SYMPTOMATIC CONGENITAL CYTOMEGALOVIRUS-INFECTION - NEONATAL MORBIDITY AND MORTALITY
SYMPTOMATIC CONGENITAL CYTOMEGALOVIRUS-INFECTION - NEONATAL MORBIDITY AND MORTALITY
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DOI：
10.1097/00006454-199202000-00007
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发表时间：
1992-02-01
影响因子：
3.6
通讯作者：
ALFORD, CA
中科院分区：
文献类型：
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作者：
BOPPANA, SB;PASS, RF;ALFORD, CA
了解新生儿有症状的先天性巨细胞病毒（CMV）感染的自然史对于预测并发症和评估抗病毒治疗的潜在益处至关重要。为了确定疾病的病程，我们回顾了106例由研究者诊断和治疗的先天性巨细胞病毒感染新生儿的资料。70%以上的患者有瘀点、黄疸和肝脾肿大。102例新生儿中有54例（53%）出现小头畸形。丙氨酸转氨酶升高，结合性高胆红素血症和血小板减少症分别占83%，81%和77%。86%有至少两种高度提示先天性感染的表现。血小板计数在出生后第二周降至最低点，而谷丙转氨酶和直接胆红素的升高持续过了第一个月。尽管很难评估新生儿的中枢神经系统功能，但大多数新生儿都存在损伤的证据。72例有小头畸形、吸力差、嗜睡/张力低下或癫痫发作。20人中有16人（80%）出现计算机断层扫描异常，39人中有20人（56%）出现听力下降。52例患者中有24例（46%）脑脊液蛋白水平为> - 120 mg/dl，且脑脊液蛋白水平升高与神经异常和听力损失有关。足月儿和早产儿的平均住院时间分别为13天和22.4天。13名婴儿（12%）在出生后的前6周死亡。在9例尸检中，有7例弥散性巨细胞病毒感染累及多器官。我们认为新生儿先天性巨细胞病毒感染是一种多系统疾病，具有显著的发病率和死亡率。
Knowledge of the natural history of symptomatic congenital cytomegalovirus (CMV) infection in the newborn is essential in order to anticipate complications and assess the potential benefit from antiviral therapy. To define the disease course we reviewed data on 106 neonates with symptomatic congenital CMV infection diagnosed and managed by the investigators. Petechiae, jaundice and hepatosplenomegaly were each noted in 70% or more patients. Microcephaly was noted in 54 of 102 (53%) at birth. Elevated alanine aminotransferase, conjugated hyperbilirubinemia and thrombocytopenia were seen in 83, 81 and 77%, respectively. Eighty-six percent had at least two of the manifestations highly suggestive of congenital infection. Platelet count fell to its nadir during the second week of life whereas elevated alanine aminotransferase and direct bilirubin persisted past the first month. In spite of the difficulty in assessing central nervous system function in the newborn, evidence of damage was present in the majority. Seventy-two had microcephaly, poor suck, lethargy/hypotonia or seizures. Abnormal computerized tomographic scan was present in 16 of 20 (80%) and decreased hearing in 20 of 39 (56%). Cerebrospinal fluid protein was > 120 mg/dl in 24 of 52 (46%) and this elevation was associated with neurologic abnormalities as well as hearing loss. The mean length of hospital stay was 13 and 22.4 days for term and preterm infants, relatively. Thirteen infants (12%) died during the first 6 weeks of life. Disseminated CMV infection with multiorgan involvement was evident in 7 of 9 at postmortem examination. We conclude that neonates with symptomatic congenital CMV infection have a multi-system disease with significant morbidity and mortality.