Elsevier

The Journal of Pediatrics

Volume 166, Issue 4, April 2015, Pages 834-839.e1
The Journal of Pediatrics

Original Article
Postnatal Human Cytomegalovirus Infection in Preterm Infants Has Long-Term Neuropsychological Sequelae

https://doi.org/10.1016/j.jpeds.2014.11.002Get rights and content

Objective

To evaluate whether an early postnatal infection poses a long-term risk for neuropsychological impairment to neonates born very prematurely.

Study design

Adolescents born very preterm (n = 42, 11.6-16.2 years, mean = 13.9; 15 girls; 19 with and 23 without an early postnatal human cytomegalovirus [CMV] infection) and typically developing, term born controls (n = 24, 11.3-16.6 years, mean = 13.6; 12 girls) were neuropsychologically assessed with the German version of the Wechsler Intelligence Scale and the Developmental Test for Visual Perception.

Results

As expected, the full cohort of adolescents born preterm had significantly lower scores than term born controls on IQ (preterm: mean [SD] = 98.43 [14.83], control: 110.00 [8.10], P = .015) and on visuoperceptive abilities (95.64 [12.87] vs 106.24 [9.95], P = .016). Furthermore, adolescents born preterm with early postnatal CMV infection scored significantly lower than those without this infection regarding overall cognitive abilities (92.67 [14.71] vs 102.75 [13.67], P = .030), but not visuoperceptive abilities (91.22 [10.88] vs 98.96 [13.45], P > .05).

Conclusions

In our small but well-characterized group, our results provide evidence for adverse effects of early postnatal CMV infection on overall cognitive functions in adolescents born preterm. If confirmed, these results support the implementation of preventive measures.

Section snippets

Methods

The present work is part of an ongoing project investigating the long-term cognitive, motor, and neurobiological outcome of preterm infants with early postnatal CMV infection via breast milk. The entire sample participated in observational studies on neonatal transmission rates,14, 15 and follow-up results of parts of our sample have been previously published, with respect to neurodevelopmental outcome between 2 and 4 years,10 between 4 and 8 years,13 and between 6 and 8 years.14 The current

Results

Demographic data are shown in Table I. Preterm and TERM groups were comparable in age and attention, but sex and maternal educational level differed significantly between groups. The 2 preterm groups did not differ in any of these covariates. Only 1 subject of the PRE CMV− group showed neurologic impairment in the form of bilateral spastic cerebral palsy, with only mild motor impairment in the upper extremity. Nine participants of the preterm group had MRI changes compatible with early white

Discussion

The present study indicates that an early postnatal CMV infection in preterm infants may have long-term neuropsychological sequelae, over and above those of preterm birth itself. In accordance with the literature,24, 25, 26, 27 our adolescents born preterm had compromised general intellectual and visuospatial abilities compared with TERM. Participants with early postnatal CMV infection scored significantly below those without such an infection in tests of general intelligence and—to a lesser

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    Supported by the Deutsche Forschungsgemeinschaft (WI3630/1-1 and 1-2 [to M.W.]), and a Margarete von Wrangell Scholarship funded by the European Social Fund & Ministry of Science and the Arts, Baden-Württemberg (to K.L.). The authors declare no conflicts of interest.

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