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