Risk factors for poor outcome in congenital cytomegalovirus infection and neonatal herpes on the basis of a nationwide survey in Japan
Risk factors for poor outcome in congenital cytomegalovirus infection and neonatal herpes on the basis of a nationwide survey in Japan
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DOI：
10.1111/ped.12122
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发表时间：
2013-10-01
影响因子：
1.4
通讯作者：
Moriuchi, Hiroyuki
中科院分区：
文献类型：
--
作者：
Ito, Yoshinori;Kimura, Hiroshi;Moriuchi, Hiroyuki
先天性巨细胞病毒(CMV)感染和新生儿疱疹是母婴感染的主要原因，分析CMV感染和新生儿疱疹是母婴传播的重要临床问题，包括影响预后的危险因素。方法对2006-2008年间首次报告的先天性巨细胞病毒感染和新生儿疱疹进行问卷调查。丙种球蛋白均与不良预后(死亡或严重后遗症)显著相关。多因素分析显示，只有胎儿宫内发育迟缓与不良结局显著相关。听力障碍是先天性巨细胞病毒感染的主要异常之一。与常规ABR相比，自动听性脑干反应(Automatic ABR，Automatic ABR)对听力损害的检测更有价值。单因素分析显示，特定的胎儿超声或异常磁共振表现与感音神经性听力损失相关。单因素分析显示，24例新生儿疱疹患儿中，发热、癫痫发作与预后不良相关。所有患者都接受了阿昔洛韦治疗，尽管相当数量的临床重症患者(播散性或中枢神经系统疾病)接受了小剂量的阿昔洛韦(
BackgroundCongenital cytomegalovirus (CMV) infection and neonatal herpes are major mother-to-child infections, and analyses of the important clinical issues, including risk factors for prognosis, are essential.MethodsA secondary survey of congenital CMV infection and neonatal herpes was performed using questionnaires for cases reported in the primary survey between 2006 and 2008.ResultsUnivariate analysis of 71 cases of congenital CMV infection showed that intrauterine growth restriction (IUGR) or other specific findings on fetal ultrasonography (US), microcephaly, intracranial calcification, disseminated intravascular coagulation, abnormal findings on computed tomography, and the use of i.v. gammaglobulin were all significantly correlated with poor outcome (death or severe sequelae). Multivariate analysis showed that only IUGR was significantly associated with poor outcome. Hearing impairment is one of the major abnormalities associated with congenital CMV infection. Automatic auditory brainstem response (automatic ABR) appeared to be useful for detection of hearing impairment in comparison with conventional ABR. Moreover, univariate analysis showed that specific fetal US or abnormal magnetic resonance imaging findings were correlated with sensorineural hearing loss. In 24 cases of neonatal herpes, fever and seizure were correlated with poor outcome on univariate analysis. All patients received acyclovir treatment, although substantial numbers of patients in severe clinical categories (disseminated or central nervous system diseases) received a low dose of acyclovir (