Document Detail


Asymptomatic DNAemia heralds CMV-associated NEC: case report, review, and rationale for preemption.
MedLine Citation:
PMID:  24144715     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Human cytomegalovirus (CMV) infection may be acquired in very low birth weight and extremely low birth weight (ELBW) infants from breast milk. The clinical relevance of such infections is uncertain. There is no consensus on whether screening breast milk for CMV, freezing/pasteurizing milk before feeding, or performing virological monitoring on at-risk infants is warranted. We describe an ELBW infant who acquired CMV postnatally from breast milk and developed CMV sepsis syndrome and clinical evidence of necrotizing enterocolitis (NEC) at ≈ 5 weeks of age. The availability of serial dried blood spots from day of life (DOL) 4 to 21, coincidentally obtained for a metabolic study, provided the novel opportunity to retrospectively test for and quantify the magnitude of CMV DNAemia. DNAemia was present for several weeks before the onset of severe CMV disease, first being noted on DOL 18 and increasing in magnitude daily to 4.8 log10 genomes/mL on DOL 21, approximately 8 days before the onset of abdominal distension and 15 days before the onset of CMV sepsis syndrome and NEC. After surgical resection, supportive care, and ganciclovir therapy, the infant recovered. This case underscores the importance of including CMV infection in the differential diagnosis of sepsis and NEC in premature infants. This case also suggests the value of prospective virological monitoring in at-risk low birth weight and ELBW infants. Future studies should examine the potential utility of preemptive monitoring for, and possibly treatment of, CMV DNAemia in premature infants, which may herald the onset of serious disease.
Authors:
Supatida Tengsupakul; Nicole D Birge; Catherine M Bendel; Robyn C Reed; Beth-Ann Bloom; Nelmary Hernandez; Mark R Schleiss
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2013-10-21
Journal Detail:
Title:  Pediatrics     Volume:  132     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-04     Completed Date:  2014-01-14     Revised Date:  2014-11-04    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1428-34     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Asymptomatic Diseases*
Cytomegalovirus* / isolation & purification
DNA, Viral*
Enterocolitis, Necrotizing / diagnosis*,  virology
Humans
Infant, Newborn
Infant, Premature*
Male
Grant Support
ID/Acronym/Agency:
R01 HD044864/HD/NICHD NIH HHS; R01 HD044864/HD/NICHD NIH HHS; T32 HD068229/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/DNA, Viral
Comments/Corrections

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