母婴输血传播病毒感染及垂直传播的分子流行病学研究

目的：探讨孕产妇输血传播病毒(TTV)感染情况及其母婴传播途径。方法：采用巢式聚合酶链反应(n PCR)技术对广州市4 90例孕产妇静脉血及其新生儿脐血标本进行TTVDNA扩增,并对 8例孕产妇静脉血及新生儿脐血TTVDNA均阳性的PCR产物进行克隆和测序。结果：87例孕产妇静脉血及12例新生儿脐血检测出TTVDNA ,孕产妇TTVDNA阳性率为17.8% ,母婴垂直传播率为13.8%。TTV广州分离株核苷酸序列与日本株的同源性为85 .3%～98.2 %。结论：孕产妇TTV感染率较高,TTV可经胎盘传递给胎儿而引起感染     

产妇血清和乳汁HBV-DNA含量检测及意义

目的 探讨HBV携带产妇血清、乳汁不同HBV-DNA含量母乳喂养的安全性,以指导母乳喂养.法应用荧光定景PCR(FQ-PCR)技术对93例HBV携带产妇血清、乳汁及婴儿血标本进行HBV-DNA定量检测.婴儿分别采用母乳和人工两种喂养方式.结果 68例血清HBV-DNA阳性产妇的乳汁中HBV-DNA阳性44例(64.71%),乳汁HBV-DNA阳性率随母血HBV-DNA载量的增加而增加,且2种标本HBV-DNA含量呈正相关(r=0.684,P＜0.05);HBeAg阳性和阴性产妇乳汁HBV-DNA阳性率差异有统计学意义(P＜O.01);仅HBsAg阳性产妇婴儿,母乳喂养组和人工喂养组均未发生HBV感染.结论 血清HBV-DNA阳性产妇哺乳应结合乳汁HBV-DNA检测;乳汁HBV-DNA检测对正确指导母乳喂养有一定的实用价值.     

广州地区新生儿输血传播病毒感染状况

目的 探讨广州地区新生儿输血传播病毒（TTV）感染率及基因型。用PCR对835例正常新生儿脐血标本进行TTVDNA扩增，对9例TTVDNA阳性PCR扩增产物进行克隆和测序。结果 18例新生儿脐血检出TTVDNA，阳性率2．2％。9例被测序的TTVDNA阳性标本核苷酸序列与日本分离株的同源性为86．8％－96．7％。结论 新生儿存在先天性TTV感染。TTV广州株与日本株具有相似的基因型。     

母婴配对巨细胞病毒感染的研究

目的进一步探讨母婴之间巨细胞病毒(CMV)的感染与传播.方法对36对母婴配对的尿和16例母乳标本进行CMV分离,其中26例检测CMVIgM抗体.结果婴儿尿CMV分离阳性率为47.2%,其中1个月内、～4个月、～1岁婴儿阳性率分别为0、60.0%和33.3%,存在显著差异(χ2＝6.57,P＜0.05).母亲母乳CMV分离阳性率为75%,显著高于其尿的排毒率5.6%(χ2＝23.74,P＜0.01).在喂养方式中,纯母乳喂养儿CMV阳性率为57.7%与非纯母乳喂养儿的20%相比,差异显著(χ2＝4.12,P＜0.05).在不同病种中,婴儿肝炎综合征(婴肝)患儿CMV培养及IgM的阳性率为55%,支气管肺炎患儿CMV阳性率则高达80%,而6例其它病种患儿仅2例阳性.结论母乳是婴儿获得CMV感染的主要来源.婴肝及小婴儿肺炎以CMV感染为主.     

乙型肝炎病毒DNA定量在母婴传播中的意义

目的　探讨孕妇不同血清HBV DNA含量对HBV母婴传播的影响。方法　应用荧光定量PCR技术检测 6 9对母婴血清HBV DNA含量 (所测数据经对数转换 ) ,对孕妇不同血清HBV DNA含量进行分组。结果　孕妇HBV DNA含量为 (6 3± 1 9)拷贝 /ml,婴儿为 (4 8± 2 0 )拷贝 /ml,两者之间呈正相关 (r=0 310 ,P <0 0 1)。 6 9例婴儿中 ,45例HBV DNA定性和 (或 )HBV血清学检查异常 ,提示HBV母婴垂直传播 ,传播率为 6 5 %;HBV母婴传播率随孕妇血清HBV DNA浓度增高而增高 ;根据孕妇血清HBV DNA含量分别向下和向上累计分析 ,显示孕妇HBV DNA含量在 5 0、6 0和 7 0拷贝 /ml三个界面的上下浓度区域 ,HBV母婴传播率差异有显著性 ,其差值分别为 32 %、34 %和 2 8%。本组资料中 ,孕妇HBeAg阳性 19例 ,HBsAb阳性 17例 ,HBeAg阳性组HBV DNA[(7 6± 1 3)拷贝 /ml]明显高于阴性组 [(5 8± 1 9)拷贝 /ml],其HBV母婴传播率 (90 %)明显高于阴性组 (5 6 %) ;HBsAb阳性组HBV DNA含量 [(5 3± 1 6 )拷贝 /ml]明显低于阴性组 [(6 6± 1 9)拷贝 /ml],HBV母婴传播率 (2 9%)也明显低于阴性组 (77%)。同时 ,HBeAg阳性主要分布在HBV DNA测定值较高的孕妇中 ,HbsAb阳性主要分布在HBV DNA测定值较低的孕妇组。结论　HBV母婴传播率受孕妇血清H     

脆骨蓝巩膜综合征一例

目的 探讨巨细胞病毒(CMV)感染在婴儿痉挛发病中的作用.方法 收集整理23例婴儿痉挛患儿的临床资料,包括患儿尿CMV DNA定量、血清巨细胞病毒抗体,患儿母亲乳汁中CMVDNA定量等.结果 尿CMV DNA定量＞10~3 18例(78.3%),血清CMV-IgM抗体阳性5例(21.7%),患儿母亲乳汁中CMA-DNA定量＞10~3 4例(17.4%).结论 婴儿痉挛患儿尿CMV-DNA定量、血清CMV-IgM抗体以及患儿母亲乳汁中CMV-DNA定量阳性率高,3种CMV检测方法联合应用,检出阳性率较高,提示CMV感染可能与婴儿痉挛发病有关.     

基因乙肝疫苗与血源乙肝疫苗对阻断乙肝病毒母婴传播的作用及免疫效果比较

目的 比较基因乙肝疫苗与血源乙肝疫苗对阻断乙肝病毒母耍传播中的作用及免疫效果。方法 选择HBsAg、抗-HBe、抗-HBc阳性(小三阳)母亲的婴儿152例，随机分为基因乙肝疫苗组及血源乙肝疫苗组免疫接种，并跟踪观察两组接种疫苗的母婴阻断作用，抗-HBs阳转率和抗-HBs水平变化趋势及与母乳喂养有无相关。结果 分娩24h内婴儿HBsAg阳性携带率为7．6％，行疫苗接种后1～3岁HBsAg阳性携带率均为0％，抗-HBs水平在第1年最高，第2～3年呈稳态下降；抗-HBs阳性率逐年明显下降。母乳喂养与人工喂养婴儿抗-HBs阳转率无差异。结论 基因乙肝疫苗较血源疫苗具有更好的免疫源性和免疫持久性，且可避免血源疫苗可能携带的其他微量或未知微生物感染。小三阳母亲及婴儿无需行乙肝免疫球蛋白被动免疫，即可有效阻断量母婴传播，且可行母乳喂养。     

婴儿获得性巨细胞病毒感染与母乳喂养

巨细胞病毒(简称CMV)感染极为普遍。产时经产道接触带病毒分泌物,产后母乳排毒,母婴接触及输血等是婴儿获得性CMV感染常见的传播途径。本文用尿病毒分离对107例母乳喂养儿和86例牛乳喂养儿进行CMV感染调查,以了解获得性CMV感染与母乳喂养的关系。并随访感染者尿排毒动态、血清学改变及临床特征。调查对象及分组一、调查对象1985年2～4月在成都市三所医院出生的193例生后1周内尿CMV分离阴性、未接受输血、至1～2月龄时正常婴儿的尿作CMV分离,其母193人血作CMV补体结合抗体(CMV-CF-Ab)检测,其中107例哺乳者作乳汁CMV分离。二、分组188例母血清CMV-CF-Ab阳性婴儿按喂养方式、母乳CMV分离结果分为3组:母乳     

维生素K选择性应用在预防母乳喂养婴儿维生素K缺乏症的临床研究

目的探讨维生素K选择性应用在预防婴儿维生素K缺乏症的临床效果。方法采用胶乳凝集半定量法对90例婴儿脐血血浆异常凝血酶原(PIVKA-Ⅱ)阳性状况进行筛检。实验组(选择性维生素K1干预组)45例纯母乳喂养婴儿根据检测结果,采用不同剂量、不同疗程、不同方式的维生素K予以选择性补充;对照组(常规维生素K1干预组)45例纯母乳喂养婴儿采用一次性肌注维生素K11mg的常规方法补充。至出生后第45、90天时复查血浆PIVKA-Ⅱ浓度,观察结果。结果90例婴儿中有42例脐血PIVKA-Ⅱ呈阳性,阳性率为46·7%。实验组和对照组脐血PIV-KA-Ⅱ阳性者分别为19例、23例,阳性率分别为42·2%、51·1%(χ2=0·71,P>0·05)。干预后实验组和对照组出生45、90d时血浆PIVKA-Ⅱ阳性发生率分别降为0%、33·3%(χ2=18·00,P<0·001)和0%、15·6%(χ2=5·58,P<0·05)。经脐血筛查后选择性补充维生素K1的干预方法,明显优于常规一次性肌注维生素K1的干预方法。结论维生素K选择性应用对母乳喂养婴儿维生素K缺乏症的预防效果满意。     

乙肝病毒母—婴垂直传播的检测

我国普通人群中的乙肝病毒表面抗原携带者可高达10％或以上[1]，其中的一半来自母婴围生期经胎盘的垂直传播。为了解孕妇和出生后婴儿携带及感染乙肝病毒（HBV）的情况，本文应用ELISA和分子杂交技术检测93例母血及婴儿血（胎盘血）中的乙肝病毒DNA（HBV－DNA）及其抗原抗体，现报告如下。材料和方法一、血清来源长春市产院正常产妇（无既往病史）所生婴儿之胎盘血（简称婴儿血），同时取母血分离血清，－40℃保存备用．二、82P-HBV-DNA探针药盒由北京医科大学附属医院肝病研究室提供。按说明书操作。三、EuSA试剂盒购自上海市传…     

Mother-to-infant transmission of TT virus: prevalence, extent and mechanism of vertical transmission

OBJECTIVE: It is currently unknown which mechanisms are responsible for TT virus (TTV) infection in early childhood and whether it may be transmitted in utero from mother to infant. METHODS: The prevalence, mode and extent of maternal TTV transmission was investigated by testing blood, cord blood and breast milk samples from mother-infant pairs for the existence of the novel DNA virus. RESULTS: By means of polymerase chain reaction, TTV DNA was detected in 57 (41.3%) of 138 mothers and in 19 (13.8%) of 138 cord blood samples; therefore 33.3% of infants are likely to be infected by their mothers during the fetal period. Direct sequencing of TTV DNA from 2 mother-child pairs showed identical isolates. Follow-up sera from 3 TTV infected babies showed persistence of viremia. In blood samples from newborns older than 1 week 9 (27.3%) of 33 sera were TTV-positive. Viral sequences were also detected in 2 of 2 breast milk samples. In none of the infected subjects were biochemical or clinical signs of hepatitis observed. CONCLUSIONS: Our data prove that TT virus is efficiently transmitted transplacentally. The increase of its prevalence in the group of newborns older than 1 week suggests that it may be furthermore transmitted postnatally. Therefore in our Caucasian population, vertical transmission, particularly in utero transmission, of TTV is likely to account for a major part of TTV infection in early childhood. However, no disease activity could be established for the novel virus by this infection route.     

Quantitative detection of HCMV-DNA in saliva from infants and breast milk on real-time polymerase chain reaction

Background:  The role of breast milk in viral transmission has not been fully studied. To determine the effect of breast milk on the establishment of primary human cytomegalovirus (HCMV) infection in term infants, HCMV-DNA was measured in breast milk and infant saliva.
Methods:  The study population consisted of 48 healthy term infants and their mothers. The copy number of HCMV-DNA in the infants' saliva and mothers' milk was measured on quantitative real-time polymerase chain reaction (PCR).
Results:  HCMV-DNA was detected in both saliva and breast milk from 21 infant–mother pairs, in milk only from four pairs, in saliva only from 12 pairs, and in neither from 11 pairs. HCMV-DNA was first detected in the saliva of 10 infants at age 4 months, seven infants at 7 months, 13 infants at 10 months, and three infants at 12 months. The viral loads peaked 4–10 months after birth, and thereafter decreased or became negative. The peak copy number and rate of HCMV-DNA detection in saliva were significantly related to peak copy number and rate of detection in the corresponding breast milk.
Conclusion:  Thus, HCMV passed through breast milk 1–7 months after delivery affects the persistence and level of HCMV-DNA in infant saliva and is the most important route of primary infection.     

Breast milk feeding in very low birthweight infants

ABSTRACT. The infant feeding practices of 77 very low birthweight (VLBW) survivors with birthweights under 1500 g were studied. 58 (75%) infants received fresh expressed breast milk (EBM) from their own mothers, of whom 42 were successfully breastfed at a medium postconceptual age of 36 weeks. Overall incidence of breastfeeding in the VLBW population was 44% at 3 months and 23% at 6 months. The postnatal ages at which breastfeeding stopped ranged from 2 months to 28 months (median 4 months). No significant differences in perinatal factors were found between the breast milk and milk formula groups. There were significantly more mothers in the breast milk group who were given advice and encouragement during their pregnancy on breastfeeding and who had planned in the antenatal period to breastfeed their infants. The most common reasons given for deciding against providing breast milk were related to extreme prematurity of the infant. Nursery weight gain of infants fed breast milk and milk formula were similar. Necrotizing enterocolitis occurred significantly less frequently in the breast milk group. The study suggested that the special attention and positve encouragement given to parents of VLBW infants had contributed to the successful establishment and continuation of a feeding regime utilizing fresh breast milk from the infant's own mother, which we believe has immunological, psychological and nutritional benefits in this high-risk infant population.     

Trends in breastfeeding: it is not only at the breast anymore

The past characterisations of breastfeeding as being only at the breast of the mother may no longer be applicable in the United States as mothers now frequently express their milk. We conducted a retrospective cohort study with women who visited the Cincinnati Children's Breastfeeding Medicine Clinic to understand breast milk feeding behaviours of healthy mothers and infants, which included questions specifically about breast milk expression. All 40 mothers in the cohort expressed their milk and all 40 infants were fed expressed milk. One infant was fed another mother's milk for 30 days. Two‐thirds (13/40) of infants received their mother's expressed milk at least a week after it was first expressed and 25% (10/40) of infants continued to be fed expressed breast milk after mothers had stopped expressing milk. There were 14 sequences of breast milk production by the mothers and 16 sequences of consumption by the infants. Early in the post‐partum period, mothers started expressing milk even though their infants were consuming all of the breast milk that they needed at the breast. As a result of breast milk expression by all mothers in this cohort, we observed highly variable patterns of maternal breast milk production and infant breast milk consumption, which were not necessarily synchronous within a dyad. It is now time to develop appropriate ways to characterise the production and consumption of breast milk more accurately and investigate whether these behaviours have consequences for the health of mothers and infants.     

Transfer of tuberculin immunity from mother to infant

The purpose of our study was to investigate transfer of tuberculin immunity from mother to infant via breast milk by studying newborn lymphocyte blastogenesis induced by purified protein derivative antigen at 1-5 days of age, 4-6 wk of age, and 3 months of age. Our study consisted of four mother-infant groups: breast-feeding and bottle-feeding infants of tuberculin-positive and tuberculin-negative mothers. A difference in the groups was found only at 4-6 wk of age where 17% (4/23) of breast-feeding infants and 13% (2/15) of bottle-feeding infants of tuberculin positive mothers had lymphocyte blastogenesis to purified protein derivative. None of the infants of tuberculin negative mothers had purified protein derivative-induced blastogenesis. Analysis of covariance with tests for equality of slopes showed that the responses of tuberculin-positive mothers were significantly different from the responses of tuberculin-negative mothers (p less than 0.05). These studies suggest transplacental transfer of tuberculin immunity evident at 4-6 wk of age which wanes by 3 months of age. We could not find evidence of transfer via human milk.     

Early acquisition of cytomegalovirus infection.

Two hundred and fifty three infants were screened for cytomegalovirus (CMV) in the urine at birth and were followed up at regular intervals for one year. Twelve per cent (of 249) were excreting virus at 3 months, and 20% (of 234) at 12 months. In all cases infection was subclinical. The major factors determining risk of acquiring infection were the mother''s serological state and whether the infant was breast fed. There was no association with social class, mother''s age, or whether the child had been in a special care baby unit or a postnatal ward. By one year 33% (of 123) of infants of seropositive mothers had acquired CMV infection compared with 4% (of 123) born to seronegative mothers. Twenty per cent (17) of seropositive women who breast fed had virus isolated from their breast milk on at least one occasion, and 76% (13) of their infants became infected. In four mother-infant pairs comparison of CMV isolates from the mother''s milk and the child''s urine was made by restriction endonuclease digestion; in each pair infection had apparently occurred with the same strain of virus. All 13 infected infants followed up for three years were still shedding virus. Infection with CMV is common in infancy, and virus shedding persists for years. Congenital infection cannot be distinguished from acquired infection unless the presence of CMV in the urine is identified within three or four weeks after birth, even when clinical problems suggestive of congenital infection are present.     

婴儿血液、尿液及母乳中病毒DNA检测在诊断人巨细胞病毒感染中的应用

目的 定量检测疑似人巨细胞病毒(HCMV)感染婴儿血液、尿液及对应母亲乳汁中的HCMV-DNA,评估三者在不同年龄组内辅助诊断HCMV感染的意义。方法 选取170例疑似HCMV感染婴儿,根据年龄分为两组:新生儿组(< 28 d, n=43)和28 d~5个月组(n=127),分别收集血液、尿液及母乳,应用荧光定量聚合酶链式反应法(FQ-PCR)检测HCMV-DNA。结果 新生儿组血液、尿液及母乳HCMV-DNA阳性检出率分别为65.1%、18.6%和93.0%,28 d~5个月组三者检出率分别为64.6%、92.9%和72.4%,28 d~5个月组尿液检出率显著高于新生儿组(P<0.01),而母乳检出率却显著低于新生儿组(P<0.01)。82例血液和尿液HCMV-DNA为阳性的患儿,其尿液HCMV-DNA拷贝数明显高于血液。结论 不同年龄组尿液及母乳中HCMV-DNA检出率不同,根据年龄选择合适的送检标本对提高检出率具有重要意义。     

Transmission of cytomegalovirus from mothers to preterm infants by breast milk

OBJECTIVES: To assess the risk of transmission of cytomegalovirus (CMV) by breast milk from CMV-seropositive mothers to their breast-fed preterm infants and to evaluate their outcome. PATIENTS AND METHODS: The study population comprised breast-fed preterm infants with a birth weight of <1,500 g and gestational age of <35 weeks. Venous blood samples from the mothers and infants were tested for CMV IgG and IgM antibodies on the 5th and 30th day after birth. Breast milk was obtained for CMV DNA detection by polymerase chain reaction and viral culture on the 5th day and on the 3rd, 6th and 12th week. Urine samples of the babies were collected at the same time for CMV culture. Neurodevelopmental assessment was done at 6 months of age, corrected for preterm birth. RESULTS: Thirty-eight mothers and 42 infants (including 4 sets of twins) were enrolled in the study. A mother-infant pair was excluded because of inadequate breast milk collection. Thirty-six mothers (97.3%) were CMV-seropositive. CMV DNA of breast milk was detected in 35 seropositive mothers. Six infants of 5 mothers were infected (infected group) at a mean of 77 days after birth, and 34 infants of 31 mothers were not (noninfected group). In all the mothers of the infected group, CMV virus could be cultured from the milk whey. The average maternal CMV IgG on day 5 after delivery was higher in the infected than in the noninfected group. Sepsis-like symptoms and hyperbilirubinemia were more frequently noted in the infected infants than in the noninfected, but the difference was not statistically significant. Neurodevelopmental outcome did not significantly differ between the 2 groups. CONCLUSIONS: The risk of CMV infection in breast-fed premature infants was highest when the mothers shed viable virus in their breast milk. These mothers had high CMV IgG, which may help identify those mother-infant pairs at risk. Inactivation of the virus in milk by freezing may be a way of reducing the transmission of this virus via breast milk.     

Breast-feeding in Bangkok, Thailand: Current status, maternal knowledge, attitude and social support

BACKGROUND: The promotion of breast-feeding is one of the essential interventions for reduction of infant mortality and improving infant development worldwide. The aim of the present study was to examine the current status of infant feeding and the influences of suspected family sociodemographic characteristics and social support as well as maternal knowledge, attitudes and behaviours in infant feeding since the Baby-Friendly Hospital Initiative was launched in Thailand. METHODS: A total of 221 mother-infant pairs were randomly drawn from six health care centers in Bangkok from 20 April to 1 May 1998. Health care staff, using a structured questionnaire, interviewed the mothers in the health care centers. RESULTS: Most sampled mothers believed that breast milk was the best food for their infants and knew that breast milk had many advantages for infants, mothers and families. Ninety-five percent of mothers breast-fed their infants up to 3 months postpartum, but the prevalence of exclusive breast-feeding was relatively low (62.4%). Multiple logistic regression analyses revealed that the following factors independently increased the risk of mixed or formula feeding during the first 3 months of life: (i) mothers with a full-time job; (ii) grandmothers and other people as the main child caretakers; (iii) mothers who did not have an antenatal plan of exclusive breast-feeding; and (iv) newborns' non-exclusive breast-feeding in hospitals after birth. However, the mother being a housewife, mother as the main child caretaker, an antenatal plan of exclusive breast-feeding and exclusive breast-feeding in hospital were more likely to improve exclusive breast-feeding. CONCLUSION: The prevalence of exclusive breast-feeding was relatively low. Antenatal plans for exclusive breast-feeding and newborn feeding type in hospital after birth may play key roles in the duration of exclusive breast-feeding. These findings suggest the importance of strengthening implementation of the Baby-Friendly Hospital policy and prenatal health education regarding breast-feeding.