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Growth Patterns in Children With Congenital Cytomegalovirus Infection

Tagarro, Alfredo PhD*,†,‡; Del Valle, Ruth PhD*,‡; Dominguez-Rodríguez, Sara MSc*,†,‡; Baquero-Artigao, Fernando PhD§; Noguera-Julian, Antoni PhD¶,‖,**; Vives-Oñós, Isabel PhD††; Santos, Mar MD‡‡; Hawkins, María M. PhD*; Pérez-Seoane, Beatriz MD*; Medina, Gema MD*; Rojo, Pablo PhD†,§§; Frick, M. Antoniette MD¶¶; Alonso-Ojembarrena, Almudena MD‖‖; Rives, María T. MD***; Sota, Itziar MD†††; Moliner, Elisenda MD‡‡‡; Colino, Elena MD§§§; Cilleruelo, María J. PhD¶¶¶; Ramos, José Tomás PhD‖‖‖,***; Bustamante, Jorge MD§; Fortuny, Claudia PhD¶,‖,**; Cañete, Alfonso PhD*,‡; Donoso, Irene MD****; Piñeiro, María MD***; Suárez, Sergio MD****; Blázquez-Gamero, Daniel PhD†,§§,**** for Spanish Registry of Infants with Congenital Cytomegalovirus Infection (REDICCMV) Study Group

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p 1230–1235
doi: 10.1097/INF.0000000000002483
Maternal-Neonatal Reports

Background: Congenital cytomegalovirus infection (CMVc) affects 0.7%–6% of recent births. Among its clinical manifestations are low weight and length at birth.

Objective: Describe the growth patterns of children with CMVc in their early years.

Methods: Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards.

Results: Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months.

Conclusion: Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.

From the *Hospital Universitario Infanta Sofía, Grupo de Investigación en Pediatría Pediatrics, Madrid, Spain

Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Pediatric Infectious Diseases Research Group, Madrid, Spain

Medical School, Universidad Europea de Madrid, Research Group in Pediatrics

§Hospital Universitario La Paz, Pediatrics Infectious and Tropical Diseases Unit, Madrid, Spain

Malaties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d’Infeccions, Servei de Pediatria, Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain

Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain, Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain

**CIBER de Epidemiología y Salud Pública, Ciberesp, Madrid, Spain

††Hospital Quirónsalud Barcelona, Grupo Quirónsalud, Pediatrics, Barcelona, Spain

‡‡Hospital Universitario Gregorio Marañón, Pediatric Infectious Diseases Unit, Madrid, Spain

§§Hospital Universitario 12 de Octubre, Pediatric Infectious Diseases Unit, Universidad Complutense de Madrid, Madrid, Spain

¶¶Hospital Universitari Vall d’Hebron, Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Barcelona, Spain

‖‖Hospital Puerta del Mar, Neonatal Intensive Care Unit, Cádiz, Spain

***Complejo Hospitalario de Navarra, Intensive Care Unit, Navarra, Spain

†††Pediatrics Department, Hospital de Donostia, Donosti, Spain

‡‡‡Hospital de la Santa Creu i Sant Pau, Neonatology Unit, Barcelona, Spain

§§§Complejo Hospitalario Universitario Insular-Materno Infantil de Las Palmas de Gran Canaria, Pediatrics Department, Las Palmas de Gran Canaria, Spain

¶¶¶Hospital Puerta de Hierro, Pediatrics Department, Madrid, Spain

‖‖‖Pediatrics Department, Hospital Clínico San Carlos, Madrid, Spain

****Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain.

Accepted for publication August 20, 2019.

Supported by a specific Research Project of Universidad Europea de Madrid (2017/UEM19, CIPI/18/104). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. This study was funded by project PI 16/00807 and PI17/00359, from the Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and cofounded by the European Regional Development Funds. D.B. has a research grant of the Instituto de Investigación Hospital 12 de Octubre (i+12) number: AY11-2016.

The authors have no conflicts of interest to disclose.

A.T. and R.D.V. contributed equally to the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Ruth del Valle Pérez, MD, PhD, Servicio de Pediatría, Hospital Infanta Sofía, Paseo de Europa, 34. 28702, San Sebastián de los Reyes, Madrid, Spain. E-mail:

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