Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection
Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection
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DOI：
10.1067/mpd.2001.112061
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发表时间：
2001-03-01
影响因子：
5.1
通讯作者：
Yow, MD
中科院分区：
文献类型：
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作者：
Noyola, DE;Demmler, GJ;Yow, MD
目的：确定新生儿临床、听力学和计算机断层扫描（CT）表现对有症状的先天性巨细胞病毒（CMV）感染儿童长期神经发育结局的预测能力。方法：对41例先天性巨细胞病毒感染儿童（n = 41）进行纵向队列研究，在出生时进行评估，并进行系列适龄神经发育测试。确定了出生特征作为长期预后预测因素的表现，并开发了临床和CT评分系统，并将其与智力结果相关联。结果：小头畸形是智力迟钝（100%;95% CI 84.5-100）和主要运动障碍（92.3%;95% CI 74.8-99）的最特异预测因子。CT检测到的异常是智力迟钝（100%;95% CI 82.3-100）和运动障碍（100%;95% CI 78.2-100）最敏感的预测因子。出生时头部大小与智商/发展商（IQ/DQ）呈极显著正相关（P < 0.001）。大约29%的儿童智商/DQ为90。出生时的感觉神经性听力损失与认知结果之间没有关联。然而，在随访中，感音神经性听力损失儿童（先天性和晚发性）的智商/DQ比听力正常儿童低（P = 0.006）。结论：出生时出现小头畸形是有症状的先天性巨细胞病毒感染儿童认知预后差的最具体预测因素，而头部CT和头围与体重成比例正常的儿童表现出良好的认知预后。
Objective: To determine the ability of neonatal clinical, audiologic, and computed tomography (CT) findings to predict long-term neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection.Methods: Longitudinal cohort study of children (n = 41) with symptomatic congenital CMV infection evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. The performance of birth characteristics as predictors of long-term outcome were determined, and clinical and CT scoring systems were developed and correlated with intellectual outcome.Results: Microcephaly was the most specific predictor of mental retardation (100%; 95% CI 84.5-100) and major motor disability (92.3%; 95% CI 74.8-99). An abnormality detected by CT was the most sensitive predictor for mental retardation (100%; 95% CI 82.3-100) and motor disability (100%; 95% CI 78.2-100). A highly significant (P < .001) positive correlation was found between head size at bir-th and the intelligence/developmental quotient (IQ/DQ). Approximately 29% of children had an IQ/DQ >90. There was no association between sensorineural hearing loss at birth and cognitive outcome. However, children with sensorineural hearing loss on follow-up (congenital and late-onset) had a lower IQ/DQ (P = .006) than those with normal hearing.Conclusions: The presence of microcephaly at birth was the most specific predictor of poor cognitive outcome in children with symptomatic congenital CMV infection, whereas children with normal findings on head CT and head circumference proportional to weight exhibited a good cognitive outcome.