Pediatrics, UC San Diego, La Jolla, California, USA
Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
BMJ Case Rep. 2023 Jul 19;16(7):e247959. doi: 10.1136/bcr-2021-247959.
A late preterm infant with intrauterine growth restriction developed respiratory distress, tachypnoea and hypoxia after birth, requiring supplemental oxygen. Chest radiographs demonstrated persistent elevation of the right hemidiaphragm. Chest ultrasound initially demonstrated symmetrical bilateral diaphragm motion, but subsequent ultrasounds showed asymmetrical excursion with weaker movement of the right hemidiaphragm. Placental pathology demonstrated chronic infectious villitis secondary to cytomegalovirus (CMV), and subsequent CMV testing on the infant was positive. The infant was microcephalic and head imaging revealed intracranial calcifications, consistent with congenital CMV infection.CMV is the most common congenital infection and has a wide array of clinical manifestations. This report highlights the rarely described association between congenital CMV infection and respiratory distress due to underlying diaphragm dysfunction. In neonates with respiratory distress and features of congenital CMV infection, clinicians should have a high index of suspicion for diaphragm dysfunction.
一名患有宫内生长受限的晚期早产儿出生后出现呼吸窘迫、呼吸急促和缺氧，需要补充氧气。胸部 X 光片显示右膈肌持续升高。胸部超声最初显示双侧膈肌对称运动，但随后的超声显示右侧膈肌运动幅度不对称，运动较弱。胎盘病理学显示继发于巨细胞病毒（CMV）的慢性感染性绒毛膜炎，随后对婴儿进行的 CMV 检测呈阳性。婴儿头小畸形，头部成像显示颅内钙化，符合先天性 CMV 感染。CMV 是最常见的先天性感染，具有广泛的临床表现。本报告强调了先天性 CMV 感染与潜在膈肌功能障碍导致的呼吸窘迫之间罕见的关联。对于患有呼吸窘迫和先天性 CMV 感染特征的新生儿，临床医生应高度怀疑膈肌功能障碍。
