CYTOMEGALOVIRUS INFECTION IN PRETERM INFANTS

大约1%的婴儿患有先天性巨细胞病毒(CMV)感染。在有症状感染的婴儿中，有些可能表现为中枢神经系统疾病(包括耳聋、部分失明、小头畸形、脑内钙化)或播散性疾病(血液系统异常、肝炎、胃肠炎)，这些症状也可能危及生命或导致严重的发病率。目前还没有针对任何一组有症状的婴儿的批准疗法，尽管那些患有中枢神经系统疾病的人可能会被提供更昔洛韦的试验，但即使是这种疗法也尚未获得批准，本身就可能产生后果。症状感染通常发生在患有原发巨细胞病毒感染的母亲所生的婴儿中。考虑到这些初次感染的妇女感染的婴儿缺乏被动获得的母体抗体，至少在一定程度上允许有症状的感染，因此婴儿早产，因此在接受高水平的被动母体抗体之前出生的情况可能是类似的。因此，如果早产儿通过接触产道或母乳中的巨细胞病毒感染，可能在出生的头几周就会出现疾病表现。该项目将招募500名早产儿，识别先天感染的婴儿，跟踪接触CMV的婴儿感染CMV，并评估感染婴儿的临床异常(包括听力损失、肺炎)和实验室异常(肝炎、血液学表现)。将评估先天性感染与围产期发病率和被动获得的母体抗体水平的相关性，以及对母乳中CMV和CMV抗体的半定量评估以及母乳喂养婴儿的出生后发病率。

Approximately 1% of all infants have congenital cytomegalovirus (CMV) infection. In symptomatically infected infants, some may have manifestations of central nervous system disease (including deafness, partial blindness, microcephaly, intracerebral calcifications) or of disseminated disease (hematologic abnormality, hepatitis, gastroenteritis) which can also be life threatening or result in serious morbidity. There are no approved therapies for either group of symptomatic infants, although those with CNS disease may be offered a trial of ganciclovir, but even this therapy is not yet approved and can have consequences in itself. Symptomatic infection usually occurs in infants born to women who have primary CMV infection. Reasoning that the lack of passively acquired maternal antibody in these infected infants of women with primary infection is at least in part permissive for symptomatic infection, the scenario in which an infant is born pre-term and therefore prior to receipt of high levels of passive maternal antibody, may be analogous. Hence if the pre-term infant is infected by exposure to CMV in the birth canal or by breastmilk, disease manifestations may be present in the first few weeks of life. The project will enroll 500 pre-term infants, identify congenitally infected infants, follow CMV exposed infants for acquisition of CMV and assess infected infants for clinical abnormalies (including hearing loss, pneumonitis) and laboratory abnormalities (hepatitis, hematologic manifestions). Correlation of congenital infection and peripartum attack rate and level of passively acquired maternal antibody will be assessed as well as semiquantitative assessment of CMV and antibody to CMV in breastmilk and postnatal attack rate in breastfed infants will be assessed.