Salomè Serena, Giannattasio Antonietta, Malesci Rita, Marciano Elio, Dolce Pasquale, Portella Giuseppe, Continisio Grazia Isabella, Di Costanzo Pasquale, Capone Eleonora, Coppola Clara, Capasso Letizia, Raimondi Francesco
Division of Neonatology, Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
Pediatric Emergency Department, AORN Santobono-Pausilipon, Naples, Italy.
Front Pediatr. 2020 May 5;8:217. doi: 10.3389/fped.2020.00217. eCollection 2020.
Cytomegalovirus (CMV) is the main cause of congenital infection in developed countries leading to deafness but the burden of sensorineural hearing loss (SNHL) in asymptomatic children remains incompletely characterized. Aim of this study was to evaluate the long-term audiological outcome in this group of patients. Consecutive neonates with congenital CMV infection were followed from 2002 to 2018. Patients were considered asymptomatic if free from any clinical and instrumental impairment at referral and underwent serial clinical exams, audiological evaluations and CMV-PCR determinations. A cohort of 258 children was analyzed and the disease onset was asymptomatic in 125 (48%) infants. Among these, we studied 102 patients with a follow-up longer than 1 year and a median observation period of 2.8 years (range: 1-10.3 years). No patient developed a stable delayed SNHL but only 14 (14%) presented a variable hearing impairment, seven of which bilateral. The unstable SNHL was mild in 12 infants and moderate in two. Patients with fluctuating SNHL had significantly higher urine viral load ( 0.002) and more often positive viremia ( 0.015) than babies with stable normal hearing. CMV infected, asymptomatic neonates have a low risk of transient SNHL later in infancy. Positive viremia and high urine viral load at onset are significant risk factors for delayed fluctuating SNHL. These data are relevant for an appropriate follow up plan of these patients.
巨细胞病毒（CMV）是发达国家先天性感染导致耳聋的主要原因，但无症状儿童感音神经性听力损失（SNHL）的负担仍未完全明确。本研究的目的是评估该组患者的长期听力学结果。对2002年至2018年连续的先天性CMV感染新生儿进行随访。如果患者在转诊时没有任何临床和仪器损伤，则被认为是无症状的，并接受系列临床检查、听力学评估和CMV-PCR测定。分析了一组258名儿童，其中125名（48%）婴儿疾病发作时无症状。在这些婴儿中，我们研究了102名随访时间超过1年且中位观察期为2.8年（范围：1 - 10.3年）的患者。没有患者出现稳定的迟发性SNHL，但只有14名（14%）出现了可变的听力障碍，其中7名是双侧的。不稳定的SNHL在12名婴儿中为轻度，在2名婴儿中为中度。与听力稳定正常的婴儿相比，SNHL波动的患者尿病毒载量显著更高（P = 0.002），病毒血症阳性的情况也更常见（P = 0.015）。CMV感染的无症状新生儿在婴儿期后期发生短暂性SNHL的风险较低。发病时病毒血症阳性和尿病毒载量高是迟发性波动性SNHL的重要危险因素。这些数据对于这些患者的适当随访计划具有重要意义。
