children’s Hospital of Soochow University between Jan 2017 and Jan 2020. We report the burden of CMV PCR in plasma and BAL within this patient group, and evaluate associations between CMV infection and pertussis in these hospitalized infants. Results During the study period, 1,867 infants <1 years were evaluated for pertussis, 190 infants were diagnosed as pertussis. For the 190 pertussis patients, 38 (20.0%) patients had positive CMV PCR in plasma. CMV PCR in plasma had high sensitivity and specificity for CMV PCR in BAL (81.3% and 94.4%, respectively). Children with positive CMV PCR in plasma were 3.67 times more likely to present with severe disease (OR 3.67; CI 1.61-8.36). Comparisons of duration of hospital stay curves using the log-rank test statistic demonstrated that the relative risk of longer hospital stay of positive CMV PCR relative to negative CMV was 1.51 (95% CI: 1.05 to 2.14, P = 0.01). Conclusions Our study reported a high prevalence of CMV reactivation in immunocompetent infants with lower respiratory tract infection. The presence of CMV in plasma may be associated with an unfavorable outcome in infants with pertussis.
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Affiliation(s)
| | | | | | | | | | - Yuqing Wang
- *Correspondence: Yuqing Wang, ; Chuangli Hao,
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Tangirala S, Amboiram P, Balakrishnan U, Sundaram S, Agarwal P, Devi U. A gastric outlet thickened mucosal fold associated with cytomegalovirus infection in an extremely preterm infant managed by surgical resection. Paediatr Int Child Health 2022; 42:41-44. [PMID: 34519253 DOI: 10.1080/20469047.2021.1967626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Non-bilious vomiting in preterm neonates discharged from neonatal intensive care units is a common complaint and is often associated with benign conditions such as gastro-oesophageal reflux. A neonate of 27 weeks gestation who presented later with vomiting owing to gastric outlet obstruction is described. He was discharged at 11 weeks of age and required re-admission 1 week later. He had persistent non-bilious vomiting from 7 weeks of age, failure to thrive and metabolic alkalosis. Clinical examination demonstrated visible gastric peristalsis, and hypertrophic pyloric stenosis was suspected. Ultrasound of the gastric pylorus and upper gastro-intestinal contrast studies were negative. Exploratory laparotomy after failure of conservative management revealed a thickened mucosal fold in the gastric pylorus, which was excised. Histopathology demonstrated inclusion bodies which are pathognomonic of cytomegalovirus infection. He was treated with valganciclovir for 6 weeks and was asymptomatic and thriving well at follow-up. Gastric outlet obstruction can be one of the manifestations of CMV infection of the gastro-intestinal tract. Diagnosis can be confirmed only by histopathology.Abbreviations: BPD: bronchopulmonary dysplasia; CMV: cytomegalovirus; H&E: haematoxylin and eosin; IHC: immunohistochemistry; IHPS: infantile hypertrophic pyloric stenosis; NEC: necrotising enterocolitis; PCR: polymerase-chain reaction; VGP: visible gastric peristalsis.
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Affiliation(s)
- Susmitha Tangirala
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | | | - Sandhya Sundaram
- Department of Pathology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Prakash Agarwal
- Department of Paediatric Surgery, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Usha Devi
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
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Lee JE, Han YS, Sung TJ, Kim DH, Kwak BO. Clinical presentation and transmission of postnatal cytomegalovirus infection in preterm infants. Front Pediatr 2022; 10:1022869. [PMID: 36479291 PMCID: PMC9719915 DOI: 10.3389/fped.2022.1022869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preterm infants are at greater risk of developing postnatal cytomegalovirus (CMV) infection with serious symptoms. Breast milk is the main route of CMV transmission in populations with a high seroprevalence. OBJECTIVES This study aimed to investigate the clinical presentation and transmission of postnatal CMV (pCMV) infection via breast milk in preterm infants under the specific setting of our neonatal intensive care unit (NICU). METHODS The medical records of 147 preterm infants were reviewed retrospectively, and their clinical characteristics and outcomes were analyzed. Breast milk and infant urine samples were collected every two weeks until discharge, and the kinetics of CMV loads were evaluated using a polymerase chain reaction assay. RESULTS Seventeen infants (11.6%) were diagnosed with pCMV infection during the study period. In comparison between the pCMV and control groups, the mean birth weight was significantly lower in the pCMV group than in the control group (1084.1 ± 404.8 g vs. 1362.5 ± 553.8 g, P = 0.047). Four (23.5%) patients had leukocytopenia, six (35.3%) had neutropenia, three (17.6%) had thrombocytopenia, and two (11.8%) had hyperbilirubinemia in the pCMV group. Five patients were treated with antiviral agents, and their CMV load in the urine decreased after treatment. CMV loads peaked at 3-5 weeks in breast milk, whereas they peaked at 8-12 weeks of postnatal age in infants' urine. A comparison between the median CMV load in breast milk from the pCMV and control groups revealed a significant difference (P = 0.043). CONCLUSION Most preterm infants with pCMV infection present a favorable clinical course and outcomes. A high CMV viral load in breast milk is associated with transmission. Further studies are warranted to prevent transmission and severe pCMV infections in preterm infants.
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Affiliation(s)
- Jun Eon Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Yea Seul Han
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Tae-Jung Sung
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, South Korea
| | - Byung Ok Kwak
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
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WORLEY GORDON, GREENBERG RACHELG, ROCQUE BRANDONG, LIU TIEBIN, DICIANNO BRADE, CASTILLO JONATHANP, WARD ELISABETHA, WILLIAMS TONYAR, BLOUNT JEFFREYP, WIENER JOHNS. Neurosurgical procedures for children with myelomeningocele after fetal or postnatal surgery: a comparative effectiveness study. Dev Med Child Neurol 2021; 63:1294-1301. [PMID: 33386749 PMCID: PMC8603138 DOI: 10.1111/dmcn.14792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/17/2022]
Abstract
AIM To compare the frequencies of neurosurgical procedures to treat comorbid conditions of myelomeningocele in patients who underwent fetal surgery versus postnatal surgery for closure of the placode. METHOD By utilizing the National Spina Bifida Patient Registry in a comparative effectiveness study, 298 fetal surgery patients were matched by birthdate (±3mo) and spina bifida clinic site with one to three postnatal surgery patients (n=648). Histories were obtained by record review on enrollment and yearly subsequently. Multivariable Poisson regression was used to compare frequencies of procedures between cohorts, with adjustments for sex, ethnicity, insurance status, spinal segmental level of motor function, age at last visit recorded in the Registry, and, for shunt revision in shunted patients, age at cerebrospinal fluid (CSF) diversion. RESULTS The median age at last visit was 4 years. In fully adjusted analyses in patients aged at least 12 months old, fetal surgery was associated with decreased frequency of CSF diversion for hydrocephalus by ventriculoperitoneal shunt insertion or endoscopic third ventriculostomy compared with postnatal surgery (46% vs 79%; incidence rate ratio=0.61; 95% confidence interval [CI] 0.53-0.71; p<0.01). Over all ages, fetal surgery was associated with decreased frequency of Chiari decompression for brainstem dysfunction (3% vs 7%; incidence rate ratio=0.41; 95% CI 0.19-0.88; p=0.02). Also over all ages, differences were not significant in frequencies of shunt revision in shunted patients (53% vs 55%; incidence rate ratio=0.87; 95% CI 0.69-1.11; p=0.27), nor tethered cord release for acquired spinal cord dysfunction (18% vs 16%; incidence rate ratio=1.11; 95% CI 0.84-1.47; p=0.46). INTERPRETATION Even with the variations inherent in clinical practice, fetal surgery was associated with lower frequencies of CSF diversion and of Chiari decompression, independent of covariates. What this paper adds Fetal surgery was associated with lower frequencies of cerebrospinal fluid diversion and decompression of Chiari II malformation than postnatal surgery. Frequencies of ventriculoperitoneal shunt revision and tethered cord release were not significantly different between cohorts.
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Affiliation(s)
- GORDON WORLEY
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - RACHEL G GREENBERG
- Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC;,Duke Clinical Research Institute, Durham, NC
| | - BRANDON G ROCQUE
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - TIEBIN LIU
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - BRAD E DICIANNO
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - JONATHAN P CASTILLO
- Division of Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - ELISABETH A WARD
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - TONYA R WILLIAMS
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - JEFFREY P BLOUNT
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - JOHN S WIENER
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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21
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Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics 2021; 148:peds.2021-054272. [PMID: 34635582 DOI: 10.1542/peds.2021-054272] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa M Stellwagen
- University of California Health Milk Bank, San Diego, California.,Department of Pediatrics, University of California, San Diego, Health, San Diego, California
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,New York City Health + Hospitals/Elmhurst
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenda B Poindexter
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia
| | - Karen M Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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22
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Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Cytomegalovirus (CMV) Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting. Viruses 2021; 13:v13101897. [PMID: 34696327 PMCID: PMC8539954 DOI: 10.3390/v13101897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/01/2023] Open
Abstract
Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seropositive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.
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23
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Weimer KED, Roark H, Fisher K, Cotten CM, Kaufman DA, Bidegain M, Permar SR. Breast Milk and Saliva Lactoferrin Levels and Postnatal Cytomegalovirus Infection. Am J Perinatol 2021; 38:1070-1077. [PMID: 32069486 PMCID: PMC9851802 DOI: 10.1055/s-0040-1701609] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Very low birth weight preterm infants are at risk for life-threatening infections in the NICU. Breast milk protects against infections but carries the risk of infection by cytomegalovirus (CMV) shed in mother's milk. Lactoferrin is a breast milk and saliva protein with potent neutralizing activity against CMV. STUDY DESIGN VLBW, maternal breast milk fed infants in the NICU and their lactating mothers were enrolled and followed for 3 months/discharge. Breast milk and infant saliva samples were collected biweekly. Maternal CMV status was determined on breast milk. CMV was measured using quantitative polymerase chain reaction and lactoferrin by enzyme-linked immunosorbent assay. RESULTS In an in vitro neutralization assay, the IC90 of purified human lactoferrin against CMV was 2.08 ng/mL. Bovine lactoferrins were more potent, IC90s > 10-fold higher. Lactoferrin was detected in all breast milk (median: 3.3 × 106 ng/mL) and saliva (median: 84.4 ng/swab) samples. Median CMV load in breast milk was 893 copies/mL. There was no correlation between breast milk lactoferrin concentration and CMV load. Five infants acquired postnatal CMV. There was no difference in saliva or breast milk lactoferrin concentration for mother-infant pairs and postnatal CMV acquisition. CONCLUSION Lactoferrin neutralizes CMV in vitro, but concentrations in breast milk and saliva are likely too low for effective neutralization in vivo.
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Affiliation(s)
- Kristin E D Weimer
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Hunter Roark
- Duke Human Vaccine Institute, Durham, North Carolina
| | - Kimberley Fisher
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - C Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - David A Kaufman
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Margarita Bidegain
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Sallie R Permar
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Duke Human Vaccine Institute, Durham, North Carolina
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24
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Wiechers C, Bernhard W, Goelz R, Poets CF, Franz AR. Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7544. [PMID: 34300000 PMCID: PMC8304391 DOI: 10.3390/ijerph18147544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks' postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers' own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Wolfgang Bernhard
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Rangmar Goelz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Christian F. Poets
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Axel R. Franz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
- Center for Pediatric Clinical Studies, University Children′s Hospital, Eberhard Karls University, 72076 Tübingen, Germany
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25
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Boucoiran I, Yudin M, Poliquin V, Caddy S, Gantt S, Castillo E. Guideline No. 420: Cytomegalovirus Infection in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:893-908. [PMID: 34089905 DOI: 10.1016/j.jogc.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To provide an update on current recommendations for cytomegalovirus (CMV) infection during pregnancy. The objectives of this guideline are: TARGET POPULATION: Patients of child-bearing age, pregnant patients, and patients planning a pregnancy. BENEFITS, HARMS, AND COSTS The patient partners urged us to make awareness of preventive strategies a high priority, despite concern that discussing CMV with patients could cause unnecessary anxiety. CMV educational interventions have shown benefits from increased awareness of cCMV prevalence and preventive strategies among providers, patients, and families. EVIDENCE We searched MEDLINE, EMBASE, and CENTRAL databases for CMV in pregnancy. The search terms were developed using MeSH terms and keywords (Appendix). The results were filtered for articles published between January 2010 and October 2020 and systematic reviews, meta-analyses, clinical trials, and observational studies. The main inclusion criteria were pregnant patients and infants, as the target population, and CMV infection, as the diagnosis of interest. Recommendations are graded according to the U.S. Preventive Services Task Force grade of recommendations and level of certainty. VALIDATION METHODS We collaborated with patient partners, including members of CMV Canada (cmvcanada.com). In formulating our recommendations, we included patients' voices to add a unique and valuable perspective, thus ensuring that our recommendations are relevant to the patient-provider partnership. INTENDED AUDIENCE All perinatal health care providers. RECOMMENDATIONS (GRADE AND LEVEL OF CERTAINTY IN PARENTHESES).
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26
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Directive clinique no 420 : Infection à cytomégalovirus pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:909-925. [PMID: 34089903 DOI: 10.1016/j.jogc.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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27
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Long-term Outcomes after Postnatal Cytomegalovirus Infection in Low Birthweight Preterm Infants: A Systematic Review. Pediatr Infect Dis J 2021; 40:571-581. [PMID: 33902071 DOI: 10.1097/inf.0000000000003072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is the most common viral infection seen in newborns. Although postnatally acquired CMV (pCMV) infection rarely results in serious manifestations in term infants, preterm infants can develop severe clinical illness. However, the long-term implications of pCMV infection of preterm infants are unknown. Few robust studies on long-term outcomes of pCMV infection have been performed, and those reported often present conflicting results. Our objective was to assess the long-term outcomes for low birthweight (LBW) preterm infants after pCMV infection. METHODS A systematic review of English and non-English articles using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science was conducted. Search strategies included a mix of keywords and database-specific subject headings for CMV and LBW infants. Editorials, comments, reviews and animal-only studies were excluded. Case reports, observational, experimental and randomized controlled trials that examined pCMV in preterm or VLBW infants and long-term (>1 month) impact of pCMV were included. RESULTS pCMV infection in preterm infants is associated with increased risk for pulmonary and neurologic complications and increases length of stay. There is less evidence to suggest that pCMV is associated with necrotizing enterocolitis, ophthalmologic, audiologic and anthropomorphic complications in preterm infants. CONCLUSIONS Preterm infants with pCMV, especially those with symptomatic infection, may have long-term pulmonary and neurodevelopmental morbidity compared with their pCMV negative counterparts. Our results highlight the importance of pCMV detection and prevention in preterm infants in the neonatal intensive care unit. Large prospective studies are needed to fully define outcomes and determine if treatment improves outcomes.
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28
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Kim KY, Kim EK, Park SH, Kim YJ, Shin SH, Kim HS. Disseminated Postnatal Cytomegalovirus Infection in a Preterm Neonate: Autopsy Case Report. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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29
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Garofoli F, Civardi E, Zanette S, Angelini M, Perotti G, Zecca M, Lombardi G. Literature Review and an Italian Hospital Experience about Post-Natal CMV Infection Acquired by Breast-Feeding in Very Low and/or Extremely Low Birth Weight Infants. Nutrients 2021; 13:660. [PMID: 33670693 PMCID: PMC7921952 DOI: 10.3390/nu13020660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
Breastfeeding is recommended for all neonates due to a known variety of beneficial effects, but infants can be infected by cell-associated bacteria and viruses from breast milk, such as cytomegalovirus (CMV). The majority of CMV-seropositive breastfeeding women have a viral, self-restricted reactivation, can shed the virus in the milk for about 12 weeks after delivery, and can transmit the infection to their offspring. Post-natal CMV-infected term infants are mainly asymptomatic, while very low birth weight (VLBW, <1500 g) and extremely low birth weight (ELBW, <1000 g) infants may present with severe disease, short-term sequelae ranging from abnormalities in laboratory indexes to sepsis-like syndrome, and long-term sequelae such as developmental problems. Thus, the use of thermally treated maternal milk for VLBW/ELBW infants may be indicated to prevent/reduce the risk of CMV transmission. Different techniques, with varying efficacy in eradicating CMV and maintaining the activity of biological compounds in milk are available: long/short pasteurization, freeze-thawing, the use of microwaves, and ultraviolet-C irradiation. In our NICU, the use of maternal raw milk is always strongly recommended for term/preterm infants, but to reduce risk of CMV transmission, freeze-thawing mother's own milk is used in neonates with GA ≤ 30 weeks or/and weight ≤ 1000 g, usually regardless of serological maternal condition, as CMV screening is not routinely offered to pregnant women and the milk of seroimmune mothers is not evaluated for CMV reactivation, as its rate is similar to seroprevalence. Over the last 4 years, we had 10 VLBW/ELBW newborns in our NICU with late-onset sepsis and negative cultures. In these cases, the research of CMV DNA in neonatal urine or saliva, for the diagnosis of post-natal symptomatic infection (once congenital transmission has been excluded) may be useful and not invasive. The take-home message we would like to share is that acquired CMV infection should be considered in VLBW/ELBW infants breastfed by seropositive mothers and presenting severe symptoms-particularly sepsis with negative cultures. This could allow pediatricians to make better-quality diagnoses, perform supportive therapy, provide antiviral treatment if needed, or establish a "pre-emptive" therapy for these high-risk neonates.
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Affiliation(s)
- Francesca Garofoli
- Neonatal and Intensive Care Unit (NICU), Fondazione IRCCS Policlinico San Matteo, Italy; (E.C.); (S.Z.); (M.A.); (G.P.); (M.Z.); (G.L.)
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30
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Teng J, Elwin A, Omarsdottir S, Aquilano G, Vanpee M, Nemeth A, Rahbar A, Bohlin K, Fischler B, Söderberg-Nauclér C. High Rate of Cytomegalovirus Detection in Cholestatic Preterm Infants. Front Pediatr 2021; 9:754941. [PMID: 34900864 PMCID: PMC8652112 DOI: 10.3389/fped.2021.754941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the prevalence of cytomegalovirus (CMV) infection in preterm infants with cholestasis. Study design: Preterm infants (<37 weeks gestational age) with cholestasis were tested for CMV DNA using Taqman PCR in blood cells from sedimented whole blood, plasma, and urine. Infants were regarded as positive for CMV if any sample was tested positive. Their mothers were tested for CMV serostatus simultaneously. A control group of non-cholestatic preterm infants, and their mothers, were tested at a similar age. Results: A total of 69 preterm infants with a median gestational age of 26 weeks and 5 days were included, 45 cholestatic and 24 non-cholestatic. Of the cholestatic infants, 31/45 (69%) were CMV positive vs. 3/24 (13%) of the non-cholestatic infants (p < 0.001). Cholestatic infants were equally preterm as the non-cholestatic ones, but were more severely ill. After adjusting for the risk factors necrotizing enterocolitis, prolonged parenteral nutrition, and gestational age, being CMV positive remained significantly associated with cholestasis in a multivariable logistic regression model. Characteristics of CMV-positive and -negative cholestatic infants showed differences only for necrotizing enterocolitis, occurring in 55% (17/31) of CMV positive vs. 21% (3/14) of CMV negative (p = 0.054), and mortality. Eight cholestatic CMV-positive infants died (26%) vs. none of the CMV-negative infants (p = 0.044). Conclusions: CMV DNA was detected in two out of three cholestatic preterm infants, by far more often than in the non-cholestatic control group. Cholestasis with simultaneous detection of CMV DNA may be associated with increased mortality.
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Affiliation(s)
- Jonas Teng
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Södertälje Hospital, Stockholm, Sweden
| | - Anne Elwin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Soley Omarsdottir
- Department of Medicine, Microbial Pathogenesis Unit, BioClinicum, Karolinska Institutet, Stockholm, Sweden
| | - Giulia Aquilano
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Mireille Vanpee
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Antal Nemeth
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Afsar Rahbar
- Department of Medicine, Microbial Pathogenesis Unit, BioClinicum, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Kajsa Bohlin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Fischler
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Söderberg-Nauclér
- Department of Medicine, Microbial Pathogenesis Unit, BioClinicum, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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31
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Stark A, Peterson J, Weimer K, Hornik C. Postnatally acquired CMV meningitis diagnosed via BioFire FilmArray: A case report. J Neonatal Perinatal Med 2020; 14:445-450. [PMID: 33325402 DOI: 10.3233/npm-200524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postnatally acquired cytomegalovirus (CMV) is commonly acquired via breast milk, with premature infants more frequently developing symptoms of CMV infection in comparison to term infants. Meningitis is a rare clinical manifestation of CMV infection. The diagnosis of meningitis is difficult to make in infants, particularly those who are preterm. Consequentially, broad-spectrum empiric antimicrobial coverage is often administered for several days while waiting for current gold standard CSF testing to result. The BioFire FilmArray (BFA) simultaneously tests for 14 different pathogens, including CMV, allowing for quicker diagnosis and shorter time to definitive treatment. Here, we report a very low birth weight infant with postnatally acquired CMV meningitis, the first to our knowledge to be diagnosed using the BioFire FilmArray.
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Affiliation(s)
- A Stark
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - J Peterson
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - K Weimer
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - C Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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32
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Osterholm EA, Schleiss MR. Impact of breast milk-acquired cytomegalovirus infection in premature infants: Pathogenesis, prevention, and clinical consequences? Rev Med Virol 2020; 30:1-11. [PMID: 32662174 PMCID: PMC8173712 DOI: 10.1002/rmv.2117] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
Maternal-fetal transmission of cytomegalovirus (CMV) represents the most common infectious cause of long-term neurodevelopmental disability in children. Congenital CMV (cCMV) infection is associated with microcephaly, seizure disorders, cognitive disability, developmental delay, and sensorineural hearing loss (SNHL). Of these disabilities, SNHL is the most common, affecting approximately 10% of infants with cCMV. Although the sequelae of cCMV are well recognized, it is much less clear what long-term morbidities may occur in neonates that acquire post-natal CMV infection. Post-natal CMV (pCMV) infection is most commonly transmitted by breast-feeding, and in full-term infants is of little consequence. However, in preterm, very-low birthweight (VLBW) infants (<1500 g), pCMV can result in a severe sepsis-like syndrome, with wide-ranging end-organ disease manifestations. Although such short-term complications are well recognized among clinicians caring for premature infants, the long-term risks with respect to adverse neurodevelopmental outcomes remain controversial. In this review, we provide an overview of the clinical manifestations of breast milk-acquired pCMV infection. In particular, we summarize studies that have examined-sometimes with conflicting conclusions-the risks of long-term adverse neurodevelopmental outcome in VLBW infants that acquire pCMV from breast milk. We highlight proposed preventive strategies and antiviral interventions, and offer recommendations for high-priority areas for future basic science and clinical research.
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Affiliation(s)
- Erin A. Osterholm
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, Minnesota
| | - Mark R. Schleiss
- Department of Pediatrics, Division of Infectious Diseases and Immunology, University of Minnesota, Minneapolis, Minnesota
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33
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Bapistella S, Hamprecht K, Thomas W, Speer CP, Dietz K, Maschmann J, Poets CF, Goelz R. Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants. Clin Infect Dis 2020; 69:438-444. [PMID: 30407512 DOI: 10.1093/cid/ciy945] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/06/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed. METHODS To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995-1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine. RESULTS Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003). CONCLUSIONS Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU. CLINICAL TRIALS REGISTRATION NCT01178905.
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Affiliation(s)
| | - Klaus Hamprecht
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen
| | - Wolfgang Thomas
- Department of Pediatrics, Klinikum Mutterhaus der Borromaeerinnen, Trier
| | | | - Klaus Dietz
- Department of Medical Biometry, University of Tuebingen
| | | | | | - Rangmar Goelz
- Department of Neonatology, University Children's Hospital Tuebingen
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34
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Kadambari S, Whittaker E, Lyall H. Postnatally acquired cytomegalovirus infection in extremely premature infants: how best to manage? Arch Dis Child Fetal Neonatal Ed 2020; 105:334-339. [PMID: 31615830 DOI: 10.1136/archdischild-2019-317650] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022]
Abstract
Postnatal cytomegalovirus (pCMV) infection is a common viral infection typically occurring within the first months of life. pCMV refers to postnatal acquisition of CMV rather than postnatal manifestations of antenatal or perinatal acquired CMV. pCMV is usually asymptomatic in term infants, but can cause symptomatic disease in preterm (gestational age <32 weeks) and very low birth weight (<1500 g) infants resulting in sepsis, pneumonia, thrombocytopaenia, neutropaenia, hepatitis, colitis and occasionally death. There are significant uncertainties regarding the management of premature infants with pCMV disease which is in part due to our limited understanding of the natural history of this disease. This review describes the current epidemiology and clinical manifestations of pCMV disease which should alert clinicians to test for CMV and also outlines a strategy to manage the condition.
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Affiliation(s)
- Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, U.K
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, U.K.,Department of Academic Paediatrics, Imperial College, 2nd Floor Wright-Fleming Building, London, U.K
| | - Hermione Lyall
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, U.K
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Nelson CS, Baraniak I, Lilleri D, Reeves MB, Griffiths PD, Permar SR. Immune Correlates of Protection Against Human Cytomegalovirus Acquisition, Replication, and Disease. J Infect Dis 2020; 221:S45-S59. [PMID: 32134477 PMCID: PMC7057792 DOI: 10.1093/infdis/jiz428] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human cytomegalovirus (HCMV) is the most common infectious cause of infant birth defects and an etiology of significant morbidity and mortality in solid organ and hematopoietic stem cell transplant recipients. There is tremendous interest in developing a vaccine or immunotherapeutic to reduce the burden of HCMV-associated disease, yet after nearly a half-century of research and development in this field we remain without such an intervention. Defining immune correlates of protection is a process that enables targeted vaccine/immunotherapeutic discovery and informed evaluation of clinical performance. Outcomes in the HCMV field have previously been measured against a variety of clinical end points, including virus acquisition, systemic replication, and progression to disease. Herein we review immune correlates of protection against each of these end points in turn, showing that control of HCMV likely depends on a combination of innate immune factors, antibodies, and T-cell responses. Furthermore, protective immune responses are heterogeneous, with no single immune parameter predicting protection against all clinical outcomes and stages of HCMV infection. A detailed understanding of protective immune responses for a given clinical end point will inform immunogen selection and guide preclinical and clinical evaluation of vaccines or immunotherapeutics to prevent HCMV-mediated congenital and transplant disease.
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Affiliation(s)
- Cody S Nelson
- Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina,Correspondence: Cody S. Nelson, Human Vaccine Institute, Duke University Medical Center, 2 Genome Ct, Durham, NC 27710 ()
| | - Ilona Baraniak
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Daniele Lilleri
- Laboratory of Genetics, Transplantation, and Cardiovascular Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matthew B Reeves
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Paul D Griffiths
- Institute for Immunity and Transplantation, University College London, London, United Kingdom
| | - Sallie R Permar
- Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina
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Schleiss MR. Breast Milk-Acquired Cytomegalovirus in Premature Infants: Uncertain Consequences and Unsolved Biological Questions. JAMA Pediatr 2020; 174:121-123. [PMID: 31790538 DOI: 10.1001/jamapediatrics.2019.4538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mark R Schleiss
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis
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Weimer KED, Kelly MS, Permar SR, Clark RH, Greenberg RG. Association of Adverse Hearing, Growth, and Discharge Age Outcomes With Postnatal Cytomegalovirus Infection in Infants With Very Low Birth Weight. JAMA Pediatr 2020; 174:133-140. [PMID: 31790557 PMCID: PMC6902194 DOI: 10.1001/jamapediatrics.2019.4532] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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Affiliation(s)
- Kristin E. D. Weimer
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Matthew S. Kelly
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Sallie R. Permar
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | | | - Rachel G. Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Panesso-Gómez S, Shimamura M, Conces M, Talavera MM, Moallem M, Sánchez PJ, Malleske DT. Detection of Cytomegalovirus in Intestinal Tissue of Infants with Necrotizing Enterocolitis or Spontaneous Intestinal Perforation. J Pediatr 2019; 214:34-40. [PMID: 31493911 DOI: 10.1016/j.jpeds.2019.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/28/2019] [Accepted: 07/12/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the frequency of detection of cytomegalovirus (CMV) in surgical or autopsy intestinal tissue from infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) of the small bowel. STUDY DESIGN This was a retrospective cohort study of infants in the neonatal intensive care unit at Nationwide Children's Hospital, Columbus, Ohio, with NEC (Bell stage ≥2B) or SIP from 2000 to 2016. Paraffin-embedded surgical or autopsy intestinal tissues were examined for CMV by polymerase chain reaction (PCR) and immunohistochemistry (IHC), and clinical characteristics of CMV-positive vs CMV-negative cases were compared. RESULTS CMV was detected by PCR or IHC in 7 (4%) of 178 infants with surgical or autopsy- confirmed NEC (n = 6) or SIP (n = 1). Among 143 NEC cases (123 surgical, 20 autopsy), CMV was detected in 6 (4%): 4 (2 surgical, 2 autopsy) by both PCR and IHC, and 2 (surgical) by PCR only. Among 35 SIP cases (32 surgical, 3 autopsy), 1 (3%) surgical case was positive, by PCR only. CMV-associated NEC cases had lower median gestational age (24 vs 28 weeks; P = .02), birth weight (649 vs 1121 g; P = .04), and platelet count (16 000/mm3 vs 50 000/mm3; P = .018) compared with CMV-negative cases, respectively. No association was found with receipt of maternal milk, age at NEC diagnosis, male sex, cholestasis, or mortality. CONCLUSIONS CMV was detected in intestinal tissue from 4% of NEC or SIP cases (NEC, 4%; SIP, 3%). Lower gestational age, lower birth weight, and thrombocytopenia were significantly associated with detection of CMV in NEC or SIP cases.
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Affiliation(s)
- Santiago Panesso-Gómez
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Masako Shimamura
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Miriam Conces
- Department of Pathology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Maria M Talavera
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Mohannad Moallem
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Pablo J Sánchez
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH; Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - Daniel T Malleske
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
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Patel RM, Shenvi N, Knezevic A, Hinkes M, Bugg GW, Stowell SR, Roback JD, Easley KA, Josephson C. Observational study of cytomegalovirus from breast milk and necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2019; 105:fetalneonatal-2018-316613. [PMID: 31326920 PMCID: PMC7336338 DOI: 10.1136/archdischild-2018-316613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the relationship between cytomegalovirus (CMV) exposure from breast milk and risk of necrotising enterocolitis (NEC). DESIGN Secondary analysis of a multicentre, observational cohort study. Maternal breast milk and infant serum or urine were serially evaluated by nucleic acid testing at scheduled intervals for CMV. Infants with evidence of congenital infection were excluded. Competing-risks Cox models, with adjustment for confounders, were used to evaluate the relationship between breast milk CMV exposure or postnatal CMV infection and NEC. SETTING Three neonatal intensive care units in Atlanta, Georgia. PATIENTS Infants with a birth weight≤1500 grams. EXPOSURES Maximal CMV viral load in breast milk in the first 14 days after birth or postnatal CMV infection. Two different approaches were used to assess the timing of onset of CMV infection (midpoint or early). MAIN OUTCOME MEASURES NEC, defined as Bell stage II or greater. RESULTS Among 596 enrolled infants, 457 (77%) were born to CMV seropositive mothers and 33 developed postnatal CMV infection (cumulative incidence 7.3%, 95% CI 5.0% to 10.1%). The incidence of NEC was 18% (6/33) among infants with CMV infection, compared with 7% (37/563) among infants without infection (adjusted cause-specific HR (CSHR): 2.81; 95% CI 0.73 to 10.9 (midpoint); 6.02; 95% CI 1.28 to 28.4 (early)). Exposure to higher breast milk CMV viral load was associated with a higher risk of NEC (adjusted CSHR per twofold increase 1.28; 95% CI 1.06 to 1.54). CONCLUSIONS CMV exposure from breast milk may be associated with the development of NEC in very low birth weight infants.
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Affiliation(s)
- Ravi Mangal Patel
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Neeta Shenvi
- Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Andrea Knezevic
- Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia, USA
- Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - George W Bugg
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sean R Stowell
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John D Roback
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kirk A Easley
- Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Cassandra Josephson
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Challenges and Clinical Implications of the Diagnosis of Cytomegalovirus Lung Infection in Children. Curr Infect Dis Rep 2019; 21:24. [PMID: 31147863 DOI: 10.1007/s11908-019-0681-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Pulmonary cytomegalovirus (CMV) infection is a potential lethal disease in children, but it remains a diagnostic challenge. The differentiation between latent CMV infections with viral shedding and active infections is difficult and may lead to false positives in bronchoalvolar lavage (BAL) PCR detection. This review summarizes current diagnostic approaches for CMV lung infection in children including progress in the identification of underlying immune defects linked to this condition. RECENT FINDINGS There is increasing literature supporting that the combined assessment of host risk factors and lung disease pattern is essential for the diagnosis of pulmonary CMV infection in children. The most important host risk factor is an immunecompromised state that has expanded from primary or acquired immunodeficiency (e.g., HIV) to include a myriad of immune-dysregulation syndromes (e.g., CTLA4, PIK3 defects). Newborns, paricularly those born premature, are also a high-risk group. At the pulmonary level, active CMV infection is typically characterized by alveolar compromise leading to hypoxemia, ground-glass opacities, and intra-alveolar infiltrates with CMV inclusions in lung biopsy. The identification of active CMV lung infection should trigger additional evaluation of immune defects (primary or secondary) impairing T and NK cell function or innate antiviral responses as well as other immune dysregulation disorders. Lung CMV infections in children are more prevalent in immunocompromised hosts and premature newborns. Lung CMV infections should prompt further investigation into conditions altering immune mechanisms usually in place to contain CMV infections. Common clinical and radiological patterns such as hypoxemia and ground-glass pulmonary opacities may allow early identification and treatment of CMV lung infection and underlying causes in the pediatric population.
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41
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Greenberg RG, Gayam S, Savage D, Tong A, Gorham D, Sholomon A, Clark RH, Benjamin DK, Laughon M, Smith PB. Furosemide Exposure and Prevention of Bronchopulmonary Dysplasia in Premature Infants. J Pediatr 2019; 208:134-140.e2. [PMID: 30579586 PMCID: PMC6486845 DOI: 10.1016/j.jpeds.2018.11.043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the association between furosemide exposure and risk of bronchopulmonary dysplasia (BPD). STUDY DESIGN This retrospective cohort study included infants (2004-2015) born at 23-29 weeks gestational age and 501-1249 g birth weight. We compared the demographic and clinical characteristics of infants exposed and not exposed to furosemide between postnatal day 7 and 36 weeks postmenstrual age. We examined the association between furosemide exposure and 2 outcomes: BPD and BPD or death. We performed multivariable probit regression models that included demographic and clinical variables in addition to 2 instrumental variables: furosemide exposure by discharge year, and furosemide exposure by site. RESULTS Of 37 693 included infants, 19 235 (51%) were exposed to furosemide; these infants were more premature and had higher respiratory support. Of 33 760 infants who survived to BPD evaluation, 15 954 (47%) had BPD. An increase in the proportion of furosemide exposure days by 10 percentage points was associated with a decrease in both the incidence of BPD (4.6 percentage points; P = .001), and BPD or death (3.7 percentage points; P = .01). CONCLUSIONS More days of furosemide exposure between postnatal day 7 and 36 weeks was associated with decreased risk of BPD and a combined outcome of BPD or death.
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Affiliation(s)
- Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Sreepriya Gayam
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Destiny Savage
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Andrew Tong
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel Gorham
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ari Sholomon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | | | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Bronchopulmonary Dysplasia in Very Preterm Infants with Symptomatic Congenital Cytomegalovirus Infection: A Propensity Score-Matched Analysis. J Pediatr 2019; 204:142-147.e1. [PMID: 30270170 DOI: 10.1016/j.jpeds.2018.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/10/2018] [Accepted: 08/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess whether symptomatic congenital cytomegalovirus infection (cCMV) is associated with bronchopulmonary dysplasia (BPD) and mortality in very preterm infants (gestational age ≤32 weeks). STUDY DESIGN We performed a retrospective study using the Kids' Inpatient Database for 2003, 2006, 2009, and 2012. Diagnoses of BPD and symptomatic cCMV were determined using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Among patients with in-hospital birth at ≤32 weeks of gestation, cases of symptomatic cCMV were matched with infants without cCMV using propensity score matching at 1:2 ratio. Outcomes of BPD and in-hospital mortality were assessed using conditional logistic regression. RESULTS Of 204 818 in-hospital births with gestational age ≤32 weeks, we identified 208 cases of symptomatic cCMV, 177 of which underwent matching. Symptomatic cCMV was associated with higher odds of BPD (OR, 2.34; 95% CI, 1.41-3.87), but was not significantly associated with in-hospital all-cause mortality (OR, 1.18, 95% CI, 0.64-2.17). CONCLUSIONS Symptomatic cCMV was associated with BPD but not with in-hospital mortality among very preterm infants. Further study is needed to determine the risk of BPD among infants with cCMV to allow for evaluation of possible preventive measures.
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43
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Bardanzellu F, Fanos V, Reali A. Human Breast Milk-acquired Cytomegalovirus Infection: Certainties, Doubts and Perspectives. Curr Pediatr Rev 2019; 15:30-41. [PMID: 30474531 PMCID: PMC6696824 DOI: 10.2174/1573396315666181126105812] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/30/2018] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
Breast Milk (BM) is the best source of nutrition for newborns, especially if premature. In fact, its beneficial impact on short- and the long-term neonatal outcome has was deeply described. Unfortunately, BM could not be always so safe, especially due to the possible presence of maternal viruses that can be shed and transferred to the breastfed neonate. Among these, Cytomegalovirus (CMV) can potentially lead to a serious and acute illness, mostly in case of low gestational age. Some studies also report the association of CMV-acquired infection to an increased risk of structural and functional brain modifications and neurological impairment. Due to these reasons, a strategy to remove CMV from BM with a minimal or absent impact on its beneficial components would be desirable. Up to now, pasteurization, freezing, ultraviolet- C or microwave irradiation are the available techniques; they show different levels of efficacy and variable effects on BM composition, even if many studies are still needed to fully clarify these implications. In this review, we provide an update of the current evidence about these topics. We focus on the factors promoting CMV shedding through BM; moreover, the possible occurrence of a severe disease in preterm neonates is also described. Finally, we investigate the potential effects showed on BM properties by the strategies that prevent or reduce viral transmission, therefore influencing newborns' health, and the new techniques which could show a relevant role in the next future, such as metabolomics.
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Affiliation(s)
- Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, Italy
| | - Alessandra Reali
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section, AOU and University of Cagliari, Italy
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Ronchi A, Ouellette CP, Mejías A, Salamon D, Leber A, Pugni L, Mosca F, Sánchez PJ. Detection of cytomegalovirus in saliva from infants undergoing sepsis evaluation in the neonatal intensive care unit: the VIRIoN-C study. J Perinat Med 2018; 47:90-98. [PMID: 29768249 DOI: 10.1515/jpm-2018-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/11/2018] [Indexed: 01/21/2023]
Abstract
Objective To determine the frequency of detection of cytomegalovirus (CMV) among infants evaluated for late-onset sepsis in the neonatal intensive care unit (NICU). Methods This study was a prospective cohort study. Results During the 13-month study, 84 infants underwent 116 sepsis evaluations, and CMV DNA was detected in saliva in three (4%) infants (median: gestational age 28 weeks, birth weight 950 g), representing 5% (n=6) of all sepsis evaluations. One infant had CMV DNA detected in saliva in all four sepsis evaluations. Two infants had acquired CMV infection, while the timing of CMV acquisition could not be determined in one infant. Two of the three infants had concomitant Gram-negative bacteremia and urinary tract infections (UTIs), two developed severe bronchopulmonary dysplasia (BPD) and none died. Conclusion Detection of CMV DNA in saliva occurred in 4% of infants and 5% of sepsis evaluations. Persistence of CMV DNA shedding in saliva made attribution of clinical illness difficult to ascertain.
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Affiliation(s)
- Andrea Ronchi
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.,Department of Pediatrics, Divisions of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher P Ouellette
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, USA
| | - Asuncion Mejías
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas Salamon
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatal-Perinatal Medicine and Pediatric Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital - The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Nationwide Children's Hospital - The Ohio State University, 700 Children's Drive, RB3, WB5245, Columbus, OH 43205-2664, USA
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45
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Verhinderung der postnatalen Zytomegalievirusinfektion bei Frühgeborenen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Lopes AA, Champion V, Mitanchez D. Nutrition of Preterm Infants and Raw Breast Milk-Acquired Cytomegalovirus Infection: French National Audit of Clinical Practices and Diagnostic Approach. Nutrients 2018; 10:E1119. [PMID: 30126187 PMCID: PMC6115774 DOI: 10.3390/nu10081119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022] Open
Abstract
Raw breast milk is the optimal nutrition for infants, but it is also the primary cause of acquired cytomegalovirus (CMV) infection. Thus, many countries have chosen to contraindicate to feed raw breast milk preterm infants from CMV-positive mothers before a corrected age of 32 weeks or under a weight of 1500 g. French national recommendations have not been updated since 2005. An audit of the French practices regarding the nutrition with raw breast milk in preterm infants was carried out using a questionnaire sent to all neonatal care units. Diagnosed postnatal milk-acquired CMV infections have been analysed using hospitalisation reports. Seventy-five percent of the neonatal units responded: 24% complied with the French recommendations, 20% contraindicated raw breast milk to all infants before 32 weeks regardless of the mothers' CMV-status, whereas 25% fed all preterm infants unconditionally with raw breast milk. Thirty-five cases of infants with milk-acquired CMV infections have been reported. The diagnosis was undeniable for five patients. In France, a high heterogeneity marks medical practices concerning the use of raw breast milk and the diagnostic approach for breast milk-acquired CMV infection is often incomplete. In this context, updated national recommendations and monitored CMV infections are urgently needed.
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Affiliation(s)
- Anne-Aurelie Lopes
- Pediatric Emergency Department, AP-HP, Robert Debre Hospital, 48 Boulevard Serurier, 75019 Paris, France.
| | - Valerie Champion
- Neonatology Department, AP-HP, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - Delphine Mitanchez
- Neonatology Department, AP-HP, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
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47
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Gang MH, Chang MY. Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Rojas P, Friaza V, García E, de la Horra C, Vargas SL, Calderón EJ, Pavón A. Early Acquisition of Pneumocystis jirovecii Colonization and Potential Association With Respiratory Distress Syndrome in Preterm Newborn Infants. Clin Infect Dis 2018; 65:976-981. [PMID: 28520902 DOI: 10.1093/cid/cix454] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/11/2017] [Indexed: 12/16/2022] Open
Abstract
Background Pneumocystis pneumonia is a well-recognized lung disease of premature and malnourished babies. Even though serologic studies have shown that children are exposed to Pneumocystis jirovecii early in life, the epidemiology of human P. jirovecii infection and the host-microorganism relationship in infancy remain poorly understood. The aim of the present study was to investigate the prevalence of P. jirovecii colonization in preterm infants and its possible association with medical complications. Methods A prospective observational study of preterm infants (birth weight <1500 g and/or gestational age <32 weeks) was carried out. Identification of P. jirovecii colonization was performed by means of molecular techniques in nasal aspirated samples at birth. Results A total of 128 preterm infants were included during the study period. Pneumocystis DNA was identified in 25.7% (95% confidence interval [CI], 17.8%-33.7%) of newborns studied. A significant increase of respiratory distress syndrome in colonized group, even after adjusting for confounding factors (odds ratio, 2.7 [95% CI, 1.0-7.5]; P = .04), was observed. No differences were observed in other medical conditions between the 2 groups. Conclusions Pneumocystis jirovecii colonization is frequent in preterm births and could be a risk factor to develop respiratory distress syndrome among preterm infants.
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Affiliation(s)
- Pilar Rojas
- Neonatology Unit, Virgen del Rocío University Children's Hospital
| | - Vicente Friaza
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Elisa García
- Neonatology Unit, Virgen del Rocío University Children's Hospital
| | - Carmen de la Horra
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Sergio L Vargas
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio Pavón
- Neonatology Unit, Virgen del Rocío University Children's Hospital
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Gunkel J, de Vries LS, Jongmans M, Koopman-Esseboom C, van Haastert IC, Eijsermans MCJ, van Stam C, van Zanten BGA, Wolfs TFW, Nijman J. Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection. Pediatrics 2018; 141:peds.2017-0635. [PMID: 29330315 DOI: 10.1542/peds.2017-0635] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess whether preterm infants with postnatal cytomegalovirus infection develop neurologic sequelae in early childhood. METHODS Infants <32 weeks' gestation were prospectively screened for cytomegalovirus (CMV) at term-equivalent age. Neurodevelopment was compared between CMV-positive and CMV-negative infants by using the Griffiths Mental Development Scales (GMDS) at 16 months' corrected age (CA); the Bayley Scales of Infant and Toddler Development, Third Edition or the GMDS at 24 to 30 months' CA; and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition and Movement Assessment Battery for Children, Second Edition at 6 years of age. At 6 years old, hearing was assessed in CMV-positive children. RESULTS Neurodevelopment was assessed in 356 infants at 16 months' CA, of whom 49 (14%) were infected and 307 (86%) were noninfected. Infected infants performed significantly better on the GMDS locomotor scale. There were no differences at 24 to 30 months' CA on the Bayley Scales of Infant and Toddler Development, Third Edition or GMDS. At 6 years of age, infected children scored lower on the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, but mean scores were within normal range, reaching significance only in verbal IQ (96 [SD 17] vs 103 [SD 15] points; P = .046). Multiple regression indicated no impact of CMV status but significant influence of maternal education and ethnicity on verbal IQ. No significant differences in motor development were found and none of the infected children developed sensorineural hearing loss. CONCLUSIONS In this cohort study, postnatal cytomegalovirus infection in preterm children did not have an adverse effect on neurodevelopment within the first 6 years of life.
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Affiliation(s)
| | | | - Marian Jongmans
- Departments of Neonatology.,Child, Family, and Education Studies
| | | | | | - Maria C J Eijsermans
- Child Development and Exercise Center, University Medical Center Utrecht, Utrecht, Netherlands
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Klotz D, Jansen S, Gebauer C, Fuchs H. Handling of Breast Milk by Neonatal Units: Large Differences in Current Practices and Beliefs. Front Pediatr 2018; 6:235. [PMID: 30234076 PMCID: PMC6131667 DOI: 10.3389/fped.2018.00235] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/02/2018] [Indexed: 01/25/2023] Open
Abstract
Background: Breast milk (BM) for premature infants is subjected to multiple steps of processing, storage and distribution. These steps may influence the quality and safety of BM. Guidelines concerning the use of mother's own milk are either not available or limited to specific aspects of BM handling and are based on evidence of variable strength. This may result in diverse BM handling routines by health care professionals. Objective: We surveyed neonatal units to increase the knowledge about the current practice of BM handling routines of mother's own milk and to identify controversial aspects that could give directions for future research. Methods: An online-based questionnaire was sent to 307 different neonatal departments providing level III to level I neonatal care within Germany, Austria and Switzerland. Practices concerning screening for cytomegalovirus and BM bacteria, pasteurization, fortification, storage, workforce and the incidence of BM administration errors were surveyed. Results: A total of 152 units, 56% of contacted level III units and 51% of level II units, participated in the survey (Germany 53%, Switzerland 71%, and Austria 56%). We found differences concerning indication and method of CMV inactivation (performed by 58%), bacterial count screening (48%) and bacterial count reduction (17%) within participating units. Thirty different thresholds for bacterial BM counts were reported by 65 units, resulting in pasteurization or discarding of BM. The use of nutrient analysis (12%) and fortification regimens in addition to standard multicomponent fortifiers (58%) using either individual (93%), targeted (3%), or adjusted (4%) fortification protocols varied profoundly. There is a high variability in staff and available facilities for BM handling. 73% of units report about BM administration errors. Conclusion: There is a wide variability in most aspects of BM handling in the participating units. Despite limited evidence labor and cost intensive procedures are applied which may have an impact on BM quality.
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Affiliation(s)
- Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefanie Jansen
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Gebauer
- Department of Neonatology, University Children's Hospital, Leipzig, Germany
| | - Hans Fuchs
- Department of Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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