Humberg Alexander, Leienbach Viola, Fortmann Mats I, Rausch Tanja K, Buxmann Horst, Müller Andreas, Herting Egbert, Härtel Christoph, Göpel Wolfgang
Department of Pediatrics, University Hospital of Schleswig Holstein, Lübeck, Germany.
Institute of Medical Biometry and Statistics, University of Lübeck, University Medical Center of Schleswig-Holstein, Campus Lübeck, Germany.
Klin Padiatr. 2018 Sep;230(5):257-262. doi: 10.1055/a-0598-4748. Epub 2018 Apr 18.
To determine the prevalence of congenital CMV infection (cCMV) in very-low-birth-weight infants (VLBWI) and to evaluate epidemiological characteristics of VLBWI with antiviral therapy (AT).
CMV-specific PCR in umbilical cord tissue was performed (n=3330). Univariate analyses and logistic regression models were used to identify associations with outcome.
22/3330 VLBWI received AT (0.66%). 4 of these (0.12%) were PCR positive, with 2 VLBWI showing pathological screening for hearing loss. VLBWI with AT and negative PCR had significantly reduced mean birth weight (BW) and higher rates of small-for-gestational-age (SGA). Clinical sepsis, bronchopulmonary dysplasia (BPD), use of reserve antibiotics (RA) and treatment for retinopathy of prematurity were significantly increased. We further observed a higher need of transfusion of red blood cells (RBC), fresh frozen plasma and platelets. Logistic regression (controlled for gender, gestational age, SGA and BW) showed associations for AT and BPD (OR 3.4 [1.2-10.1], p=0.024), RA (OR 20.4 [4.2-98.9], p≤0.001), transfusions of RBC (OR 11.9 [1.3-105.7], p=0.026) and platelets (OR 8.7 [2.9-26.4], p≤0.001).
All VLBWI with positive PCR received AT. We hypothesize from our data by assuming a postnatal aquired CMV infection in VLBWI with AT and negative PCR that VLBWI born SGA have a different risk profile.
Further prospective studies concerning postnatal transmission should take VLBWI born SGA into account and should study the impact of infection on short- and long-term complications in this supposed vulnerable group.
确定极低出生体重儿（VLBWI）先天性巨细胞病毒感染（cCMV）的患病率，并评估接受抗病毒治疗（AT）的VLBWI的流行病学特征。
对脐带组织进行巨细胞病毒特异性PCR检测（n = 3330）。采用单因素分析和逻辑回归模型确定与结局的关联。
3330例VLBWI中有22例接受了AT（0.66%）。其中4例（0.12%）PCR呈阳性，2例VLBWI出现听力损失的病理筛查结果。接受AT且PCR阴性的VLBWI平均出生体重（BW）显著降低，小于胎龄儿（SGA）发生率更高。临床败血症、支气管肺发育不良（BPD）、储备抗生素（RA）的使用以及早产儿视网膜病变的治疗显著增加。我们还进一步观察到红细胞（RBC）、新鲜冰冻血浆和血小板的输血需求更高。逻辑回归（对性别、胎龄、SGA和BW进行校正）显示AT与BPD（比值比[OR] 3.4 [1.2 - 10.1]，p = 0.024）、RA（OR 20.4 [4.2 - 98.9]，p≤0.001）、RBC输血（OR 11.9 [1.3 - 105.7]，p = 0.026）和血小板输血（OR 8.7 [2.9 - 26.4]，p≤0.001）之间存在关联。
所有PCR阳性的VLBWI均接受了AT。根据我们的数据，我们假设接受AT且PCR阴性的VLBWI存在出生后获得性巨细胞病毒感染，推测出生时为SGA的VLBWI具有不同的风险特征。
关于产后传播的进一步前瞻性研究应考虑出生时为SGA的VLBWI，并应研究感染对这一假定脆弱群体短期和长期并发症的影响。
