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Postnatal Cytomegalovirus Infection and the Risk of Bronchopulmonary Dysplasia
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Dec 07 2015
Source: JAMA Pediatr. 169(12):e153785. -
Alternative Title:JAMA Pediatr
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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.
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Pubmed ID:26642118
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Pubmed Central ID:PMC4699399
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