Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review
-
Michael M. Espiritu
,
Sean Bailey
Abstract
Background:
Due to the extremely low incidence of TORCH (toxoplasmosis, rubella, CMV, herpes simplex virus) infections, diagnostic testing of all small for gestational age (SGA) infants aimed at TORCH etiologies may incur unnecessary tests and cost.
Objective:
To determine the frequency of urine CMV PCR and total IgM testing among infants with birth weight <10% and the rate of test positivity. To evaluate the frequency of alternative etiologies of SGA in tested infants.
Methods:
Retrospective chart review of SGA infants admitted to the neonatal intensive care unit (NICU) at NYU Langone Medical Center between 2007 and 2012. Subjects were classified as being SGA with or without intrauterine growth restriction (IUGR). The IUGR subjects were then further categorized as having either symmetric or asymmetric IUGR utilizing the Fenton growth chart at birth. Initial testing for TORCH infections, which included serum total IgM, CMV PCR and head ultrasound, were reviewed and analyzed.
Results:
Three hundred and eighty-six (13%) infants from a total of 2953 NICU admissions had a birth weight ≤10th percentile. Of these, 44% were IUGR; 34% being symmetric IUGR and 10% asymmetric. A total of 32% of SGA infants had urine CMV PCR and total IgM tested with no positive results. As expected, significantly higher percentage of symmetric IUGR infants were tested compared to asymmetric IUGR and non-IUGR SGA infants, (64% vs. 47% vs. 19%) P≤0.01. However, 63% of infants with a known cause for IUGR had same testing done aimed at TORCH infections. We calculated additional charges of $64,065 that were incurred by such testing.
Conclusions:
The majority of infants in our study who received testing for urine CMV PCR and total IgM aimed at TORCH infections had one or more other known non-infectious etiologies for IUGR. Because the overall yield of such testing is extremely low, we suggest tests for possible TORCH infections may be limited to symmetric IUGR infants without other known etiologies. Improved guidelines testing for TORCH infections can result in reducing hospital charges and unnecessary studies.
Article note:
This article was selected from submitted papers on the occasion of the 39th Annual Scientific Meeting of The New York Perinatal Society, held on Monday, April 20, 2016.
Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.
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- Original articles – Fetus
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- Original articles – Newborn
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- Letter to the Editor
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Articles in the same Issue
- Frontmatter
- Review article
- The assessment of labor: a brief history
- Original articles – Obstetrics
- The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates
- Uterine artery Doppler pulsatility index at 11–38 weeks in ICSI pregnancies with egg donation
- Violence before pregnancy and the risk of violence during pregnancy
- Cancer during pregnancy – clinical characteristics, treatment outcomes and prognosis for mothers and infants
- The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes
- Serum fibrinogen levels could be an index of successful use of balloon tamponade in postpartum hemorrhage
- Impact factors on cervical dilation rates in the first stage of labor
- Feasibility and acceptability of text messaging to support antenatal healthcare in Iraqi pregnant women: a pilot study
- Clinical characteristics and outcome of twin pregnancies complicated by single intrauterine death
- Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review
- The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: a cohort study
- Original articles – Fetus
- Causes of intrauterine fetal death are changing in recent years
- Original articles – Newborn
- Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks’ gestation
- Letter to the Editor
- Exact days of gestation necessary for infants at borderline viability: reply to Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23weeks’ gestation. P. Šimják, J. Smíšek, M. Koucký, T. Lamberská, R. Plavka and Z. Hájek. J Perinat Med 2017
