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400014 重庆,重庆医科大学附属儿童医院,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室
[ 包蕾, E-mail: cqb10046@163.com BAO Lei, E-mail: cqb10046@163.com
收稿:2017-10-13,
修回:2018-03-10,
纸质出版:2018-05-30
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冉丽红, 包蕾. 早产儿经母乳获得性巨细胞病毒感染情况及随访观察[J]. 第三军医大学学报, 2018,40(10):939-944.
Lihong RAN, Lei BAO. Infection status and follow-up observation for acquiring cytomegalovirus infection
冉丽红, 包蕾. 早产儿经母乳获得性巨细胞病毒感染情况及随访观察[J]. 第三军医大学学报, 2018,40(10):939-944. DOI: 10.16016/j.1000-5404.201710077.
Lihong RAN, Lei BAO. Infection status and follow-up observation for acquiring cytomegalovirus infection
目的
2
探讨早产儿母亲母乳存在明确的巨细胞病毒(cytomegalovirus,CMV)感染证据时,早产儿经母乳获得性CMV感染情况及短期预后。
方法
2
收集2015年9月至2016年12月本院新生儿科住院的早产儿113例,其中37例经母乳获得性CMV感染(感染组),76例未感染(对照组)。分析CMV感染的发病率、相关临床表现及随访半年时的情况。
结果
2
新鲜母乳喂养的早产儿中有32.7%(37/113)感染CMV,其中51.4%(19/37)的感染患儿有临床表现。感染组早产儿血小板减少症、转氨酶升高、肝脾肿大及新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)的发生率高于对照组[18.9%(7/37)
vs
1.3%(1/76),29.7%(11/37)
vs
13.2%(10/76),10.8%(4/37)
vs
0.0%(0/76),27.0%(10/37)vs 9.2%(7/76),
P
<
0.05
]
。感染组中有症状患儿胎龄、出生体质量均小于无症状患儿[31.3(25.6~35.7)周
vs
33.4(31.1~36.3)周,(1.5±0.5)kg
vs
(1.9±0.3)kg,
P
<
0.05
]
。随访半年,感染组与对照组患儿体格发育、神经发育及听力损害情况差异均无统计学意义(
P
>
0.05)。
结论
2
CMV DNA阳性新鲜母乳喂养的早产儿经母乳获得性CMV感染率较高,但其短期预后较好。
Objective
2
To investigate the infection status of breast milk transmitted cytomegalovirus (CMV) and short-term prognosis among premature infants when their mothers' milk were positive to CMV.
Methods
2
A total of 113 premature infants admitted in our department from September 2015 to December 2016 were enrolled in this study. There were 37 infected infants with breast milk transmitted CMV and 76 control infants. The incidence
clinical manifestations
and short-term outcome of 6 months were analyzed.
Results
2
Postnatal CMV infection was observed in 32.7 % (37/113) of premature infants who were fed fresh breast milk. CMV infection was symptomatic in 51.4% (19/37) of the infected cases. When compared with the control infants
these infected infants had significantly higher incidence rates of thrombocytopenia
aminotransferase elevation
hepatomegaly
and neonatal necrotizing enterocolitis (NEC) [18.9% (7/37)
vs
1.3% (1/76)
29.7% (11/37)
vs
13.2% (10/76)
10.8% (4/37)
vs
0.0% (0/76)
27.0% (10
/37)
vs
9.2% (7/76)
P
<
0.05
]
and obviously shorter gestational age and lower birth weight [31.3 (25.6~35.7)
vs
33.4 (31.1~ 36.3) weeks
1.5±0.5
vs
1.9±0.3 kg
P
<
0.05
]
. During the 6 months' follow up
no statistical differences were found in growth status
neurodevelopmental outcome and hearing impairment between the 2 groups (
P
>
0.05).
Conclusion
2
The infants fed with CMV positive breast milk have higher incidence of breast milk-acquired CMV infection
but they have good short-term prognosis.
邵肖梅, 叶鸿瑁, 丘小汕.实用新生儿学[M]. 4版.北京:人民卫生出版社, 2011: 310-311.
SHAO X M, YE H M, QIU X S. Practice of neonatology[M]. 4th ed.Beijing: People's Medical Publishing House, 2011: 310-311.
LEE H, PARK H, HA E, et al . Effect of breastfeeding duration on cognitive development in infants: 3-year follow-up study[J ] . J Korean Med Sci, 2016, 31(4): 579-584. DOI: 10.3346/jkms.2016.31.4.579.
GINOVART G, GICH I, VERD S. Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre-post cohort analysis[J]. J Matern Fetal Neonatal Med, 2016, 29(23): 3790-3795. DOI: 10.3109/14767058.2016.1145648.
ZHOU J, SHUKLA VV, JOHN D, et al . Human milk feeding as a protective factor for retinopathy of prematurity: a meta-analysis[J ] . Pediatrics, 2015, 136(6): e1576-e1586. DOI: 10.1542/peds.2015-2372.
BINNS C, LEE M, LOW W Y. The long-term public health benefits of breastfeeding[J]. Asia Pac J Public Health, 2016, 28(1): 7-14. DOI: 10.1177/1010539515624964.
中华医学会儿科学分会感染消化学组.巨细胞病毒感染诊断方案.中华儿科杂志, 1999, 37(7): 441. DOI: 10.3760/j.issn: 0578-1310.1999.07.015.
The group of infectious diseases and gastroenterology, Chinese pediatric society, Chinese medical association.The diagnosis scheme of cytomegalovirus infection[J]. Chin J Pediatr, 1999, 37(7): 441. DOI: 10.3760/j.issn: 0578-1310.1999.07.015.
九市儿童体格发育调查协作组, 首都儿科研究所.2005年中国九市七岁以下儿童体格发育调查[J].中华儿科杂志, 2007, 45(8): 609-614. DOI: 10.3760/j.issn: 0578-1310.2007.08.012.
Coordinating study group of nine cities on the physical grouth and develoment of children, Capital institute of pediatrics.A national survey on growth of children under 7 years of age in nine cities off china, 2005[J].Chin J Pediatr, 2007, 45(8): 609-614. DOI: 10.3760/j.issn: 0578-1310.2007.08.012.
JOSEPHSON C D, CALIENDO A M, EASLEY K A, et al . Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study[J ] . JAMA Pediatr, 2014, 168(11): 1054-1062. DOI: 10.1001/jamapediatrics.2014.1360.
KURATH S, HALWACHS-BAUMANN G, M LLER W, et al . Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review[J ] . Clin Microbiol Infect, 2010, 16(8): 1172-1178. DOI: 10.1111/j.1469-0691.2010.03140.x.
MASCHMANN J, HAMPRECHT K, DIETZ K, et al . Cytomegalovirus infection of extremely low-birth weight infants via breast milk[J ] . Clin Infect Dis, 2001, 33(12): 1998-2003. DOI: 10.1086/324345.
MEIER J, LIENICKE U, TSCHIRCH E, et al . Human cytomegalovirus reactivation during lactation and mother-to-child transmission in preterm infants[J ] . J Clin Microbiol, 2005, 43(3): 1318-1324. DOI: 10.1128/JCM.43.3.1318-1324.2005.
JIM W T, CHIU N C, HO C S, et al . Outcome of preterm infants with postnatal cytomegalovirus infection via breast milk: a two-year prospective follow-up study[J ] . Medicine (Baltimore), 2015, 94(43): e1835. DOI: 10.1097/MD.0000000000001835.
MEHLER K, OBERTHUER A, LANG-ROTH R, et al . High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk[J ] . Neonatology, 2014, 105(1): 27-32. DOI: 10.1159/000355306.
BUXMANN H, MILJAK A, FISCHER D, et al . Incidence and clinical outcome of cytomegalovirus transmission via breast milk in preterm infants weeks[J ] . Acta Paediatr, 2009, 98(2): 270-276. DOI: 10.1111/j.1651-2227.2008.01105.x.
ALARCÓN A A, BAQUERO-ARTIGAO F. Review and guidelines on the prevention, diagnosis and treatment of post-natal cytomegalovirus infection.[J]. Anales de Pediatria, 2010(1): 52-51. DOI: 10.1016/j.anpedi.2010.05.024.
TENGSUPAKUL S, BIRGE N D, BENDEL C M, et al . Asymptomatic DNAemia heralds CMV-associated NEC: case report, review, and rationale for preemption[J ] . Pediatrics, 2 013, 132(5): e1428-e1434. DOI: 10.1542/peds.2013-0087.
YOO H S, SUNG S I, JUNG Y J, et al . Prevention of cytomegalovirus transmission via breast milk in extremely low birth weight infants[J ] . Yonsei Med J, 2015, 56(4): 998-1006. DOI: 10.3349/ymj.2015.56.4.998..
BEVOT A, HAMPRECHT K, KR GELOH-MANN I, et al . Long-term outcome in preterm children with human cytomegalovirus infection transmitted via breast milk[J ] . Acta Paediatr, 2012, 101(4): e167-e172. DOI: 10.1111/j.1651-2227.2011.02538.x.
HUANG L, XIONG F, LI J, et al . An analysis of hearing screening test results in 2291 premature infants of Chinese population[J ] . Int J Pediatr Otorhinolaryngol, 2017, 95(4): 15-19. DOI: 10.1016/j.ijporl.2017.01.027.
XIA Y F, LIU C Q, LI H X, et al . Investigation of risk factors for hearing impairment in premature infants[J ] . Chin J Contemporary Pediatr, 2013, 15(12): 1050-1053.
LANZIERI T M, DOLLARD S C, JOSEPHSON C D, et al . Breast milk-acquired cytomegalovirus infection and disease in VLBW andpremature infants[J ] . Pediatrics, 2013, 131(6): e1937-e1945. DOI: 10.1542/peds.2013-0076.
CHIAVARINI M, BRAGETTI P, SENSINI A, et al . Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk[J ] . Ital J Pediatr, 2011, 37(1): 6. DOI: 10.1186/1824-7288-37-6.
HAYASHI S, KIMURA H, OSHIRO M, et al . Transmission of cytomegalovirus via breast milk in extremely premature infants[J ] . J Perinatol, 2011, 31(6): 440-445. DOI: 10.1038/jp.2010.150..
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