High Rate of Symptomatic Cytomegalovirus Infection in Extremely Low Gestational Age Preterm Infants of 22-24 Weeks' Gestation after Transmission via Breast Milk
High Rate of Symptomatic Cytomegalovirus Infection in Extremely Low Gestational Age Preterm Infants of 22-24 Weeks' Gestation after Transmission via Breast Milk
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DOI：
10.1159/000355306
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发表时间：
2014-01-01
期刊：
影响因子：
2.5
通讯作者：
Kribs, Angela
中科院分区：
文献类型：
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作者：
Mehler, Katrin;Oberthuer, Andre;Kribs, Angela
背景：如果巨细胞病毒通过母乳传播，非常不成熟的早产儿就有出现症状或严重感染的风险。人类巨细胞病毒（HCMV）感染是否会导致长期后遗症仍存在争议。目的：我们假设通过母乳传播的有症状且严重的 HCMV 感染以非常高的比例影响极不成熟的婴儿。方法：2012年，在获得父母知情同意后，对极低出生体重婴儿进行未经处理的母乳喂养。我们回顾性分析了 2012 年出生的妊娠 22 至 24 周婴儿的 HCMV 感染数据。结果：HCMV IgG 血清阳性母亲生下 17 名婴儿。其中 11 人（65%）被诊断为有症状感染。在所有情况下，血小板减少症都是分析婴儿尿液的原因。 HCMV 感染的平均诊断时间为出生后 12 周。 5 名（45%）婴儿的唯一症状是血小板减少症，无需抗病毒治疗或血小板输注即可缓解。 6 名（55%）婴儿出现脓毒症样疾病，CRP 值轻度升高，并出现呼吸衰竭迹象。 3 名 (27%) 能够通过 CPAP 保持稳定，3 名 (27%) 必须插管和机械通气。 4 名儿童接受更昔洛韦和/或缬更昔洛韦治疗。 55% 的人在出院时未通过耳声发射和/或自动听觉脑干反应测试。结论：对于出生在生存能力边缘且患有多种先前存在问题的非常不成熟的婴儿，HCMV 感染可能会引发临床病程的严重恶化。 (C) 2013 S. Karger AG，巴塞尔
Background: Very immature preterm infants are at risk of developing symptomatic or severe infection if cytomegalovirus is transmitted via breast milk. It is still a matter of debate whether human cytomegalovirus (HCMV) infection may lead to long-term sequelae. Objectives: We hypothesized that symptomatic and severe HCMV infection transmitted via breast milk affects extremely immature infants at a very high rate. Methods: In 2012, untreated breast milk was fed to extremely low birth weight infants after parental informed consent was obtained. We retrospectively analyzed data on HCMV infection of infants born in 2012 between 22 and 24 weeks of gestation. Results: 17 infants were born to HCMV IgG-seropositive mothers. 11 (65%) of these were diagnosed with symptomatic infection. In all cases, thrombocytopenia was the reason to analyze the infant's urine. HCMV infection was diagnosed at a median time of 12 weeks after birth. In 5 (45%) infants, thrombocytopenia was the only symptom and resolved without antiviral therapy or platelet transfusion. 6 (55%) infants developed sepsis-like disease with mildly elevated CRP values and showed signs of respiratory failure. 3 (27%) were able to be stabilized on CPAP, 3 (27%) had to be intubated and mechanically ventilated. 4 children were treated with ganciclovir and/or valganciclovir. 55% failed otoacoustic emissions and/or automated auditory brain-stem response testing at discharge. Conclusions: In very immature infants born at the border of viability and suffering from multiple preexisting problems, HCMV infection may trigger a severe deterioration of the clinical course. (C) 2013 S. Karger AG, Basel