331 - Trends of Congenital Cytomegalovirus Infection in the United States

Poster Number: 331
Publication Number: 331.439

Marwa M. Elgendy, Cleveland Clinic Children's Hospital, cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States; Afeez Adisa, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States

Background: Congenital cytomegalovirus infection (CMV) has been associated with several morbidities and increased mortality. Prevalence of congenital CMV varied between 0.2-6.0% among newborn infants in industrial world. Many U.S. States has implemented stricter screening protocols aiming for early detection of congenital CMV.

Objective: To examine recent changes in congenital CMV diagnosis in the U.S. in all newborns and in infants < 1500 grams birth weight (BW) in response to enhanced screening protocols and to examine changes in mortality associated with congenital CMV in recent years.

Design/Methods: We examined the national inpatient sample (NIS) datasets and its pediatrics subversion (KID) for the years 2003-2018.  Congenital CMV infection was identified using the International Classification of Diseases codes version 9 (ICD9) 771.1 and ICD10 P35.1. We measured prevalence of CMV infection in each year for all newborns and repeated the measurement for infants BW < 1500g. We compared mortality in association with CMV infection over the years. We examined changes in trends using Chi square test for trends.  

Results: Weighted sample included 66,213,034 infants in which 48.6% were females, 43.1% were Caucasians, 96.7% were singleton and 1.37% were < 1500g BW. There were 10,363 infants with congenital CMV infection in the overall sample (0.156/1000 live birth). Prevalence of congenital CMV was (0.126-0.151/1000 live birth) in 2003-2006 which increased to (0.173-0.209) in 2016-2018 with statistically significance test for trend (p < 0.001). Among infants BW < 1500g, prevalence of congenital CMV was (1.74-2.13/1000 live birth) in 2003-2006 which increased to (3.13-4.21/1000 live birth) in 2016-2018 with statistically significance test for trend (p < 0.001), Fig (1): Panel A & B. Mortality among infants with congenital CMV infection declined from (4.94-7.74%) in 2003-2006 to (4.38-6.52) in 2016-2018 in the overall sample (p=0.001), Fig (1): Panel C. Similarly, mortality among infants BW < 1500g declined from (7.48-18.0%) in 2003-2006 to (11.4-13.6%) in 2016-2018 with statistically significance test for trend (p < 0.001).Conclusion(s): Diagnosis of congenital CMV infection has increased over recent years. It is not known if this phenomenon is due to actual increase in number of CMV cases or due to increased screening and improved diagnosis. Mortality due to congenital CMV has declined in overall newborns and in infants < 1500g BW.
Figure 1Panel A: Prevalence of congenital cytomegalovirus infection in the U.S.
Panel B: Prevalence of congenital CMV infection in infants < 1500g at birth.
Panel C: Mortality associated with congenital CMV Infections in infants < 1500g.