Postnatal Human Cytomegalovirus Infection in Preterm Infants Has Long-Term Neuropsychological Sequelae

Brecht, Katharina F.; Goelz, Rangmar; Bevot, Andrea; Krägeloh‐Mann, Ingeborg; Wilke, Marko; Lidzba, Karen

doi:10.1016/j.jpeds.2014.11.002

Cited by 80 publications

(85 citation statements)

References 30 publications

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“…A total of 45 studies met all the inclusion criteria. Executive function data were provided by 35 of these studies (3360 children born preterm/low birthweight and 2812 term‐born controls) either in the study paper or after a request for additional data sent to the authors . The characteristics and main study results are given in (Tables SI, SII, and SIII, online supporting information; working memory, inhibition, and cognitive flexibility respectively).…”

Section: Resultsmentioning

confidence: 99%

Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

Houdt

Oosterlaan

Wassenaer-Leemhuis

et al. 2019

Develop Med Child Neuro

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AimTo investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight.MethodPubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures.ResultsThirty‐five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta‐regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth.InterpretationChildren born preterm/low birthweight since 1990 perform half a SMD below term‐born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age.What this paper adds Children born preterm/low birthweight perform below term‐born children on core executive functions.Lower gestational age or male sex are not risk factors for poorer executive functions.Executive function difficulties in children born preterm/low birthweight remain stable across childhood.Executive function difficulties are similar for children born recently and children born in earlier eras.

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Section: Resultsmentioning

confidence: 99%

Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

Houdt

Oosterlaan

Wassenaer-Leemhuis

et al. 2019

Develop Med Child Neuro

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“…In contrast, transmission to preterm or very‐low‐birth‐weight infants (VLBWIs) occasionally develops into a serious CMV disease, such as sepsis‐like syndrome, probably because of the low level of transferred maternal anti‐CMV antibodies and the immature state of the infant's immune system. Furthermore, acquired infection in VLBWIs during the neonatal period has been reported to influence the development of cognitive or motor functions later in life . Therefore, prevention of CMV transmission to VLBWIs is clinically important.…”

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confidence: 99%

Sequence analyses of variable cytomegalovirus genes for distinction between breast milk– and transfusion‐transmitted infections in very‐low‐birth‐weight infants

et al. 2018

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BACKGROUND: Cytomegalovirus (CMV) transmission to very-low-birth-weight infants (VLBWIs) sometimes induces serious clinical symptoms. Although breast milk is considered a major source of transmission, transfusion-transmitted CMV (TT-CMV) infection is often suspected when CMV disease develops after transfusion. Thus, it is clinically important to distinguish between transfusion-transmitted and breast milktransmitted CMV infections. STUDY DESIGN AND METHODS: Study A: The incidence of acquired CMV transmission was prospectively investigated in 65 VLBWIs. Study B: To determine the transmission routes in 18 TT-CMVsuspected VLBWIs who had been reported in our hemovigilance system, we performed polymerase chain reaction for CMV DNA in fed breast milk and/or repository blood samples related to transfused leukoreduced blood products. Furthermore, we evaluated the identity of CMV strains in patients' urine/blood samples and fed breast milk by sequence analyses of variable CMV genes UL139 and UL146.RESULTS: Study A: Acquired CMV infection was found in 4 of 65 VLBWIs (6.2%). Study B: CMV DNA was detected in fed breast milk for 12 of 14 TT-CMVsuspected cases, for which breast milk was available. Furthermore, CMV DNA sequence-matching rates between fed breast milk and patients' urine/blood for both UL139 and UL146 genes were 100% or nearly 100% in 11 patients. In contrast, repository blood samples for 11 of 14 patients were CMV DNA negative.CONCLUSION: CMV is principally transmitted through breast milk in VLBWIs. The risk of TT-CMV seems to be extremely low when using leukoreduced blood products. Sequence analyses of the variable CMV genes are useful for evaluating CMV transmission routes. ABBREVIATIONS: BM-CMV = breast milk-transmitted CMV; CMV = cytomegalovirus; JRCS = Japanese Red Cross Society; LOD = limit of detection; PCR = polymerase chain reaction; TT-CMV = transfusiontransmitted CMV; VLBWI = very-low-birth-weight infantFrom the * The number of tested repository blood samples is the same as the number of transfused blood products. † Homology (the repository blood sample vs. patient) is 64.6% for the UL139 gene and 68.6% for the UL146 gene. 16 ‡ CMV DNA was detected in the testing conducted at the hospital. § Homology (the repository blood sample vs. patient) is 89.3% for the UL139 gene and 78.1% for the UL146 gene. FFP = fresh-frozen plasma; NT = not tested; PC = platelet concentrate; PCR = polymerase chain reaction; RBC = red blood cell. TRANSFUSION Volume 58, December 2018FURUI ET AL.

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“…Kelly et al 7) demonstrated that postnatal CMV infection was associated with an increased risk of bronchopulmonary dysplasia at 36 weeks of PMA in VLBW infants. Some follow-up studies indicated poor neurocognitive outcome in adolescents born preterm with postnatal CMV infection 43,44) . In contrast, other studies showed that preterm infants might not have an increased risk for neurological sequelae after CMV postnatal infection 9,45) .…”

Section: Resultsmentioning

confidence: 99%

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

Gang

Chang

2018

Neonatal Med

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Purpose: The purpose of this study is to describe the rate of cytomegalovirus (CMV) virolactia, and the prevalence of breast milk (BM)-transmitted postnatal CMV infection among premature infants after freeze-thawing (FT) and Holder pasteurization (HP) of breast milk. Methods: This is a single-center, retrospective study of 312 infants born at less than 32 weeks of gestation, or with a birth weight less than 1,500 g from January 2013 to June 2017. All infants were screened for CMV-specific immunoglobulin (Ig) G and IgM at birth. Initial CMV specific polymerase chain reaction (PCR) and CMV culture were performed on mothers' BM and babies' urine within the first 21 days of life. FT and HP of BM was used to prevent the transmission of CMV. For the surveillance of postnatal CMV infection, CMV culture and CMV specific PCR of urine from babies were repeated one to two months after the initial screening. Screening for viremia and viruria was performed if postnatal CMV infection was suspected. Results: Among 178 BM samples obtained from mothers of CMV-IgG-seropositive infants, 80 (44.9%) were CMV PCR positive. CMV deoxyribonucleic acid (DNA) was detected in five of the 22 BM samples (22.7%) obtained from the mothers of CMV-IgG seronegative infants. When CMV DNA load in BM was measured before and after HP, various results were shown. Sixty-three infants out of 232 (27.2%) were evaluated for postnatal CMV infection and four infants out of 63 (6.3%) were infected. Conclusion: Interventions to prevent BM-transmitted CMV infection can reduce the chance of postnatal CMV infection, but not completely eliminate it.

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Postnatal Human Cytomegalovirus Infection in Preterm Infants Has Long-Term Neuropsychological Sequelae

Cited by 80 publications

References 30 publications

Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

Sequence analyses of variable cytomegalovirus genes for distinction between breast milk– and transfusion‐transmitted infections in very‐low‐birth‐weight infants

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

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