Nishida Kosuke, Morioka Ichiro, Nakamachi Yuji, Kobayashi Yoko, Imanishi Takamitsu, Kawano Seiji, Iwatani Sota, Koda Tsubasa, Deguchi Masashi, Tanimura Kenji, Yamashita Daisuke, Nibu Ken-Ichi, Funakoshi Toru, Ohashi Masanobu, Inoue Naoki, Iijima Kazumoto, Yamada Hideto
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Department of Pediatrics, Kobe University Hospital, Kobe, Japan.
Brain Dev. 2016 Feb;38(2):209-16. doi: 10.1016/j.braindev.2015.08.003. Epub 2015 Aug 14.
Newborn screening for urinary cytomegalovirus (CMV) and early introduction of antiviral treatment are expected to improve neurological outcomes in symptomatic congenital CMV-infected infants. This cohort study prospectively evaluated neurological outcomes in symptomatic congenital CMV-infected infants following the introduction of hospital-based newborn urinary CMV screening and antiviral treatment.
SUBJECTS/METHODS: Following institutional review board approval and written informed consent from their parents, newborns were prospectively screened from 2009 to 2014 for urinary CMV-DNA by PCR within 1 week after birth at Kobe University Hospital and affiliated hospitals. CMV-positive newborns were further examined at Kobe University Hospital, and those diagnosed as symptomatic were treated with valganciclovir for 6 weeks plus immunoglobulin. Clinical neurological outcomes were evaluated at age ⩾12 months and categorized by the presence and severity of neurologic sequelae.
Urine samples of 6348 newborns were screened, with 32 (0.50%) positive for CMV. Of these, 16 were diagnosed with symptomatic infection and 12 received antiviral treatment. Four infants developed severe impairment (33%), three developed mild impairment (25%), and five developed normally (42%).
This is the first Japanese report of neurological assessments in infants with symptomatic congenital CMV infection who received early diagnosis and antiviral treatment. Urinary screening, resulting in early diagnosis and treatment, may yield better neurological outcomes in symptomatic congenital CMV-infected infants.
对新生儿进行尿巨细胞病毒（CMV）筛查并尽早引入抗病毒治疗有望改善有症状的先天性CMV感染婴儿的神经学预后。这项队列研究前瞻性评估了在引入基于医院的新生儿尿CMV筛查和抗病毒治疗后，有症状的先天性CMV感染婴儿的神经学预后。
受试者/方法：在获得机构审查委员会批准并征得其父母的书面知情同意后，于2009年至2014年对出生后1周内在神户大学医院及其附属医院出生的新生儿进行前瞻性PCR检测尿CMV-DNA筛查。CMV阳性的新生儿在神户大学医院进一步检查，被诊断为有症状的婴儿接受缬更昔洛韦治疗6周加免疫球蛋白治疗。在年龄≥12个月时评估临床神经学预后，并根据神经后遗症的存在和严重程度进行分类。
对6348例新生儿的尿液样本进行了筛查，其中32例（0.50%）CMV呈阳性。其中，16例被诊断为有症状感染，12例接受了抗病毒治疗。4例婴儿出现严重损害（33%），3例出现轻度损害（25%），5例发育正常（42%）。
这是日本首篇关于对有症状的先天性CMV感染婴儿进行早期诊断和抗病毒治疗后神经学评估的报告。尿液筛查可实现早期诊断和治疗，可能使有症状的先天性CMV感染婴儿获得更好的神经学预后。
