CYTOMEGALOVIRUS INFECTION IN NEWBORNS AT CHILDREN'S HOSPITAL 1: TREATMENT OUTCOMES AND ASSOCIATED FACTORS
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Abstract
Background: Cytomegalovirus (CMV) is the leading cause of congenital infection, associated with high mortality and severe sequelae. Although antiviral therapy is effective, drug toxicities such as neutropenia and hepatotoxicity remain major challenges. Therefore, identifying factors associated with complications and treatment outcomes is essential to ensure safety and optimize therapeutic efficacy.
Objectives: To determine the factors associated with complications and treatment outcomes of CMV infection in neonates at Children's Hospital 1.
Methods: A case series study was conducted at Children's Hospital 1 from January 1, 2022, to March 31, 2025. The study subjects included infants diagnosed with CMV infection confirmed by urine CMV DNA testing who were treated with antiviral therapy.
Results: Among 36 CMV-infected infants treated with antiviral therapy, results showed that intravenous ganciclovir monotherapy was associated with both neutropenia (OR=17.1; P=0.022) and hepatotoxicity (OR=8.1; P=0.041). Additionally, a pre-treatment neutrophil count < 1.5×109/L was associated with a 12.6-fold increase in the risk of neutropenia (P=0.038). Regarding mortality, multivariate analysis identified petechiae (OR=7.4; P=0.032) and platelet count as significant associated factors. Specifically, platelet count demonstrated high prognostic value (AUC=0.914), with a cut-off of < 21×109/L yielding a sensitivity of 90.6% and specificity of 75.0%.
Conclusion: This study highlights the critical need for close monitoring of complete blood counts and liver enzymes during CMV treatment, particularly in patients receiving only ganciclovir or presenting with baseline neutropenia, to ensure therapeutic safety. Furthermore, markers such as petechiae and platelet count serve as valuable predictors for identifying infants at high risk of mortality due to severe systemic disease. These findings underscore the necessity for future larger-scale studies to confirm these findings.
Keywords
cytomegalovirus (CMV) infection, neonates, complication, treatment outcome.
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References
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