Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.
Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.
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DOI：
10.1001/jamapediatrics.2015.3785
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发表时间：
2015-12
期刊：
影响因子：
26.1
通讯作者：
Permar SR
中科院分区：
文献类型：
--
作者：
Kelly MS;Benjamin DK;Puopolo KM;Laughon MM;Clark RH;Mukhopadhyay S;Benjamin DK Jr;Smith PB;Permar SR
出生后获得性巨细胞病毒（CMV）在足月儿中通常是良性的，但在极低出生体重（VLBW）婴儿中，可引起肺炎和败血症样疾病。出生后巨细胞病毒感染是否会导致这些婴儿长期的肺部后遗症尚不清楚。探讨出生后巨细胞病毒感染与支气管肺发育不良（BPD）和VLBW婴儿死亡率之间的关系。倾向匹配回顾性队列研究。1997-2012年美国348个新生儿重症监护室。住院的极低出生体重（<1500 g）婴儿。出生后CMV感染定义为在出生当天或之后诊断为CMV或从血液、尿液、脑脊液或呼吸道分泌物中检测到CMV 21。在出生后第21天之前有CMV诊断或CMV病毒学检测的婴儿不被认为有出生后感染。我们将出生后CMV感染的婴儿与使用倾向评分进行比较的婴儿1：1匹配，并使用泊松回归来检查出生后CMV对经后36周时死亡或BPD综合风险的影响。为了描述出生后CMV感染的特征，我们提取了婴儿符合出生后CMV标准前7天至7天的临床和实验室数据。在101，111名婴儿中，328名（0.3%）患有产后CMV感染。我们匹配了一个比较婴儿303（92%）CMV感染的婴儿的606名婴儿的最后一个队列。该队列的中位胎龄和出生体重分别为25周和730 g。出生后CMV感染与经后36周时死亡或BPD（风险比[RR]：1.21，95%置信区间[CI]：1.10-1.32）和BPD（RR：1.33，95% CI：1.19-1.50）的风险增加相关。与出生后CMV感染相关的心肺状态变化包括新的血管加压药物需求（9%）、机械通气插管（15%）、新的氧气需求（28%）和死亡（1.2%）。在极低出生体重婴儿中，出生后CMV感染与BPD风险增加相关。需要进一步的研究来确定CMV预防措施在这一人群中的作用。
Postnatally acquired cytomegalovirus (CMV) is typically benign in term infants but, in very low birth weight (VLBW) infants, can cause pneumonitis and sepsis-like illness. Whether postnatal CMV infection results in long-term pulmonary sequelae in these infants is unknown. To investigate the relationship between postnatal CMV infection and bronchopulmonary dysplasia (BPD) and mortality in a large, multicenter cohort of VLBW infants. Propensity-matched retrospective cohort study. 348 neonatal intensive care units in the United States from 1997–2012. Hospitalized VLBW (<1500 g) infants. Postnatal CMV infection was defined as a diagnosis of CMV or detection of CMV from blood, urine, cerebrospinal fluid, or respiratory secretions on or after day of life 21. Infants with a CMV diagnosis or virologic detection of CMV prior to day of life 21 were not considered to have postnatal infection. We matched infants with postnatal CMV infection 1:1 to comparison infants using propensity scores, and used Poisson regression to examine the effect of postnatal CMV on the combined risk of death or BPD at 36 weeks postmenstrual age. To describe features of postnatal CMV infection, we extracted clinical and laboratory data from 7 days before until 7 days after infants met criteria for postnatal CMV. Of 101,111 infants, 328 (0.3%) had postnatal CMV infection. We matched a comparison infant to 303 (92%) CMV-infected infants for a final cohort of 606 infants. The median gestational age and birth weight of this cohort were 25 weeks and 730 g, respectively. Postnatal CMV infection was associated with an increased risk of death or BPD at 36 weeks postmenstrual age (risk ratio [RR]: 1.21, 95% confidence interval [CI]: 1.10–1.32) and BPD (RR: 1.33, 95% CI: 1.19–1.50). Changes in cardiorespiratory status associated with postnatal CMV infection included a new requirement for vasopressor medications (9%), intubation for mechanical ventilation (15%), a new oxygen requirement (28%), and death (1.2%). In VLBW infants, postnatal CMV infection was associated with increased risk of BPD. Further studies are needed to determine the role of preventative measures against CMV in this population.