484 - Small but Not the Same: Small for Gestational Age (SGA) vs. Intrauterine Growth Restriction (IUGR) in Congenital Cytomegalovirus (cCMV) Infection

Publication Number: 3466.484

Zachery S. Lewald, Nationwide Children's Hospital, Columbus, OH, United States; Sebastian Martinez, Nationwide Children's Hospital, Columbus, OH, United States; Traci Pifer, Nationwide Children's Hospital, Columbus, OH, United States; Concepcion de Alba Romero, Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Nationwide Children's Hospital, Columbus, OH, United States; Chance Alvarado, Nationwide Children's Hospital, Columbus, OH, United States; Abigail Parro, Nationwide Children's Hospital, Columbus, OH, United States; Masako Shimamura, Nationwide Children's Hospital, Columbus, OH, United States; Pablo J. Sanchez, Nationwide Children's Hospital -OSU, Columbus, OH, United States

Background: Fetal growth in cCMV infection is often suboptimal. Newborns may be small-for-gestational-age (SGA, birth weight < 10%), intrauterine growth restricted (IUGR; ponderal index < 10%), or both. Knowledge of growth parameters among infants with cCMV infection may inform targeted CMV screening recommendations at birth.

Objective: To assess growth characteristics among newborns with cCMV infection and compare clinical characteristics among SGA-only, IUGR-only, and combined SGA+IUGR infants with cCMV

Design/Methods: From 2013 to 2025, all infants with cCMV infection were identified by referral to the NEO-ID Clinic, Nationwide Children's Hospital (NCH), Columbus, OH as well as CMV (saliva/urine) screening at the time of admission to the 9 neonatal intensive care units in Columbus. All infants with cCMV infection underwent complete evaluation. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Growth parameters were assessed at birth for SGA and IUGR; their clinical characteristics were compared using the Chi-square test.

Results: During the 13 year study, 458 infants were diagnosed with cCMV infection. Of the 458, 159 (35%) infants had abnormal growth parameters at birth with 89 (19%) being only SGA, 20 (4%) only IUGR, and 50 (11%) both SGA and IUGR (p < 0.001). Their clinical characteristics are shown in Table 1. The majority of infants in each group had other symptoms of CMV infection. Of infants who had hearing evaluation performed (n=430), those with abnormal growth parameters at birth were more likely to also have sensorineural hearing loss (SNHL; p=0.04; Table 1).

Conclusion(s): The majority of infants with cCMV infection (76%) had normal growth parameters at birth. SGA was more frequent than IUGR, but both SGA and IUGR were associated with other symptomatology of CMV infection including SNHL. Expanded targeted cCMV newborn screening that includes only growth abnormalities will fail to identify the majority of infants with cCMV.

Characteristics by growth parameters at birth in the 458 infants with congenital CMV infection