Shmueli Einat, Hadar Eran, Pardo Joseph, Attias Joseph, Amir Jacob, Bilavsky Efraim
From the *Department of Pediatrics C, Schneider Children's Medical Center, and †Department of Gynecology and Obstetrics, Rabin Medical Center, Beilinson Hospital Petah Tikva, Petah Tikva, Israel; ‡Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; §Institute of Audiology and Clinical Neurophysiology, Schneider Children's Medical Center, Petah Tikva, Israel; and ¶Department of Communication Sciences & Disorders, University of Haifa, Haifa, Israel.
Pediatr Infect Dis J. 2017 Dec;36(12):e298-e302. doi: 10.1097/INF.0000000000001725.
Congenital cytomegalovirus (cCMV) infection is an important cause of hearing loss and neurodevelopment delay. While data on vertical transmission and neonatal outcome after singleton pregnancy with cCMV are well established, only scarce reports have addressed cCMV in multiple birth pregnancies. Furthermore, no studies have yet compared the outcome after birth and long-term follow-up of children with cCMV born after a singleton versus multiple pregnancies.
Infant outcome after birth of symptomatic versus asymptomatic infection was compared for infants born with cCMV after multiple (study group) and singleton (control group) pregnancies in a 1:2 ratio.
Of 508 infants diagnosed with cCMV, 25 (4.9%) were born after a multiple pregnancy. Children in the study and control groups did not differ in terms of specific prenatal CMV investigations including amniocentesis and brain magnetic resonance imaging studies. However, prematurity rates were significantly higher in the study compared with control group (52% vs. 4%, P < 0.001). There was a higher rate of symptomatic cCMV infection in the study group than in the controls (48% vs. 14%, P < 0.001). Hearing impairment at birth was also more frequent in the study group (32% vs. 8%, P = 0.016). A long-term follow-up demonstrated that children in the study group had higher rates of neurologic sequelae (hearing impairment or neurodevelopmental delay) compared with children in the control group (20% vs. 4%, P = 0.016).
Infants with cCMV born after multiple birth pregnancies are born earlier and have a higher risk of symptomatic disease at birth and worse long-term neurologic outcome than those born after a singleton pregnancy. This important group of children warrants meticulous prenatal and postnatal care.
先天性巨细胞病毒（cCMV）感染是导致听力丧失和神经发育迟缓的重要原因。虽然关于单胎妊娠合并cCMV时垂直传播及新生儿结局的数据已很明确，但关于多胎妊娠合并cCMV的报道却很少。此外，尚无研究比较单胎和多胎妊娠后出生的cCMV感染儿童的出生后结局及长期随访情况。
以1:2的比例比较多胎妊娠（研究组）和单胎妊娠（对照组）后出生的cCMV感染婴儿出现症状性与无症状性感染后的婴儿结局。
在508例诊断为cCMV的婴儿中，25例（4.9%）为多胎妊娠后出生。研究组和对照组儿童在包括羊膜穿刺术和脑磁共振成像研究在内的特定产前CMV检查方面无差异。然而，研究组的早产率显著高于对照组（52%对4%，P<0.001）。研究组有症状性cCMV感染的发生率高于对照组（48%对14%，P<0.001）。研究组出生时听力障碍也更常见（32%对8%，P=0.016）。长期随访表明，与对照组儿童相比，研究组儿童出现神经后遗症（听力障碍或神经发育迟缓）的发生率更高（20%对4%，P=0.016）。
多胎妊娠后出生的cCMV感染婴儿比单胎妊娠后出生的婴儿出生更早，出生时出现症状性疾病的风险更高，长期神经结局更差。这一重要的儿童群体需要精心的产前和产后护理。
