Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
J Infect Chemother. 2020 Aug;26(8):790-794. doi: 10.1016/j.jiac.2020.03.009. Epub 2020 Apr 6.
This prospective cohort study aimed to evaluate the efficacy of the universal neonatal urine screening, followed by diagnosis, workup and antiviral therapy for symptomatic congenital cytomegalovirus (CMV) infection to reduce neurological impairments and sequelae.
Neonates born in three facilities underwent the universal urine screening of PCR analyses for CMV-DNA. Neonates with symptomatic congenital CMV infection (cCMV) received oral valganciclovir (VGCV) of 32 mg/kg/day for six weeks or six months, and were evaluated for neurological outcomes including developmental quotient (DQ) and hearing function at around 18 months of corrected age.
cCMV was diagnosed in 56 (0.48%) of 11,736 neonates, consisting of 23 neonates with symptomatic and 33 with asymptomatic cCMV. The incidence of cCMV in the general perinatal medical center (0.69%) was higher than that in the primary maternity hospital (0.23%, p<0.01%). Twenty of the 23 infants with symptomatic cCMV received VGCV therapy, and 19 underwent neurological assessment. Eight neonates (42%) had severe sequelae of DQ < 70, bilateral hearing dysfunction, and/or epilepsy. Four neonates (21%) had mild sequelae of DQ 70-79 or unilateral hearing dysfunction only, and seven (37%) showed normal development without any impairment.
This study on a large scale demonstrated that a series of universal neonatal urine screening, diagnosis, workup, and VGCV therapy for neonates with symptomatic cCMV may decrease neurological impairments, because 58% of the treated infants had normal development or mild sequelae. The universal urine screening likely identifies subclinical symptomatic cCMV. Mothers with fetuses of cCMV seem to be selectively transferred to perinatal medical centers before deliveries.
本前瞻性队列研究旨在评估对有症状先天性巨细胞病毒（cCMV）感染新生儿进行普遍尿筛查、诊断、检查和抗病毒治疗的疗效，以减少神经损伤和后遗症。
在三个医疗机构出生的新生儿接受针对 CMV-DNA 的普遍尿 PCR 分析筛查。有症状先天性 CMV 感染（cCMV）的新生儿接受口服缬更昔洛韦（VGCV）32mg/kg/天，持续 6 周或 6 个月，并在大约 18 个月校正年龄时评估神经结局，包括发育商（DQ）和听力功能。
在 11736 名新生儿中诊断出 56 例（0.48%）cCMV，包括 23 例有症状和 33 例无症状 cCMV。一般围产医学中心（0.69%）的 cCMV 发生率高于初级妇产医院（0.23%，p<0.01%）。23 例有症状 cCMV 新生儿中有 20 例接受了 VGCV 治疗，19 例进行了神经评估。8 名新生儿（42%）有 DQ<70、双侧听力障碍和/或癫痫的严重后遗症。4 名新生儿（21%）有 DQ 70-79 的轻度后遗症或仅单侧听力障碍，7 名（37%）有正常发育且无任何损伤。
本大规模研究表明，对有症状 cCMV 新生儿进行一系列普遍新生儿尿筛查、诊断、检查和 VGCV 治疗可能会减少神经损伤，因为 58%的治疗婴儿有正常发育或轻度后遗症。普遍尿筛查可能会发现无症状的有症状 cCMV。有 cCMV 胎儿的母亲在分娩前似乎会选择性转到围产医学中心。
