Álvarez Domínguez E, Figueras Aloy J, Botet Mussons F, Marcos Maeso M A, Pérez Fernández J M
Servicio de Neonatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
An Pediatr (Barc). 2013 Jul;79(1):3-9. doi: 10.1016/j.anpedi.2012.09.018. Epub 2012 Nov 24.
Cytomegalovirus (CMV) is the most common congenital and acquired vertically transmitted viral infection in humans. The aim of the study is to determine the clinical relevance of this infection in very low birth weight (VLBW) infants in our area.
Preterm infants (gestational age ≤ 31 weeks) with a birth weight ≤ 1500g treated between March 2006 and December 2010 were included. They underwent the screening protocol for diagnosing CMV infection. CMV serology was performed on the mothers. When it was positive, their breast milk was frozen at -20°C for 72hours from the 7th day of birth. At 5 weeks, the urine of the newborn was tested for CMV-DNA. In case of a positive result, CMV-DNA was performed in breast milk and in the dry blood sample from metabolic screening.
A total of 342 preterm infants were studied, with 53 (15.5%) infected by CMV: 8 (2.3%) with congenital infection, 35 (10.2%) with acquired infection, and 10 (2.9%) in which it was impossible to determine precisely. IgM-CMV+in the mother was found in two congenital infections and two acquired infections. Newborns affected by congenital CMV infection showed a lower birth weight, more intrauterine growth restriction, thrombopenia, need for platelet transfusions, early sepsis (including clinical sepsis), and cerebral ultrasound anomalies. Late sepsis was more frequent in cases of acquired CMV infection.
Congenital or acquired CMV infections are frequent in VLBW infants, and our protocol enables them to be diagnosed and probably prevents some acquired CMV infections by selecting which patients should freeze the breast milk.
巨细胞病毒（CMV）是人类最常见的先天性和后天性垂直传播病毒感染。本研究的目的是确定该感染在我们地区极低出生体重（VLBW）婴儿中的临床相关性。
纳入2006年3月至2010年12月期间治疗的出生体重≤1500g、孕周≤31周的早产儿。他们接受了诊断CMV感染的筛查方案。对母亲进行CMV血清学检测。当结果为阳性时，从出生第7天起将其母乳在-20°C冷冻72小时。在5周时，检测新生儿尿液中的CMV-DNA。如果结果为阳性，则对母乳和代谢筛查的干血样本进行CMV-DNA检测。
共研究了342例早产儿，其中53例（15.5%）感染CMV：8例（2.3%）为先天性感染，35例（10.2%）为后天性感染，10例（2.9%）无法精确确定。在2例先天性感染和2例后天性感染中发现母亲IgM-CMV呈阳性。受先天性CMV感染的新生儿出生体重较低，宫内生长受限、血小板减少、需要输注血小板、早期败血症（包括临床败血症）和脑超声异常更为常见。后天性CMV感染病例中晚期败血症更为频繁。
先天性或后天性CMV感染在VLBW婴儿中很常见，我们的方案能够对其进行诊断，并且通过选择哪些患者应冷冻母乳，可能预防一些后天性CMV感染。
