title: Urine is superior to saliva when screening for postnatal CMV infections in preterm infants.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is the most frequently contracted virus in preterm infants. Postnatal infection is mostly asymptomatic but is sometimes associated with severe disease. To diagnose an infection, urine or saliva samples can be tested for CMV-DNA by real-time polymerase chain reaction (rtPCR). Although the diagnostic accuracy of testing saliva samples has not been determined in preterm infants, saliva is widely used because it is easier to obtain than urine.
  
  
  OBJECTIVE
  To determine whether screening of saliva is equivalent to urine to detect a postnatal CMV infection in preterm infants.
  
  
  METHODS
  Between 2010 and 2013 saliva and urine samples were collected from infants admitted to the Neonatal Intensive Care Unit of the University Medical Center Utrecht and born with a gestational age (GA) below 32 weeks. Urine samples were obtained within three weeks after birth and urine and saliva samples at term equivalent age (40 weeks GA) and tested for CMV-DNA by rtPCR. Infants with a congenital CMV infection were excluded.
  
  
  RESULTS
  Of 261 preterm infants included in the study, CMV-DNA was detected in urine of 47 and in saliva of 43 children. Of 47 infants with postnatal CMV infection, CMV was detected in 42 saliva samples (sensitivity 89.4%; CI 76.9-96.5). Of 214 children without postnatal CMV infection, one saliva sample tested positive for CMV (specificity 99.5%; CI 97.4-99.9).
  
  
  CONCLUSIONS
  Screening saliva for CMV-DNA by rtPCR is inferior to urine to diagnose postnatal CMV infections in preterm infants.
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: j.gunkel@umcutrecht.nl.
authors.forename: J
authors.initials: J
authors.lastname: Gunkel
authors.affiliation: Department of Pediatric Infectious Diseases, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: T.Wolfs@umcutrecht.nl.
authors.forename: T F W
authors.initials: TF
authors.lastname: Wolfs
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: J.Nijman@umcutrecht.nl.
authors.forename: J
authors.initials: J
authors.lastname: Nijman
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: R.Schuurman-1@umcutrecht.nl.
authors.forename: R
authors.initials: R
authors.lastname: Schuurman
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Verboon-Maciolek
authors.affiliation: Department of Neonatology, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. Electronic address: L.S.deVries@umcutrecht.nl.
authors.forename: L S
authors.initials: LS
authors.lastname: de Vries
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: J.Murk@umcutrecht.nl.
authors.forename: J L
authors.initials: JL
authors.lastname: Murk
mesh_terms: D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D060888:Real-Time Polymerase Chain Reaction; D012463:Saliva / Q000821:virology*; D012680:Sensitivity and Specificity; D014556:Urine / Q000821:virology*
chemical_list: D004279:DNA, Viral
keywords: Cytomegalovirus; Postnatal infection; Premature infants; Real-time polymerase chain reaction; Saliva; Urine