Cytomegalovirus load among Egyptian newborn infants admitted to the neonatal intensive care unit: new perspective

ABSTRACT

CMV transmission is very hazardous to neonates whether due to its severe congenital form or the latent effects of this virus. The aim of the study was to assess CMV load among Egyptian newborn infants admitted to the NICU, to clarify the risk factors for CMV transmission and to set clinical criteria for suspicion of this viral infection among such neonates. This cross-sectional prospective study included 260 neonates admitted to the NICU of the Gynecology and Obstetric hospital, Ain Shams University. Each enrolled case was subjected to detailed history taking laying stress on the socioeconomic st and ard, maternal diseases such as infection, fever, premature - rupture of membranes and past history of any abortion, neonatal deaths or affected newborns. APGAR score at 1 and 5 minutes, their birth weights and skull circumferences were assessed. Thorough clinical examination including assessment of gestational age was done together with regular follow up of the clinical course of the neonates during their NICU admission for a mean postnatal age of 12.35 +/- 10.34 days. In addition to the routine laboratory investigations and the sepsis screen, peripheral blood samples and nasopharyngeal secretions were taken from all the studied neonates on their first and fifth day of life for viral isolation using human fibroblasts cell line culture. Indirect Fluorescent Antibody [IFA] test was carried out for the identification of isolated CMV virus. The present study revealed positive viral culture in 49 cases, 13 of which were confirmed CMV by IFA. Ten of the CMV positive cases were detected in the first day sample [prenatally acquired] and the other three were detected in the fifth day sample which denotes either perinatal or community acquired infection. In all, 84.6% of the CMV positive cases were delivered prematurelv and 61.5% were IDM. Clinical examination showed that 53.9% of them had MCA, 53.9% had jaundice, 46.2% had rash and 38.5% had enlarged lymph nodes, 30.8% were hypothermic, 23.1% had poor peripheral perfusion, 7.7% were pale and 7.7% were cyanosed. Systemic examination revealed that 46.2% had HSM and 23.1% had abdominal distension. As regards the neurological manifestations, 30.8% had hyporeflexia while 15.4% had hyperreflexia, 38.5% were hypotonic while 15.4% were hypertonic and 15.4% suffered from tonic convulsions. A cardiac murmur was heard in 15.4% and inguinal hernia was detected in 7.7%. In conclusion, CMV acquisition especially the congenital form represent a significant problem among newborn Egyptian infants who may be asymptomatic or present with various manifestations ranging from mild to fetal illness. Thus increasing awareness of this viral infection, its ways of transmission, risk factors for neonatal acquisition and its mode of presentation are m and atory to prevent its neonatal as well as the delayed hazards