Small but Not the Same: Small for Gestational Age (SGA) vs. Intrauterine Growth Restriction (IUGR) in Congenital Cytomegalovirus (cCMV) Infection

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ID: 327384
2026
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Abstract
Abstract Background Fetal growth in cCMV infection is often suboptimal. Newborns may be small-for-gestational-age (SGA, birth weight <10%), intrauterine growth restricted (IUGR; ponderal index <10%), or both. Knowledge of growth parameters among infants with cCMV infection may inform targeted CMV screening recommendations at birth. Objectives To assess growth characteristics among newborns with cCMV infection and compare clinical characteristics among SGA-only, IUGR-only, and combined SGA+IUGR infants with cCMV Methods From 2013 to 2025, all infants with cCMV infection were identified by referral to the NEO-ID Clinic, Nationwide Children’s Hospital (NCH), Columbus, OH as well as CMV (saliva/urine) screening at the time of admission to the 9 neonatal intensive care units in Columbus. All infants with cCMV infection underwent complete evaluation. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Growth parameters were assessed at birth for SGA and IUGR; their clinical characteristics were compared using the Chi-square test. Results During the 13 year study, 458 infants were diagnosed with cCMV infection. Of the 458, 159 (35%) infants had abnormal growth parameters at birth with 89 (19%) being only SGA, 20 (4%) only IUGR, and 50 (11%) both SGA and IUGR (p<0.001). Their clinical characteristics are shown in Table 1. The majority of infants in each group had other symptoms of CMV infection. Of infants who had hearing evaluation performed (n=430), those with abnormal growth parameters at birth were more likely to also have sensorineural hearing loss (SNHL; p=0.04; Table 1). Conclusion The majority of infants with cCMV infection (76%) had normal growth parameters at birth. SGA was more frequent than IUGR, but both SGA and IUGR were associated with other symptomatology of CMV infection including SNHL. Expanded targeted cCMV newborn screening that includes only growth abnormalities will fail to identify the majority of infants with cCMV.
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Authors Zachery Lewald, Sabastian Martinez, Traci Pifer, Concepción de Alba Romero, Sara Conroy, Chance Alvarado, Abigail Parro, Masako Shimamura, Pablo Sanchez
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag070/piag070.028
URL
https://academic.oup.com/jpids/article-pdf/15/Supplement_2/S13/70833161/piag070.028.pdf
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