From the Department of Pediatrics, Duke University School of Medicine, Durham, NC.
Duke Medical Center Library and Archives, Durham, NC.
Pediatr Infect Dis J. 2021 Jun 1;40(6):571-581. doi: 10.1097/INF.0000000000003072.
Cytomegalovirus (CMV) is the most common viral infection seen in newborns. Although postnatally acquired CMV (pCMV) infection rarely results in serious manifestations in term infants, preterm infants can develop severe clinical illness. However, the long-term implications of pCMV infection of preterm infants are unknown. Few robust studies on long-term outcomes of pCMV infection have been performed, and those reported often present conflicting results. Our objective was to assess the long-term outcomes for low birthweight (LBW) preterm infants after pCMV infection.
A systematic review of English and non-English articles using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science was conducted. Search strategies included a mix of keywords and database-specific subject headings for CMV and LBW infants. Editorials, comments, reviews and animal-only studies were excluded. Case reports, observational, experimental and randomized controlled trials that examined pCMV in preterm or VLBW infants and long-term (>1 month) impact of pCMV were included.
pCMV infection in preterm infants is associated with increased risk for pulmonary and neurologic complications and increases length of stay. There is less evidence to suggest that pCMV is associated with necrotizing enterocolitis, ophthalmologic, audiologic and anthropomorphic complications in preterm infants.
Preterm infants with pCMV, especially those with symptomatic infection, may have long-term pulmonary and neurodevelopmental morbidity compared with their pCMV negative counterparts. Our results highlight the importance of pCMV detection and prevention in preterm infants in the neonatal intensive care unit. Large prospective studies are needed to fully define outcomes and determine if treatment improves outcomes.
巨细胞病毒（CMV）是新生儿中最常见的病毒感染。虽然新生儿期获得的 CMV（pCMV）感染在足月婴儿中很少导致严重表现，但早产儿可能会出现严重的临床疾病。然而，pCMV 感染早产儿的长期影响尚不清楚。关于 pCMV 感染早产儿的长期结局的研究很少，而且报告的研究结果往往存在矛盾。我们的目的是评估 pCMV 感染的低出生体重（LBW）早产儿的长期结局。
使用 MEDLINE、EMBASE、Cochrane 中央对照试验注册中心、CINAHL 和 Web of Science 对英文和非英文文章进行系统评价。搜索策略包括使用关键词和数据库特定主题词混合的方式来搜索 CMV 和 LBW 婴儿。排除社论、评论、综述和仅动物研究。纳入研究了 pCMV 在早产儿或极低出生体重儿中的感染以及 pCMV 对早产儿的长期（>1 个月）影响的病例报告、观察性、实验性和随机对照试验。
早产儿 pCMV 感染与肺部和神经系统并发症风险增加以及住院时间延长相关。证据表明 pCMV 与坏死性小肠结肠炎、眼科、听力和人体测量学并发症在早产儿中相关的证据较少。
与 pCMV 阴性早产儿相比，pCMV 感染的早产儿，尤其是有症状感染的早产儿，可能存在长期肺部和神经发育的发病率。我们的结果强调了在新生儿重症监护病房中检测和预防 pCMV 对早产儿的重要性。需要进行大型前瞻性研究以充分定义结局，并确定治疗是否可以改善结局。
