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Salud Pública de México

versión impresa ISSN 0036-3634

Salud pública Méx vol.64 no.3 Cuernavaca may./jun. 2022  Epub 30-Oct-2023

https://doi.org/10.21149/13538 

Cartas al editor

Congenital infection by cytomegalovirus in newborns with very low birth weight

Infección congénita por citomegalovirus en recién nacidos de muy bajo peso al nacer

Mariana Chávez-Rodríguez, Rdte Esp Ped1 

Cesar Alberto Ochoa-Meza, Rdte Esp Neonat1 

Juan Carlos Lona-Reyes, M en C de la SP2  3 

Rene Oswaldo Pérez-Ramírez, Esp Neonat3  4 

Larissa María Gómez-Ruiz, M en C Méd3 

Araceli Cordero-Zamora, Esp en Infect Ped2  3 

(1) Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara. Guadalajara, Mexico.

(2) Servicio de Infectología, División de Pediatría, Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Guadalajara, Mexico.

(3) Centro Universitario de Tonalá, Universidad de Guadalajara. Tonala, Mexico.

(4) Servicio de Neonatología, División de Pediatría, Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Guadalajara, Mexico.


Dear editor: Cytomegalovirus (CMV) is the main cause of congenital infection, it affects 0.5 to 2% of newborns (NB) and has been related to auditory and/or neurological sequelae in both symptomatic and asymptomatic patients at birth. Different studies have evaluated the usefulness of neonatal screening to identify infection, but the conclusions are not consistent.

We present the results of a cross-sectional study carried out at the Hospital Civil de Guadalajara with the objective of estimating the frequency of congenital CMV infection in newborns with very low birth weight (VLBW, <1 500 g). Infections were confirmed by polymerase chain reaction (PCR) of saliva samples in the first hours of life and before initiating breastfeeding. Saliva was collected with a sterile swab and transported in tubes free of RNAses and DNAses. The variables studied were obtained from the medical records.

95 newborns with VLBW were studied, 57.9% were male, the median gestational age was 30.4 weeks (maximum 37, minimum 23, IQR 3) and the median birth weight was 1 195 grams (maximum 1 499, minimum 480, IQR 390). The prevalent route of birth was caesarean section, with 66.3 per cent.

Congenital infection was identified in nine NB (10.46%, 95%CI 5.2,18.3). Among those infected, the most frequent symptom was jaundice (6/9), other less common were microcephaly (2/9) and hepatomegaly (2/9). When comparing infected and non-infected newborns, a longer hospital stay was observed in the former.

We observed that 95.16% of the mothers had serum IgG antibodies against CMV, and we also noted that all mothers of neonates with congenital CMV infection presented some comorbidity, with a tendency to a higher occurrence of premature rupture of membranes (table I).

Table I Comparison of demographic and clinical characteristics and maternal history in very low birth weight neonates with and without congenital cytomegalovirus infection. Study carried out at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca between November 2019 and April 2020. Mexico 

Congenital infection absent

n 77

Congenital infection present

n 9

p*

Newborn variables

Birth weight

Median grams

1 195.00

1 099.00

0.72

Gestational age

Median weeks

30.6

30.3

0.55

Apgar at 5 min

Median points

8.0

9.0

0.15

Fever

%

6.6 (4/61)

11.1 (1/9)

0.51

Petechiae

%

4.7 (3/64)

0.0 (0/9)

0.67

Microcephaly

%

27.0 (17/63)

25.0 (2/9)

0.56

Jaundice

%

73.8 (45/61)

66.7 (6/9)

0.46

Hepatomegaly

%

19.7 (12/61)

22.2 (2/9)

0.58

Splenomegaly

%

14.8 (9/61)

0.0 (0/9)

0.27

Low weight for gestational age

%

34.9 (22/63)

11.1(1/9)

0.15

Thrombocytopenia

%

25.9 (15/58)

22.2 (2/9)

0.59

Maximum total bilirubins

Median (mg/dl)

7.7

6.6

0.15

Hemoglobin

Median (mg/dl)

15.65

14.88

0.43

Hematocrit

%

48.26

45.14

0.43

Dilation of the cerebral ventricles

%

13.8 (4/29)

16.7 (1/6)

0.63

Neonatal sepsis

%

20.8 (16/77)

44.4 (4/9)

0.12

Hospital stay days

Median days

28.0

55.0

0.007

Death

%

49.4 (38/77)

22.2 (2/9)

0.12

Maternal variables

Maternal age

Median years

24.0

24.0

0.88

Adequate prenatal care

%

54.5 (42/77)

33.3 (3/9)

0.19

Teenage mother

%

1.3% (1/77)

11.1 (1/9)

0.19

Maternal occupation housewife

%

83.1 (54/65)

66.7 (6/9)

0.55

Previous abortions

%

14.3 (11/77)

22.2 (2/9)

0.41

Overcrowded housing

%

20.0 (12/60)

22.2 (2/9)

0.59

Contact with children

%

91.8 (56/61)

77.8 (7/9)

0.22

Oligohydramnios in pregnancy

%

8.1 (6/74)

11.1 (1/9)

0.57

Clinical virosis in pregnancy

%

15.3 (9/59)

33.3 (3/9)

0.19

Maternal IgG positive antibodies

%

96.2 (51/53)

88.9 (8/9)

0.38

Maternal comorbidities§

%

57.1 (44/77)

100 (9/9)

0.01

Premature rupture of membranes

%

18.2 (14/77)

44.4 (4/9)

0.08

Placental dystocia#

%

5.2 (4/77)

22.2 (2/9)

0.12

Preeclampsia / eclampsia

%

16.9 (13/77)

22.2 (2/9)

0.49

* Hypothesis test for qualitative variables: Fisher’s exact, and for quantitative variables: U-Mann-Whitney.

Causes of death in newborns with VLBW (n. 40): respiratory distress syndrome: 14, late neonatal sepsis: 7, intraventricular hemorrhage: 5, extreme immaturity: 4, early neonatal sepsis: 3, skeletal dysplasia: 2, and an atrioventricular block event, asphyxia perinatal syndrome, body stalk syndrome, Potter syndrome, and pulmonary hypoplasia.

§ Maternal comorbidities (53/86): premature rupture of membranes: 18, pre-eclampsia / eclampsia: 15, placental dystocia: 6, diabetes mellitus or gestational diabetes: 5, hypothyroidism: 2, drug addict: 2, cervicovaginitis: 2, intrauterine growth restriction type III: 2, lupus erythematosus: 1.

# Placental dystocia (6/86): placental abruption: 4, placenta accrete: 2.

Source of information: medical records and physical examination.

In developing countries almost all pregnant women present antibodies against CMV. Factors such as poverty and overcrowding are likely to facilitate early infection.1 Similar to our results, Uchida2 and Yamada3 described a higher occurrence of preterm labor in these patients.

Martínez-Contreras and colleagues also identified a high frequency of CMV infection in neonates with respiratory distress syndrome.4 With the findings of the study, we suggest implementing screening tests in high-risk subgroups such as newborns with VLBW.

References

Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, Griffiths P. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev Med Virol. 2019;29(3):e2034. https://doi.org/10.1002/rmv.2034 [ Links ]

Uchida A, Tanimura K, Morizane M, Fujioka K, Morioka I, Oohashi M,et al. Clinical factors associated with congenital cytomegalovirus infection: A cohort study of pregnant women and newborns. Clin Infect Dis. 2020;71(11):2833-39. https://doi.org/10.1093/cid/ciz1156 [ Links ]

Yamada H, Tanimura K, Tairaku S, Morioka I, Deguchi M, Morizane M,et al. Clinical factors associated with congenital cytomegalovirus infection in pregnant women with non-primary infection. J Infect Chemother. 2018;24(9):702-6. https://doi.org/10.1016/j.jiac.2018.04.010 [ Links ]

Martínez-Contreras A, Lira R, Soria-Rodríguez C, Hori-Oshima S, Maldonado-Rodríguez A, Rojas-Montes O, et al. Citomegalovirus: infección congénita y presentación clínica en recién nacidos con síndrome de dificultad respiratoria. Rev Med Inst Mex Seguro Soc. 2015;53(3):286-93. Available from:http://revistamedica.imss.gob.mx/editorial/index.php/revista_medica/article/view/32Links ]

carloslona5@hotmail.com

Declaration of conflict of interests. The authors declare that they have no conflict of interests.

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