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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


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1619-3997
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Volume 46, Issue 1

Issues

Utility of routine urine CMV PCR and total serum IgM testing of small for gestational age infants: a single center review

Michael M. Espiritu
  • Corresponding author
  • Department of Pediatrics, Division of Neonatology, New York University School of Medicine, 317 E 34th Street, Suite 902, New York, NY 10016, USA
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  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sean Bailey
  • Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
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/ Elena V. Wachtel
  • Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
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/ Pradeep V. Mally
  • Department of Pediatrics, Division of Neonatology, New York University School of Medicine, New York, NY 10016, USA
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Published Online: 2017-08-14 | DOI: https://doi.org/10.1515/jpm-2016-0287

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.

Keywords: Asymmetric; CMV; IgM; IUGR; SGA; symmetric; TORCH

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.

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About the article

Corresponding author: Dr. Michael M. Espiritu, MD, Department of Pediatrics, Division of Neonatology, New York University School of Medicine, 317 E 34th Street, Suite 902, New York, NY 10016, USA


Received: 2016-08-29

Accepted: 2017-07-17

Published Online: 2017-08-14

Published in Print: 2018-01-26


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.


Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 1, Pages 81–86, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0287.

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