巨细胞病毒感染极低出生体重儿的发生率和影响。
Incidence and impact of CMV infection in very low birth weight infants.
机构信息
Divisions of Neonatology, and.
出版信息
Pediatrics. 2014 Mar;133(3):e609-15. doi: 10.1542/peds.2013-2217. Epub 2014 Feb 2.
BACKGROUND AND OBJECTIVES
Congenital cytomegalovirus (CMV) is the leading cause of nongenetic deafness in children in the United States and can cause neurodevelopmental impairment in term infants. Limited data exist regarding congenital CMV infections in preterm infants. We aimed to determine the incidence and association with outcomes of congenital CMV in very low birth weight (VLBW) preterm infants.
METHODS
VLBW infants born in 1993 to 2008 and admitted to the University of Alabama in Birmingham Regional Neonatal ICU were screened on admission for congenital CMV. CMV status and clinical outcomes were identified by using internal patient databases and hospital-based medical records. The primary outcome was death. Secondary outcomes included evidence of neurologic injury in the form of abnormal cranial ultrasound findings, sensorineural hearing loss, or abnormal motor development. Multivariate analysis was performed.
RESULTS
Eighteen of 4594 VLBW infants had congenital CMV (0.39%; 95% confidence interval, 0.25%-0.62%). An additional 16 infants (0.35%; 95% confidence interval, 0.21%-0.57%) were identified who acquired CMV postnatally. Congenital CMV was not associated with death. Compared with controls, congenitally infected VLBW infants were more likely to have hearing loss at initial screening (67% vs. 9%, P < .0001) and confirmed at follow-up (83% vs. 2.1%, P < .0001). Congenital CMV was also associated with abnormal neuroimaging (72% vs. 25%, P < .0001) and adverse developmental motor outcomes (43% vs. 9%, P = .02). Acquired CMV was not associated with any adverse outcomes.
CONCLUSIONS
Congenital CMV in VLBW infants is associated with high rates of neurologic injury and hearing loss but not death.
背景和目的
先天性巨细胞病毒（cytomegalovirus，CMV）是美国儿童非遗传性耳聋的主要原因，并且可导致足月婴儿的神经发育障碍。关于早产儿先天性 CMV 感染的数据有限。我们旨在确定极低出生体重（very low birth weight，VLBW）早产儿中先天性 CMV 感染的发生率及其与结局的关系。
方法
1993 年至 2008 年在阿拉巴马大学伯明翰分校地区新生儿重症监护病房出生并入院的 VLBW 婴儿在入院时接受先天性 CMV 筛查。通过内部患者数据库和医院病历确定 CMV 状态和临床结局。主要结局为死亡。次要结局包括异常头颅超声发现、感觉神经性听力损失或运动发育异常等神经损伤证据。进行了多变量分析。
结果
4594 例 VLBW 婴儿中有 18 例（0.39%；95%置信区间，0.25%-0.62%）患有先天性 CMV。另外还有 16 例（0.35%；95%置信区间，0.21%-0.57%）婴儿在出生后获得了 CMV。先天性 CMV 与死亡无关。与对照组相比，先天性感染的 VLBW 婴儿在初次筛查时更有可能出现听力损失（67%比 9%，P<0.0001），在随访时也更有可能出现听力损失（83%比 2.1%，P<0.0001）。先天性 CMV 还与异常神经影像学（72%比 25%，P<0.0001）和不良发育运动结局（43%比 9%，P=0.02）相关。获得性 CMV 与任何不良结局均无关。
结论
VLBW 婴儿的先天性 CMV 与较高的神经损伤和听力损失发生率相关，但与死亡率无关。
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