Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed.
Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed.
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DOI：
10.1097/qad.0000000000002856
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发表时间：
2021-05-01
期刊：
影响因子：
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通讯作者：
Davies MA
中科院分区：
文献类型：
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作者：
Anderson K;Kalk E;Madlala HP;Nyemba DC;Jacob N;Slogrove A;Smith M;Kroon M;Harrison MC;Eley BS;Boulle A;Myer L;Davies MA
暴露于艾滋病毒但未感染（HEU）的婴儿与未暴露于艾滋病毒但未感染（HUU）的婴儿相比，不良出生结局、发病率和住院的风险更高。在普及孕产妇抗逆转录病毒治疗的时代，对新生儿发病模式的具体见解很少。前瞻性群组。我们比较了2017年至2019年间出生的HEU （n=463）和HUU （n=466）婴儿与来自南非一家大型产前诊所的孕妇队列的新生儿住院情况。我们使用逻辑回归检查了与住院相关的母婴因素。新生儿HEU和HUU的住院率相似（13% vs. 16%; p=0.25）。总体而言，大多数住院直接发生在出生后（87%）；感染相关的原因占34%。与感染无关的最常见住院原因是呼吸窘迫（25%）。重度早产（<32w）（29%对11%，p=0.01）和极低出生体重（<1500 g）（34%对16%，p=0.02）在住院的HEU新生儿中更为常见。在住院患者中，HEU患儿（53%）入住重症监护病房（ICU）的风险高于HUU患儿（27%）（RR=2.1; 95% CI 1.3-3.3）。经极早产调整后，HEU新生儿进入ICU的风险仍然较高（aRR=1.8; 95% CI 1.1-2.9）。新生儿HEU（与HUU相比）没有增加全因或感染相关住院。然而，极早产、极低出生体重和ICU入院的可能性在HEU住院的新生儿中更大，这表明新生儿发病率的严重程度增加。
Infants who are HIV exposed but uninfected (HEU) compared to HIV unexposed uninfected (HUU) have increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically. Prospective cohort. We compared neonatal hospitalizations among infants who were HEU (n=463) vs HUU (n=466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression. Hospitalization rates were similar between neonates who were HEU and HUU (13% vs. 16%; p=0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32w) (29% vs. 11%; p=0.01) as well as very low birthweight (<1500 g) (34% vs. 16%; p=0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) compared to HUU (27%) (RR=2.1; 95% CI 1.3–3.3). Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR=1.8; 95% CI 1.1–2.9). Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.