1. CMV +ve Control Introduction cCMV affects ~1% of all newborns born annually in the U.S. ~ 10% born with symptoms typically associated with cCMV Most develop sequelae: sensori-neural hearing loss, visual impairment and neuro-developmental disabilities ~ 90% appear asymptomatic at birth (AcCMV) May develop long-term sequelae Subtle differences may exist when comparing AcCMV infants and uninfected newborns (NoCMV) Hypotheses Gestational age(GA) of AcCMV will differ from NoCMV Birth characteristics of weight, length and head circumference of AcCMV differ from NoCMV Increased Prevalence of Preterm Birth in Asymptomatic Neonates with Congenital Cytomegalovirus (cCMV) Results Background Abstract Study Design Conclusions References 2012 Texas Pediatric Society Electronic Poster Contest Vedanta S. Dariya, M.B;B.S. 1,2, A. Chantal Caviness, M.D., M.P.H., Ph.D. 1, Marily Flores, M.S. 1, Holly Corwin, M.P.H. 1 and Gail J. Harrison, M.D. 1 for the Houston Congenital CMV Longitudinal Study 1 Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas (77030),U.S. 2 Neonatal-Perinatal Medicine Post-doctoral Fellow Houston Congenital CMV Longitudinal Study (1982-1992) Screened: 32,543 Symptomatic CMV (ScCMV) N=77 Asymptomatic CMV (AcCMV) N=109 AcCMV GA available N=109 Control (NoCMV) N=307 NoCMV GA available N=294 CMV (+) patients Referred in (1993-2005) *Study Design: Prospective, longitudinal follow-up study *Study Group Urine Culture in the First 3 Days of Life Signs/Symptoms of CMV Infection ScCMVPositiveYes AcCMVPositiveNo NoCMVNegativeNo Asymptomatic congenital CMV subjects were more likely to be born preterm than uninfected controls Asymptomatic congenital CMV subjects were smaller than uninfected controls, however this finding was not significant when only term infants in both groups were compared *Characteristics AcCMV (N=109) NoCMV (N=307) p-value Agep=0.99 <20 yr2 (1.8%)6 (2%) 20-34 yr92 (84.4%)257 (83.7%) ≥ 35 yr13 (11.9%)38 (12.4%) missing2 (1.8%)6 (2%) Race/Ethnicityp=0.003 White non-Hispanic84 (77.1%)219 (71.3%) White Hispanic10 (9.2%)20 (6.5%) Black15 (13.8%)34 (11.1%) Other04 Unknown030 (9.8%) Delivery Typep=0.374 Vaginal72 (66.1%)181 (59.1%) C-section33 (30.3%)108 (35.2%) Missing4 (3.7%)18 (5.9%) Multiple gestationp=0.011 Singleton birth101 (92.7%)301 (98%) Twin birth8 (7.3%)5 (1.6%) Triplet birth01 Characteristics AcCMV (N=109) NoCMV (N=294) p-value Gestational age (wk) (Mean +/- S.D.) 38.5 +/- 2.039.3 +/-1.6p=0.001 Frequency of preterm births 17.4%6.1%p<0.0001 Frequency of multiple births 7.3%2%p=0.007 Singleton births AcCMV (N=101) NoCMV (N=288) p-value Frequency of preterm births 12.9%5.6%p= 0.016 No differences in maternal age/delivery type between the two groups Difference in race/ethnicity likely due to large number of missing data Significant difference in number of multiple gestation births Mean gestational age of AcCMV < NoCMV Frequency of preterm birth in AcCMV > NoCMV Frequency of multiple birth in AcCMV > NoCMV In singleton births, AcCMV more likely than NcCMV to be preterm Birth Characteristics AcCMV (N=109) (Mean +/- S.D.) NoCMV (N=294) (Mean +/-S.D.) p-value All infants Weight (g)3222 +/- 6823423 +/- 558p=0.003 Length (cm)49.9 +/- 3.150.8 +/- 2.7p=0.006 Head Circumference (FOC)(cm) 33.7 +/- 2.034.3 +/- 1.7p=0.002 Term infants Weight (g)3402 +/- 5433487 +/- 477p=0.16 Length (cm)50.7 +/- 2.451.1 +/- 2.4p=0.124 FOC (cm)34.1 +/- 1.634.5 +/- 1.5p=0.059 All infants: AcCMV significantly smaller than NoCMV Term infants: AcCMV appear smaller than NoCMV (findings not statistically significant) Background: Congenital infection with CMV (cCMV) affects up to 1% of newborns born in the U.S.A. Most newborns with cCMV appear asymptomatic (AcCMV) at birth but may develop long-term sequelae. Objective: Define birth characteristics of growth and GA of newborns with AcCMV and compare them to uninfected newborns (NoCMV) Design/Methods: Newborns with AcCMV and NoCMV were identified through a newborn screening program for cCMV conducted from 1982 to 1992 at a private maternity hospital or referred from hospitals in the Houston area and enrolled in a longitudinal study on the long-term effects of cCMV. Newborns with a positive urine CMV culture and who were without clinical evidence of cCMV at birth, were classified as AcCMV. Newborns with a negative urine CMV culture and without clinical evidence of cCMV at birth were classified as controls (NoCMV). Birth weight, length, head circumference (FOC), and GA at birth were compared between groups using t-tests for continuous variables and chi-square tests for preterm birth (born prior to 37 completed weeks of gestation) and stratified by multiple births. Results: There were 109 AcCMV and 294 NoCMV identified for whom GA was known. GA was significantly younger in AcCMV than NoCMV (38.5 vs 39.3 weeks, p=0.001). The frequency of preterm birth was significantly higher in AcCMV than NoCMV (17.4% vs 6.1% p<0.0001). The frequency of preterm birth was higher in twin than singleton births (57.1% vs 7.5%, p<0.0001) and the frequency of multiple birth was higher in AcCMV than NoCMV (7.3% vs 2.0%, p=0.007). However, in singleton births, AcCMV were still more likely than NoCMV to be born preterm (12.9% vs 5.6%, p=0.016). In all infants, AcCMV were significantly smaller than NoCMV (weight 3222 vs 3423 g, p =0.003; length 49.9 vs 50.8 cm p=0.006; FOC 33.7 vs 34.3 cm p=0.002). In term infants, AcCMV appear smaller than NoCMV (mean weight 3402 vs 3487 g, p=0.16; length 50.7 vs 51.1 cm, p=0.124; FOC 34.1 vs 34.5 cm, p=0.059) Conclusion: Newborns with AcCMV are more likely to be born preterm and appeared smaller than NoCMV indicating an independent risk factor for perinatal morbidity in this sub-population of newborns with cCMV. ^Testing for CMV Urine samples of patients born on the same day tested in batches of 3 Ratio of CMV (+) : Controls 1:2 + - - *Demographic data *Birth characteristics *Gestational age and Preterm birth # Clinical findings s/o cCMV: SGA, Generalized petechiae, Hepatomegaly, Splenomegaly, Microcephaly, Jaundice at birth *Classification of Study Subjects # Clinical findings of cCMV ^ Method of recruiting Controls Williamson WD, Percy AK, Yow MD, et al. Asymptomatic congenital cytomegalovirus infection: Audiologic, neuroradiologic and neuro- developmental abnormalities during the first year. Am J. Dis Child.1990