Postnatal Cytomegalovirus Infection and the Risk of Bronchopulmonary Dysplasia

Details

• Alternative Title:
  JAMA Pediatr
• Personal Author:
  Kelly, Matthew S. ; Benjamin, Daniel K. ; Puopolo, Karen M. ; Laughon, Matthew M. ; Clark, Reese H. ; Mukhopadhyay, Sagori ; Smith, P. Brian ; Permar, Sallie R.
• 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.
  
  
• Subjects:
  Article Bronchopulmonary Dysplasia Cohort Studies Cytomegalovirus Cytomegalovirus Infections Female Humans Infant Infant, Newborn Infant, Very Low Birth Weight Infant Mortality Male Propensity Score Retrospective Studies Risk Factors

  More +
• Source:
  JAMA Pediatr. 169(12):e153785.
• Pubmed ID:
  26642118
• Pubmed Central ID:
  PMC4699399
• Document Type:
  Journal Article
• 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
• Place as Subject:
  United States
• Volume:
  169
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bd2cfd78c7110caed9d3652fbe924591f72990586cb9620df5c822e7fbd5f23b
• Download URL:
  https://stacks.cdc.gov/view/cdc/38489/cdc_38489_DS1.pdf
• File Type:
  [PDF - 369.92 KB ]