Association of Adverse Hearing, Growth, and Discharge Age Outcomes With Postnatal Cytomegalovirus Infection in Infants With Very Low Birth Weight.
Association of Adverse Hearing, Growth, and Discharge Age Outcomes With Postnatal Cytomegalovirus Infection in Infants With Very Low Birth Weight.
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DOI：
10.1001/jamapediatrics.2019.4532
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发表时间：
2019-12
期刊：
影响因子：
26.1
通讯作者：
K. Weimer;M. Kelly;S. Permar;R. Clark;R. Greenberg
中科院分区：
文献类型：
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作者：
K. Weimer;M. Kelly;S. Permar;R. Clark;R. Greenberg
重要性 研究表明，出生后巨细胞病毒 (CMV) 感染可导致极低出生体重 (VLBW；<1500 g) 婴儿的长期发病，包括支气管肺发育不良 (BPD)、坏死性小肠结肠炎 (NEC) 和神经发育障碍。然而，迄今为止，VLBW 婴儿出生后 CMV 与听力、生长和住院时间的关系尚不清楚。目的 确定出生后感染 CMV 的 VLBW 婴儿与未感染 CMV 的婴儿相比，听力筛查失败、出生后出院年龄增加或出院时生长下降的风险，并比较出生后 CMV 感染和未感染婴儿的其他主要早产结局（包括 BPD 和 NEC）的风险。参与者 这项多中心回顾性队列研究包括来自 Pediatrix 医疗集团从 2002 年 1 月 1 日至 2016 年 12 月 31 日期间管理的 302 个新生儿重症监护病房的 VLBW 婴儿。研究人群包括出生后第 21 天住院、诊断为出生后 CMV 并在月经后 34 周后进行听力筛查结果的婴儿。数据分析时间为2017年12月11日至2019年6月14日。主要结果和措施使用倾向评分对出生后CMV感染和未感染的婴儿进行匹配。使用泊松和线性回归来检查出生后 CMV 与听力筛查失败风险、出生后出院年龄、生长、BPD 和 NEC 之间的关联。结果 共鉴定出 304 名患有产后 CMV 的婴儿，其中 273 名婴儿（89.8%；155 名男孩[56.8%]）与 273 名无产后 CMV 的婴儿（148 名男孩[54.2%]）进行匹配。 273 名患有产后 CMV 的婴儿中，有 45 名 (16.5%) 出现听力筛查失败，而 273 名没有产后 CMV 的婴儿中，有 25 名 (9.2%) 出现听力筛查失败（风险比 [RR]，1.80；95% CI，1.14 至 2.85；P = .01）。出生后 CMV 还与出生后出院年龄增加 11.89 天（95% CI，6.72 至 17.06 天；P < .001）和较低的年龄别体重 z 评分相关（-0.23；95% CI，-0.39 至 -0.07；P = .005）。分析证实，BPD 风险增加（RR，1.30；95% CI，1.17 至 1.44；P < .001），此前曾报道过 1997 年至 2012 年该队列婴儿的情况，但出生后第 21 天后 NEC 风险并未增加（RR，2.00；95% CI，0.18 至 22.06；P = .57）。结论和相关性这些数据表明，出生后巨细胞病毒感染与极低出生体重儿的听力和生长状态的持久后遗症以及长期住院有关。需要进行前瞻性研究来确定出生后巨细胞病毒感染的全部影响以及抗病毒治疗是否可以降低相关发病率。
Importance Studies suggest that postnatal cytomegalovirus (CMV) infection can lead to long-term morbidity in infants with very low birth weight (VLBW; <1500 g), including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and neurodevelopmental impairment. However, to date, the association of postnatal CMV with hearing, growth, and length of stay among VLBW infants is unknown. Objectives To determine the risk for failed hearing screen, increased postnatal age at discharge, or decreased growth at discharge in VLBW infants with postnatal CMV infection compared with CMV-uninfected infants and to compare the risk for other major outcomes of prematurity, including BPD and NEC, in infants with and without postnatal CMV infection. Participants This multicenter retrospective cohort study included VLBW infants from 302 neonatal intensive care units managed by the Pediatrix Medical Group from January 1, 2002, through December 31, 2016. Infants hospitalized on postnatal day 21 with a diagnosis of postnatal CMV and hearing screen results after a postmenstrual age of 34 weeks were included in the study population. Data were analyzed from December 11, 2017, to June 14, 2019. Main Outcomes and Measures Infants with and without postnatal CMV infection were matched using propensity scores. Poisson and linear regression were used to examine the association between postnatal CMV and the risk of failed hearing screen, postnatal age at discharge, growth, BPD, and NEC. Results A total of 304 infants with postnatal CMV were identified, and 273 of these infants (89.8%; 155 boys [56.8%]) were matched with 273 infants without postnatal CMV (148 boys [54.2%]). Hearing screen failure occurred in 45 of 273 infants (16.5%) with postnatal CMV compared with 25 of 273 infants (9.2%) without postnatal CMV (risk ratio [RR], 1.80; 95% CI, 1.14 to 2.85; P = .01). Postnatal CMV was also associated with an increased postnatal age at discharge of 11.89 days (95% CI, 6.72 to 17.06 days; P < .001) and lower weight-for-age z score (-0.23; 95% CI, -0.39 to -0.07; P = .005). Analysis confirmed an increased risk of BPD (RR, 1.30; 95% CI, 1.17 to 1.44; P < .001), previously reported on infants from this cohort from 1997 to 2012, but not an increased risk of NEC after postnatal day 21 (RR, 2.00; 95% CI, 0.18 to 22.06; P = .57). Conclusions and Relevance These data suggest that postnatal CMV infection is associated with lasting sequelae in the hearing and growth status of VLBW infants and with prolonged hospitalization. Prospective studies are needed to determine the full effects of postnatal CMV infection and whether antiviral treatment reduces the associated morbidity.