480 - Discharge Outcomes of Postnatal Cytomegalovirus Infection in Very Preterm Infants and Very Low Birth Weight Infants: A Multicenter Cohort Study

Publication Number: 3463.480

Ningxin Luo, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jie yang, Fudan Children's Hospital, Shanghai, Shanghai, China (People's Republic); Yan Mo, Maternal and Child Health Hospital of Guangxi, Nanning, Guangxi, China (People's Republic); Luyang Hong, Children's hospital of Fudan university, Shanghai, Shanghai, China (People's Republic); Yihuang Huang, Children's hospital of Fudan university, Shanghai, Shanghai, China (People's Republic); Shujuan Li, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Weiyin Yu, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Lan Zhang, children's hospital of fudan university, shanghai, Shanghai, China (People's Republic); Ruimiao Bai, Northwest Women and Children’s Hospital, Xi’an, Shaanxi, China (People's Republic); Yongyan Shi, Shengjing Hospital of Cnina Medical University, Shenyang, Liaoning, China (People's Republic); Aimin Qian, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Yun Cao, Children's Hospital, Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: Very preterm (VP) infants are at an increased risk of developing symptomatic postnatal CMV (pCMV) infections due to immature immunity system.

Objective: To analyze the impact of pCMV infection on discharge outcomes in VP infants.

Design/Methods: This multicenter cohort study utilized data from the Chinese Neonatal Network (CHNN) which collected data from VP infants less than 32 weeks’ gestational age (GA) or with birth weight less than 1500 g between January 2022 and December 2023. Infants with a discharge diagnosis of pCMV infection were included in the study population. Outcomes included a series of diseases occurring after day 21, including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), late-onset sepsis (LOS). Logistic regression model fitted by generalized estimating equation approach was used to evaluate the association between pCMV infection and outcomes. Five scenarios of sensitivity analyses were also performed to assess the robustness of the findings. Scenario I used the the original data without imputation. Scenario II excluded centers without cases of pCMV during the study period. Scenario III excluded centers with the average number of very preterm inpatients < 50/year. Scenario IV excluded all the LOS cases to avoid the impact of LOS on BPD and other discharge outcomes. Scenario V used propensity score 1:4 caliper matching (caliper=0.2) to further compare the outcomes of the two groups.

Results: A total of 17645 infants were enrolled, of which 146 (0.8%) with the discharge diagnosis of pCMV infection. pCMV infection was significantly associated with higher risk of moderate to severe BPD (aOR, 3.45; 95% CI, 2.25–5.29). Compared with control group, pCMV group had a higher rate of LOS (8.9% vs 3.3%) . A higher rate of coagulase negative staphylococci (85.6% vs 66.4%) and fungus (15.4% vs 5.1%) were seen in culture-positive LOS in pCMV group. Subgroup analyses showed that infant with GA < 28 weeks (aOR, 4.08; 95% CI, 2.08–7.99) were more prone to developing moderate to severe BPD compared to those with GA≥28 weeks (aOR, 2.43; 95% CI, 1.51–3.91). In all sensitivity analyses, the association between pCMV infection and increased risk of moderate to severe BPD remained consistent. The pCMV group also had a significantly longer hospital stay (83 vs. 64 days) after propensity score matching.

Conclusion(s): pCMV infection was associated with an increased risk of BPD in VP infants. pCMV screening and preventive measures against transmission warranted further study.

Clinical characteristics of the pCMV group and the control group (missing values for covariates were imputed)
Table 1.pdfAbbreviations: pCMV, postnatal cytomegalovirus; absolute standardised differences (ASD); PROM, premature rupture of membranes;GA, gestational age; TRIPS, Transport Risk Index of Physiologic Stability; PS, pulmonary surfactant; DOL, day of life; NEC, necrotizing enterocolitis; EOS, early-onset sepsis; LOS, late-onset sepsis; IVH, intraventricular hemorrhage; PDA, patent ductus arteriosus; M, mean; IQR, interquartile range; SD, standard deviation; TRIPS scores range from 0 to 54. Higher values represent greater illness severity.
a Data on maternal diabetes were missing in 157 infants (0.9%).
b Data on maternal hypertension were missing in 162 infants (0.9%).
c Data on antenatal steroids were missing in 828 infants (4.5%).
d Data on cesarean delivery were missing in 10 infants (0.1%).
e Data on male were missing in 140 infants (0.8%).
f Data on TRIPS score were missing in 352 infants (2.0%).
g Data on IVH ≥ stage III were missing in 548 infants (3.1%).

Neonatal outcomes in the pCMV group and the control group.
Table 2.pdfAbbreviations: OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; ROP, retinopathy of prematurity; PVL, periventricular leukomalacia; UTI, urinary tract infection; DOL, day of life.
Generalized estimating equation model adjusted for relevant confounders, including gestational age, small for gestational age, male sex, cesarean birth, use of antenatal steroids, maternal hypertension, maternal diabetes, Transport Risk Index of Physiologic Stability score, use of pulmonary surfactant ≥2 times within 21 days, type of respiratory support on DOL 21, maternal breastfeeding within 21 days, red blood cell suspension infusion within 21 days, IVH≥ stage III, and patent ductus arteriosus requiring treatment.

Neonatal outcomes in the pCMV group and the control group by gestational age ( <28+0 weeks and ≥28+0 weeks) and treatment status (treatment group and non-treatment group).
Fig1.pdfAbbreviations: aOR, adjusted odds ratio; BPD, bronchopulmonary dysplasia; LOS, late-onset sepsis; UTI, urinary tract infection; DOL, day of life.
Generalized estimating equation model adjusted for relevant confounders, including gestational age, small for gestational age, male sex, cesarean birth, use of antenatal steroids, maternal hypertension, maternal diabetes, Transport Risk Index of Physiologic Stability score, use of pulmonary surfactant ≥2 times within 21 days, type of respiratory support on DOL 21, maternal breastfeeding within 21 days, red blood cell suspension infusion within 21 days, IVH≥ stage III, and patent ductus arteriosus requiring treatment.