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Postnatal Cytomegalovirus Infection and the Risk of Bronchopulmonary Dysplasia
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Details:
  • Pubmed ID:
    26642118
  • Pubmed Central ID:
    PMC4699399
  • Description:
    Importance

    Postnatally acquired cytomegalovirus (CMV) is typically benign in term infants but, in very low birth weight (VLBW) infants, can cause pneumonitis and sepsis-like illness. Whether postnatal CMV infection results in long-term pulmonary sequelae in these infants is unknown.

    Objective

    To investigate the relationship between postnatal CMV infection and bronchopulmonary dysplasia (BPD) and mortality in a large, multicenter cohort of VLBW infants.

    Design

    Propensity-matched retrospective cohort study.

    Setting

    348 neonatal intensive care units in the United States from 1997–2012.

    Participants

    Hospitalized VLBW (<1500 g) infants.

    Exposures

    Postnatal CMV infection was defined as a diagnosis of CMV or detection of CMV from blood, urine, cerebrospinal fluid, or respiratory secretions on or after day of life 21. Infants with a CMV diagnosis or virologic detection of CMV prior to day of life 21 were not considered to have postnatal infection.

    Main Outcomes and Measures

    We matched infants with postnatal CMV infection 1:1 to comparison infants using propensity scores, and used Poisson regression to examine the effect of postnatal CMV on the combined risk of death or BPD at 36 weeks postmenstrual age. To describe features of postnatal CMV infection, we extracted clinical and laboratory data from 7 days before until 7 days after infants met criteria for postnatal CMV.

    Results

    Of 101,111 infants, 328 (0.3%) had postnatal CMV infection. We matched a comparison infant to 303 (92%) CMV-infected infants for a final cohort of 606 infants. The median gestational age and birth weight of this cohort were 25 weeks and 730 g, respectively. Postnatal CMV infection was associated with an increased risk of death or BPD at 36 weeks postmenstrual age (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 1.10–1.32) and BPD (RR: 1.33, 95% CI: 1.19–1.50). Changes in cardiorespiratory status associated with postnatal CMV infection included a new requirement for vasopressor medications (9%), intubation for mechanical ventilation (15%), a new oxygen requirement (28%), and death (1.2%).

    Conclusions and Relevance

    In VLBW infants, postnatal CMV infection was associated with increased risk of BPD. Further studies are needed to determine the role of preventative measures against CMV in this population.

  • Document Type:
  • Collection(s):
  • Funding:
    DPHD2075699/PHS HHS/United States
    HHSN267200700051C/HD/NICHD NIH HHS/United States
    K24 HD058735/HD/NICHD NIH HHS/United States
    R03 HD072796/HD/NICHD NIH HHS/United States
    1R18-FD005292-01/FD/FDA HHS/United States
    R01AI06380/AI/NIAID NIH HHS/United States
    R21 AI106494/AI/NIAID NIH HHS/United States
    P30AI064518/AI/NIAID NIH HHS/United States
    HHSN275201000003C/AA,HD/None/None
    R01 HD081044/HD/NICHD NIH HHS/United States
    DP2 HD075699/HD/NICHD NIH HHS/United States
    K23 HD068497/HD/NICHD NIH HHS/United States
    DP2HD2075699/DP/NCCDPHP CDC HHS/United States
    1R01-HD081044-01/HD/NICHD NIH HHS/United States
    HHSN275201000003I/PHS HHS/United States
    UL1TR001117/TR/NCATS NIH HHS/United States
    T32-HD060558/HD/NICHD NIH HHS/United States
    K23HD068497/HD/NICHD NIH HHS/United States
    HHSN275201000003I/HD/NICHD NIH HHS/United States
    R18 FD005292/FD/FDA HHS/United States
    R03HD072796/HD/NICHD NIH HHS/United States
    P01 AI117915/AI/NIAID NIH HHS/United States
    R01 AI106380/AI/NIAID NIH HHS/United States
    UL1 TR001117/TR/NCATS NIH HHS/United States
    T32 HD060558/HD/NICHD NIH HHS/United States
    P30 AI064518/AI/NIAID NIH HHS/United States
    R21AI0694/AI/NIAID NIH HHS/United States
    HHSN272201500006C/AI/NIAID NIH HHS/United States
    HHSN272201500006I/PHS HHS/United States
    HHSN267200700051C/PHS HHS/United States
    2K24HD058735-06/HD/NICHD NIH HHS/United States
    P01-AI117915-01/AI/NIAID NIH HHS/United States
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