Sequelae of acquired cytomegalovirus infection in premature and sick term infants

To assess the risk of long-term sequelae after acquired cytomegalovirus (CMV) infection in premature and sick term infants, 55 CMV infected patients were matched prospectively with 55 control patients and these matched pairs were evaluated at 3 years of age. Sensorineural hearing losses were present in four of 43 CMV infected patients (all mild-moderate) and in two of 43 controls (one severe). The incidence of neurologic sequelae was not increased in CMV infected patients with birth weight greater than 2000 gm. Among patients with birth weight less than 2001 gm, moderately abnormal EEGs were found in four (17%) of 23 CMV infected patients and in one (4%) of 23 controls, and severe handicaps occurred in four (14%) of 29 CMV infected patients and in two (7%) of 29 controls. Severe handicaps in premature infants were significantly (P less than 0.05) associated with early onset of CMV excretion (less than 8 weeks of age) and severe cardiopulmonary disease. Among the premature infants who were documented early excretors, three of 13 had severe neuromuscular impairment, four of 13 had severe handicaps (DQ less than 70, severe neuromuscular impairment, or profound loss of vision or hearing), and an additional four had DQs of 70 to 79. Among their matched control subjects, none of 13 had severe neuromuscular impairment, two of 13 had severe handicaps, and an additional two had DQs between 70 and 79. None of the premature infants who were documented late excretors (greater than or equal to 8 weeks of age) had any neurologic sequelae. The risk of neurologic sequelae and handicap may be increased in premature infants with onset of CMV excretion in the first 2 months of life.     

早产儿经母乳获得性巨细胞病毒感染:疑虑与挑战

母乳喂养是所有婴儿的最佳食物。母乳可促进早产儿免疫系统和其他未成熟器官的不断发育,明显改善其近、远期预后;但母乳可能携带病原微生物,尤其是巨细胞病毒可通过母乳喂养感染早产儿,出现一系列临床症状,并对其近、远期预后产生不利影响。本文结合国内外研究进展讨论了早产儿生后经母乳获得性巨细胞病毒感染的现状,并重点介绍了现有的临床预防处理策略。     

Sequelae associated with cerebral candidiasis in two premature infants

This study reports on two premature infants who developed cerebral candidiasis and survived. Both were found to have significant handicaps on follow-up.     

早产儿经母乳获得性巨细胞病毒感染的研究现状

母乳是早产儿最理想的食物,但母乳喂养也是早产儿生后巨细胞病毒（CMV）感染的主要途径,可造成败血症样综合征、血小板减少症、中性粒细胞减少症、黄疸、肝损伤、肺损伤等严重的临床表现。该文综述了早产儿经母乳获得性CMV 感染的临床表现、治疗措施、预后及预防方法的研究进展。     

Post-transfusion cytomegalovirus infection in premature infants weighing less than 1,500 g

The incidence of cytomegalovirus (CMV) infection among 107 low birth weight transfused infants (birth weight less than or equal to 1,500 g) admitted to an intensive care nursery over an 18 month period was evaluated. The diagnosis of CMV infection was based on specific serologic tests (presence of IgM, increased IgG by ELISA technic) and identification of the virus in the urine. During the first 8 months, the infants received untested blood and CMV disease occurred in 8 infants out of 44 (18.2%). During the following 10 months, all transfusions performed in 63 infants were supposed to be CMV negative. However, 32 infants received untested blood due to emergency, and 5 of them developed a CMV infection (15.6%). Finally, only 31 infants received CMV negative blood without any case of CMV infection. These data clearly demonstrate that, considering the severity of the CMV disease in the premature infants, transfusions should be performed with CMV negative blood products.     

Serum C-reactive protein in early diagnosis of bacterial infections in premature infants

Serum C-reactive protein (CRP) is known to be produced by full-term infants and children in many diseases causing severe inflammation. We examined the usefulness of CRP as an early indicator of bacterial infection in premature newborn infants. CRP was obtained from 100 patients enrolled in a prospective study. All babies were suspected of having bacterial infection (meningitis-septicaemia) because of complications during pregnancy and/or symptoms suggestive of infection during the perinatal period. CRP was measured with the radial immunodiffusion technique. Examinations were done daily as long as elevated serum CRP levels were found. 100% (6/6) of our patients with culture-proven bacterial infections showed elevated CRP values within 24 h after the first clinical or laboratory signs suggesting sepsis. In 52.3% (11/21) of cases most probably suffering from infection, CRP rose within 72 h after the appearance of other symptoms. Even extremely immature infants were able to react with elevated CRP concentrations. Peak values of CRP were independent of birth weight. On the other hand, only 2.7% (2/73) of babies without findings of infection had slightly elevated amounts of CRP for a short time. Thus, serum CRP levels are a helpful parameter for the early diagnosis of severe bacterial infection in premature infants.     

Case-control study of symptoms and neonatal outcome of human milk-transmitted cytomegalovirus infection in premature infants

OBJECTIVE: Preterm infants are at risk of acquiring human cytomegalovirus (CMV) infection through breast milk transmission, possibly leading to serious symptoms, as suggested by previous studies. Over a period of 8.5 years, we compared infants infected postnatally with CMV with noninfected controls to determine whether CMV infection transmitted through breast milk poses serious acute risks. STUDY DESIGN: CMV monitoring included maternal serologic testing and biweekly viral culture and polymerase chain reaction in breast milk and infant urine. Clinical and laboratory test findings were assessed retrospectively in infected infants and controls matched for gestational age during the initial hospital stay. RESULTS: Forty CMV-infected infants met the study criteria. They had lower minimal platelet and neutrophil counts and a higher frequency of C-reactive protein (CRP) elevations to 10 to 20 mg/L than their matched controls (P < or = .001). But no association of CMV infection with bronchopulmonary dysplasia, necrotizing enterocolitis, growth, or CRP elevations to > 20 mg/L was found. Cholestasis appeared in 3 infants in the CMV-infected group, but disappeared within 10 weeks. CONCLUSIONS: Neonatal symptoms related to postnatal CMV infection were transient and had no affect on neonatal outcome in these infants, in contrast with uncontrolled reports. Whether withholding or pasteurizing breast milk is warranted, however, depends on long-term outcome.