Departments of Neonatology.
Child, Family, and Education Studies.
Pediatrics. 2018 Feb;141(2). doi: 10.1542/peds.2017-0635. Epub 2018 Jan 12.
To assess whether preterm infants with postnatal cytomegalovirus infection develop neurologic sequelae in early childhood.
Infants <32 weeks' gestation were prospectively screened for cytomegalovirus (CMV) at term-equivalent age. Neurodevelopment was compared between CMV-positive and CMV-negative infants by using the Griffiths Mental Development Scales (GMDS) at 16 months' corrected age (CA); the Bayley Scales of Infant and Toddler Development, Third Edition or the GMDS at 24 to 30 months' CA; and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition and Movement Assessment Battery for Children, Second Edition at 6 years of age. At 6 years old, hearing was assessed in CMV-positive children.
Neurodevelopment was assessed in 356 infants at 16 months' CA, of whom 49 (14%) were infected and 307 (86%) were noninfected. Infected infants performed significantly better on the GMDS locomotor scale. There were no differences at 24 to 30 months' CA on the Bayley Scales of Infant and Toddler Development, Third Edition or GMDS. At 6 years of age, infected children scored lower on the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, but mean scores were within normal range, reaching significance only in verbal IQ (96 [SD 17] vs 103 [SD 15] points; = .046). Multiple regression indicated no impact of CMV status but significant influence of maternal education and ethnicity on verbal IQ. No significant differences in motor development were found and none of the infected children developed sensorineural hearing loss.
In this cohort study, postnatal cytomegalovirus infection in preterm children did not have an adverse effect on neurodevelopment within the first 6 years of life.
评估患有生后巨细胞病毒感染的早产儿在幼儿期是否会出现神经后遗症。
前瞻性地在胎龄<32 周的婴儿中在足月龄时筛查巨细胞病毒(CMV)。通过在 16 个月校正年龄(CA)时使用 Griffiths 精神发育量表(GMDS);在 24 至 30 个月 CA 时使用贝利婴幼儿发育量表,第三版或 GMDS;以及在 6 岁时使用韦氏学前和小学智力量表,第三版和运动评估电池为儿童,第二版,比较 CMV 阳性和 CMV 阴性婴儿的神经发育情况。在 6 岁时,评估 CMV 阳性儿童的听力。
在 16 个月 CA 时对 356 名婴儿进行了神经发育评估,其中 49 名(14%)感染,307 名(86%)未感染。感染婴儿在 GMDS 运动量表上的表现明显更好。在婴儿和幼儿发展的贝利量表,第三版或 GMDS 上,在 24 至 30 个月 CA 时没有差异。在 6 岁时,感染儿童在韦氏学前和小学智力量表,第三版上的得分较低,但平均得分在正常范围内,仅在言语智商上达到显著性(96 [SD 17] 与 103 [SD 15] 分;=.046)。多元回归分析表明 CMV 状态无影响,但母亲教育和种族对言语智商有显著影响。未发现运动发育的显著差异,也未发现感染儿童出现感觉神经性听力损失。
在这项队列研究中,早产儿生后巨细胞病毒感染在生命的前 6 年内对神经发育没有不良影响。