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Congenital cytomegalovirus (cCMV) among infants in U.S. neonatal intensive care units (NICU) during 2010-2020

Abstract Summary

Objective: To describe clinical characteristics of infants tested and diagnosed for congenital cytomegalovirus (cCMV) in U.S. neonatal intensive care units (NICU) during 2010-2020 to help inform a standardized case definition for cCMV disease. Methods: We used a de-identified dataset derived from a proprietary electronic health record documentation system, Pediatrix Medical Group Clinical DataWarehouse, which included records from 840,988 infants admitted to 389 NICUs in 35 states during 2010-2020. We defined cCMV as a positive culture or polymerase chain reaction (PCR) test using urine, blood or cerebrospinal fluid collected from an infant within 21 days of life. We compared the frequency of certain cCMV-related clinical signs among infants with and without CMV testing, and their positive predictive value (PPV) for cCMV diagnosis. Results: A total of 10,057 (1%) infants were tested for cCMV within 21 days of life, by culture (68%) or PCR (32%), from urine (79%), saliva (14%) or blood (6%); 7,879 (78%) presented with >=1 cCMV-related clinical sign. Of infants tested, 560 (6%) were diagnosed with cCMV (81% by urine culture or PCR). Infants tested for cCMV most commonly presented hyperbilirubinemia (63%) and thrombocytopenia (44%) in comparison to cholestasis (12%), microcephaly (4%), abnormal hearing screening (4%), intracranial calcification (1%), hepatomegaly (1%), petechiae (1%), and hepatosplenomegaly (1%). These clinical signs were present in <=8% of non-tested infants, with the exception of hyperbilirubinemia (56%). The PPVs were highest for intracranial calcification (74%), hepatosplenomegaly (51%), and petechiae (41%), and low for thrombocytopenia (9%) and hyperbilirubinemia (6%). Conclusions: Although NICU infants may represent the most severe cases of cCMV disease, clinical signs were uncommon, except thrombocytopenia and hyperbilirubinemia; however, of infants with these clinical signs only fraction had a diagnosis of cCMV. These data were useful to inform the selection of lab and clinical criteria for a standardized case definition of cCMV disease.

Learning Objectives

• Describe testing methods for congenital cytomegalovirus (cCMV) among infants in neonatal intensive care units (NICUs) in the U.S.
• Examine cCMV-related clinical signs in infants tested or not tested for cCMV
• Examine diagnosis of cCMV in infants with cCMV-related clinical signs

Presentation

3440589_16073KelleyRaines.pdf

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