No transfusion‐transmitted cytomegalovirus infections in neonates receiving leukoreduced‐only blood products

BACKGROUND: Preterm, very low birth weight (VLBW) neonates have worse outcomes from cytomegalovirus (CMV) infection, which can be transfusion-transmitted (TT-CMV). Mitigation strategies include leukoreduction (LR) and using CMV seronegative donors, which are costly and logistically challenging. We aim to characterize the risk of TT-CMV using the LR-only strategy. STUDY DESIGN AND METHODS: This is a retrospective review of all VLBW preterm neonates treated over a 50-month period at Vanderbilt University Medical Center. Patients were characterized by CMV status and grouped by blood products received. CMV infection was classified as congenital and excluded, or postnatal, of which potential exposures were identified. Odds ratios (OR) for postnatal infection were calculated and a Firth penalized logistic regression was performed. RESULTS: Nine hundred and sixty-three patients were included, of whom seven were excluded for congenital CMV. Among the remainder, 333 received red blood cells (RBCs), 16 received platelets, and 132 received both. There were no cases of postnatal CMV in the non-transfused or platelet-only groups, two cases in the RBC-only group (OR 7.2, 95% confidence interval (CI) 0.3-149.8; p = .20), and three cases in the platelet and RBC group (OR 25.7, 95% CI 1.3-500.8; p = .03). Accounting for birth weight and gestational age eliminated the association between transfusion and postnatal CMV (OR 2.8, 95% CI 0.2-450.3; p = .53). DISCUSSION: There were no demonstrable cases of TT-CMV in 481 preterm, VLBW infants who received leukoreduced-only blood products. In five cases of postnatal CMV, alternative sources of exposure were present. dLR-only is a safe TT-CMV mitigation strategy and is more logistically manageable than alternatives.