Characteristics and mortality rate of neonates with congenital cytomegalovirus infection
Background. Cytomegalovirus (CMV) infection is a common congenital infection in neonates. Clinical presentation and laboratory findings in CMV-infected infants in a setting where HIV is prevalent are not well characterised.
Objective. To determine the characteristics and survival to hospital discharge of neonates with congenital CMV infection.
Methods. In this retrospective, case-control study, hospital records of neonates, tested for CMV in the first 3 weeks of life from January 2004 to December 2008, were reviewed for maternal and neonatal characteristics, clinical presentation, laboratory findings and inpatient mortality. Comparisons were made between CMV-infected and CMV-uninfected neonates in those infants who were tested for CMV.
Results. Among the CMV-infected, 91% were of low birth weight, 83% were preterm and 29% were small for gestational age. The CMV-infected neonates were more likely to present with hepato/splenomegaly compared with uninfected neonates (p=0.02). Thrombocytopenia was more severe in CMV-infected neonates (p=0.004). Congenital CMV-infected neonates were more likely to be HIV-exposed (p=0.003) and HIV-infected (p=0.02). Mortality before hospital discharge was significantly higher in congenital CMV-infected neonates (p=0.01) and in those with HIV co-infection (p=0.02). The male gender was a significant independent predictor of inpatient mortality (odds ratio: 23, 95% confidence interval 1.19 - 445.698; p=0.04).
Conclusion. Neonates presenting with hepato/splenomegaly and severe thrombocytopenia are most likely to be CMV-infected. Neonates with congenital CMV are more likely to be co-infected with HIV. The co-infection of CMV and HIV is associated with a high mortality rate, especially in male neonates.
Hitesh Amrat Diar, Division of Neonatology, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
Sithembiso Velaphi, Division of Neonatology, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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Date published: 2014-11-13
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