Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
J Reprod Immunol. 2021 Feb;143:103263. doi: 10.1016/j.jri.2020.103263. Epub 2020 Dec 16.
Infants with symptomatic congenital cytomegalovirus infection (cCMV) suffer from long-term sequelae. This study aimed at evaluating the efficacy of combining immunoglobulin (Ig) fetal therapy (FT) and neonatal therapy (NT) with antiviral drugs to improve neurological outcomes of affected infants. Women whose fetuses had symptomatic cCMV received Ig injection into the fetal peritoneal cavity and/or maternal blood as FT, while affected newborns received oral valganciclovir or intravenous ganciclovir as NT. We compared the neurological outcomes at ≥18 months old between infants receiving FT with or without NT (FT group) and those receiving NT only (NT group). From 2009-2019, 15 women whose fetuses had symptomatic cCMV received FT, while 19 newborns received NT only. In FT group, two newborns died, and two were <18 months old. Neurological outcomes of the remaining 11 infants in FT group were as follows: normal 45.5 %, mild impairments 36.4 %, and severe impairments 18.2 %. In NT group, one newborn died, one's parents refused the follow-up, one was <18 months old, and two had only chorioretinitis as symptoms. Neurological outcomes of the remaining 14 infants in NT group were as follows: normal 21.4 %, mild impairments 14.3 %, and severe impairments 64.3 %. The proportion of infants with severe impairments in FT group was significantly lower than that in NT group (18.2 % vs 64.3 %, p < 0.05). This is the first trial demonstrating that the combination of Ig FT and NT with antiviral drugs may be more effective in improving neurological outcomes of newborns with symptomatic cCMV as compared to NT only.
患有症状性先天性巨细胞病毒感染（cCMV）的婴儿会出现长期后遗症。本研究旨在评估联合免疫球蛋白（Ig）胎儿治疗（FT）和新生儿治疗（NT）与抗病毒药物对改善受影响婴儿的神经结局的疗效。胎儿有症状性 cCMV 的女性接受 Ig 注入胎儿腹腔和/或母体血液作为 FT，而受影响的新生儿接受口服缬更昔洛韦或静脉用更昔洛韦作为 NT。我们比较了接受 FT 加或不加 NT（FT 组）与仅接受 NT（NT 组）的婴儿在≥18 个月时的神经结局。2009-2019 年，15 名胎儿有症状性 cCMV 的女性接受了 FT，19 名新生儿仅接受了 NT。在 FT 组中，有 2 名新生儿死亡，2 名<18 个月。FT 组中其余 11 名婴儿的神经结局如下：正常 45.5%，轻度损伤 36.4%，重度损伤 18.2%。在 NT 组中，有 1 名新生儿死亡，1 名家长拒绝随访，1 名<18 个月，2 名仅有脉络膜视网膜炎作为症状。NT 组中其余 14 名婴儿的神经结局如下：正常 21.4%，轻度损伤 14.3%，重度损伤 64.3%。FT 组重度损伤婴儿的比例明显低于 NT 组（18.2%比 64.3%，p<0.05）。这是第一个试验，表明与仅 NT 相比，联合 Ig FT 和 NT 与抗病毒药物可能更有效地改善有症状性 cCMV 的新生儿的神经结局。
