Characteristics and mortality rate of neonates with congenital cytomegalovirus infection

Abstract

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.