Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.

TitlePostnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.
Publication TypeJournal Article
Year of Publication2015
AuthorsKelly MS, Benjamin DK, Puopolo KM, Laughon MM, Clark RH, Mukhopadhyay S, Benjamin DK, P Smith B, Permar SR
JournalJAMA Pediatr
Volume169
Issue12
Paginatione153785
Date Published2015 Dec
ISSN2168-6211
Abstract

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

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

DESIGN, SETTING, AND PARTICIPANTS: Conducted between October 2014 and June 2015, this propensity-matched retrospective cohort study involved 101,111 hospitalized VLBW (<1500 g) infants at 348 neonatal intensive care units in the United States from 1997 to 2012. We matched infants with postnatal CMV infection 1:1 to comparison infants using propensity scores, and we used Poisson regression to examine the effect of postnatal CMV on the combined risk for 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.

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: The primary outcome was death or BPD at 36 weeks' postmenstrual age.

RESULTS: Of 101,111 infants, 328 (0.3%) had postnatal CMV infection. We matched a comparison infant to 303 CMV-infected infants (92%) 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 for death or BPD at 36 weeks' postmenstrual age (risk ratio, 1.21; 95% CI, 1.10-1.32) and BPD (risk ratio, 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%; n = 29), intubation for mechanical ventilation (15%; n = 49), a new oxygen requirement (28%; n = 91), and death (1.2%; n = 4).

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

DOI10.1001/jamapediatrics.2015.3785
Alternate JournalJAMA Pediatr
PubMed ID26642118
PubMed Central IDPMC4699399
Grant List1R01-HD081044-01 / HD / NICHD NIH HHS / United States
1R18-FD005292-01 / FD / FDA HHS / United States
2K24HD058735-06 / HD / NICHD NIH HHS / United States
DP2 HD075699 / HD / NICHD NIH HHS / United States
DP2HD2075699 / DP / NCCDPHP CDC HHS / United States
DPHD2075699 / / PHS HHS / United States
HHSN267200700051C / HD / NICHD NIH HHS / United States
HHSN267200700051C / / PHS HHS / United States
HHSN272201500006I / / PHS HHS / United States
HHSN275201000003I / HD / NICHD NIH HHS / United States
HHSN275201000003I / / PHS HHS / United States
K23 HD068497 / HD / NICHD NIH HHS / United States
K23HD068497 / HD / NICHD NIH HHS / United States
K24 HD058735 / HD / NICHD NIH HHS / United States
P01 AI117915 / AI / NIAID NIH HHS / United States
P01-AI117915-01 / AI / NIAID NIH HHS / United States
P30AI064518 / AI / NIAID NIH HHS / United States
R01 AI106380 / AI / NIAID NIH HHS / United States
R01 HD081044 / HD / NICHD NIH HHS / United States
R01AI06380 / AI / NIAID NIH HHS / United States
R03 HD072796 / HD / NICHD NIH HHS / United States
R03HD072796 / HD / NICHD NIH HHS / United States
R21 AI106494 / AI / NIAID NIH HHS / United States
R21AI0694 / AI / NIAID NIH HHS / United States
T32 HD060558 / HD / NICHD NIH HHS / United States
T32-HD060558 / HD / NICHD NIH HHS / United States
UL1 TR001117 / TR / NCATS NIH HHS / United States
UL1TR001117 / TR / NCATS NIH HHS / United States