Audra Stewart

Urine Collection Method for the Diagnosis of Congenital Cytomegalovirus Infection.

Congenital cytomegalovirus infection is traditionally diagnosed by virus detection in saliva or urine. Virus culture was positive in significantly fewer urine samples collected using cotton balls in diapers (55.2%) than with samples collected by bags (93.2%) from newborns screened positive for CMV in saliva. However, polymerase chain reaction was positive in 95% of urine samples regardless of the collection method.

Newborn Dried Blood Spot Polymerase Chain Reaction to Identify Infants with Congenital Cytomegalovirus-Associated Sensorineural Hearing Loss

Objective To determine the utility of dried blood spot (DBS) polymerase chain reaction (PCR) in identifying infants with cytomegalovirus (CMV) infection–associated sensorineural hearing loss (SNHL). Study design Newborns at 7 US hospitals between March 2007 and March 2012 were screened for CMV by saliva rapid culture and/or PCR. Infected infants were monitored for SNHL during the first 4 years of life to determine sensitivity, specificity, and positive and negative likelihood ratios of DBS PCR for identifying CMV‐associated SNHL. Results DBS at birth was positive in 11 of 26 children (42%) with SNHL at age 4 years and in 72 of 270 children (27%) with normal hearing (P = .11). The sensitivity (42.3%; 95% CI, 23.4%‐63.1%) and specificity (73.3%; 95% CI, 67.6%‐78.5%) was low for DBS PCR in identifying children with SNHL at age 4 years. The positive and negative likelihood ratios of DBS PCR positivity to detect CMV‐associated SNHL at age 4 years were 1.6 (95% CI, 0.97‐2.6) and 0.8 (95% CI, 0.6‐1.1), respectively. There was no difference in DBS viral loads between children with SNHL and those without SNHL. Conclusions DBS PCR for CMV has low sensitivity and specificity for identifying infants with CMV‐associated hearing loss. These findings, together with previous reports, demonstrate that DBS PCR does not identify either the majority of CMV‐infected newborns or those with CMV‐associated SNHL early in life.

Ductus Arteriosus Aneurysm With Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection and Spontaneous Rupture: A Potentially Fatal Quandary

We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

Routine use of diuretics in very-low birth-weight infants in the absence of supporting evidence

Routine use of diuretics in very-low birth-weight infants in the absence of supporting evidence

Racial and Ethnic Differences in the Prevalence of Congenital Cytomegalovirus Infection

Objective To evaluate the impact of race and ethnicity upon the prevalence and clinical spectrum of congenital cytomegalovirus infection (cCMV). Study design From 2007 to 2012, 100 332 infants from 7 medical centers were screened for cCMV while in the hospital. Ethnicity and race were collected and cCMV prevalence rates were calculated. Results The overall prevalence of cCMV in the cohort was 4.5 per 1000 live births (95% CI, 4.1‐4.9). Black infants had the highest cCMV prevalence (9.5 per 1000 live births; 95% CI, 8.3‐11.0), followed by multiracial infants (7.8 per 1000 live births; 95% CI, 4.7‐12.0). Significantly lower prevalence rates were observed in non‐Hispanic white infants (2.7 per 1000 live births; 95% CI, 2.2‐3.3), Hispanic white infants (3.0 per 1000 live births; 95% CI, 2.4‐3.6), and Asian infants (1.0 per 1000 live births; 95% CI, 0.3‐2.5). After adjusting for socioeconomic status and maternal age, black infants were significantly more likely to have cCMV compared with non‐Hispanic white infants (adjusted prevalence OR, 1.9; 95% CI, 1.4‐2.5). Hispanic white infants had a slightly lower risk of having cCMV compared with non‐Hispanic white infants (adjusted prevalence OR, 0.7; 95% CI, 0.5‐1.0). However, no significant differences in symptomatic cCMV (9.6%) and sensorineural hearing loss (7.8%) were observed between the race/ethnic groups. Conclusions Significant racial and ethnic differences exist in the prevalence of cCMV, even after adjusting for socioeconomic status and maternal age. Although once infected, the newborn disease and rates of hearing loss in infants are similar with respect to race and ethnicity.

Contribution of Breastfeeding to False-Positive Saliva Polymerase Chain Reaction for Newborn Congenital Cytomegalovirus Screening

Real-time polymerase chain reaction (PCR) of saliva is highly sensitive for newborn congenital cytomegalovirus (CMV) screening. This study uses nationally published CMV seroprevalence and breastfeeding rates to estimate the contribution of CMV DNA in breast milk to false-positive saliva PCR results. The false-positive rates adjusted for breastfeeding ranged from 0.03% in white Hispanic persons to 0.14% in white non-Hispanic persons. Saliva CMV PCR for newborn screening is highly sensitive, and the low false-positive rates in this study suggest that saliva PCR results are unlikely to be significantly influenced by breastfeeding or other perinatal exposures.

997Saliva vs Urine PCR: The Ideal Sample for congenital CMV Screening and Diagnosis

Objective University of Alabama at Birmingham, Birmingham,AL1, University of Mississippi Medical Center, Jackson, MS2 Carolinas Medical Center, Charlotte, NC3, Nationwide Children’s Hospital, Columbus, OH4, Children’s Hospital of Pittsburgh, Pittsburgh, PA5, Cincinnati Children’s Medical Center, Cincinnati, OH6, Saint Peters University Hospital, New Brunswick, NJ7, University of Texas Southwestern Medical School, Dallas, TX8