Wojciechowska Dobrochna, Galli Dominika, Kowalczewska Justyna, Szczapa Tomasz, Wróblewska-Seniuk Katarzyna Ewa
II Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
Doctoral School, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
Children (Basel). 2025 Jul 8;12(7):900. doi: 10.3390/children12070900.
: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants-especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)-are at an increased risk for severe infections. These can manifest as thrombocytopenia, liver failure, sepsis-like symptoms, and, in rare cases, death. HCMV is transmitted through various human secretions, including breast milk, which is the optimal feeding method for premature infants. We present five premature neonates, born between 23 and 26 weeks of gestation, each with a distinct clinical presentation of acquired HCMV infection. All infants tested negative for congenital CMV infection via molecular urine testing within the first three weeks of life. Acquired infection was diagnosed between the second and third month of life, with symptoms such as septic shock, persistent thrombocytopenia, and signs of liver failure. Each infant received antiviral treatment along with regular viral load monitoring. Unfortunately, one patient died due to complications of prematurity. The remaining infants were discharged and continue to receive follow-up care in an outpatient clinic. These cases of postnatally acquired CMV infection aim to increase awareness of its highly heterogeneous and nonspecific clinical presentation, which may result in an incorrect, delayed, or concealed diagnosis. Currently, there are no clear guidelines on how to manage the presence of the virus in maternal breast milk, particularly for premature infants. It should be recommended to perform a molecular CMV test in all breast-fed preterm infants who present with sepsis-like symptoms, thrombocytopenia, liver failure, or other organ involvement. In case of a confirmed aCMV diagnosis, appropriate treatment should be introduced.
人巨细胞病毒（HCMV）是新生儿先天性和后天性病毒感染的主要原因。虽然后天感染通常无症状，但早产儿——尤其是那些在妊娠30周前出生或出生体重极低（<1500克）的婴儿——发生严重感染的风险增加。这些感染可能表现为血小板减少、肝功能衰竭、败血症样症状，在极少数情况下会导致死亡。HCMV通过各种人体分泌物传播，包括母乳，而母乳是早产儿的最佳喂养方式。我们介绍了5例妊娠23至26周出生的早产新生儿，每例都有后天性HCMV感染的独特临床表现。所有婴儿在出生后的前三周通过分子尿检测先天性CMV感染均为阴性。后天感染在出生后第二至第三个月被诊断出来，症状包括感染性休克、持续性血小板减少和肝功能衰竭迹象。每个婴儿都接受了抗病毒治疗并定期监测病毒载量。不幸的是，一名患者因早产并发症死亡。其余婴儿出院后继续在门诊接受随访护理。这些产后获得性CMV感染病例旨在提高对其高度异质性和非特异性临床表现的认识，这可能导致诊断错误、延迟或隐匿。目前，对于如何处理母乳中病毒的存在，特别是对于早产儿，尚无明确的指导方针。建议对所有出现败血症样症状、血小板减少、肝功能衰竭或其他器官受累的母乳喂养早产儿进行分子CMV检测。如果确诊为后天性CMV感染，应进行适当治疗。
