December 28, 2015
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CMV linked to bronchopulmonary dysplasia in low-birth-weight infants

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Postnatal cytomegalovirus infection among infants born weighing less than 1,500 g increased their risk for developing bronchopulmonary dysplasia, according to recent data in JAMA Pediatrics.

“Our results indicate that postnatal CMV infection at less than 36 weeks’ postmenstrual age was associated with an increased risk for [bronchopulmonary dysplasia (BPD)],” Matthew S. Kelly, MD, MPH, research fellow for the division of pediatric infectious disease at Duke University School of Medicine, and colleagues wrote.

matt kelly

Matthew S. Kelly

The researchers retrospectively studied a cohort of 101,111 very low-birth-weight newborns at 348 neonatal ICUs in the United States born from 1997 to 2012. Neonates with postnatal CMV infection were matched to control group patients for comparison of mortality and BPD at 36 weeks.

Overall, 328 neonates were diagnosed with postnatal CMV infection, with 303 matched to control infants (n = 303) for the final analysis. Among the intervention group, 76% of neonates either died or developed BPD at age 36 weeks, compared with 63% among the controls. The researchers found that CMV infection was associated with death or BPD at 36 weeks (RR = 1.21; 95% CI, 1.1-1.32). They also found that CMV infection was associated with an overall increased risk for BPD (RR = 1.33; 95% CI 1.19-1.5).

The researchers noted that complications related to CMV infection may be caused by introducing very low-birth-weight infants to breast milk.

“With the practice of transfusion of CMV-seronegative or leukoreduced blood, breast-feeding is also the primary route of CMV acquisition among infants in the United States,” Kelly and colleagues wrote. “Further research is needed to define the long-term sequelae of postnatal CMV on pulmonary and neurological outcomes and develop novel CMV prevention measures to permit safe breast milk feeding by very low-birth-weight infants.”

In a related editorial, David W. Kimberlin, MD, of the division of pediatric infectious diseases at the University of Alabama at Birmingham, praised Kelly and colleagues for expanding the knowledge base of possible long-term harms caused by CMV, but warned that the study should not be used as a basis for withholding breast milk from vulnerable neonates.

“At the current time, we do not know whether postnatally acquired CMV causes chronic lung disease of prematurity in very low-birth-weight neonates, although the Kelly et al study likely will spur additional investigations that one day may definitively answer this question,” Kimberlin wrote. “In contrast, we do know that breast milk has tremendous nutritional value for infants, including those who are born prematurely. As such, properly treated breast milk should not be withheld from very low-birth-weight neonates on the basis of this study.” – by David Costill

Disclosure: Kelly reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.