骆凝馨 1洪鹭洋 2黄一璜 1李淑涓 1郭欣惠 1陈绘宇 1卞一丁 3曹云2
作者信息
- 1. 复旦大学附属儿科医院新生儿科 上海,201102
- 2. 复旦大学附属儿科医院新生儿科 上海,201102||复旦大学附属儿科医院国家卫生健康委员会新生儿疾病重点实验室(复旦大学) 上海,201102
- 3. 国家呼吸医学中心,呼吸和共病全国重点实验室,国家呼吸疾病临床研究中心,中国医学科学院呼吸病学研究院,中日友好医院呼吸中心,呼吸与危重症医学科 北京,100029
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摘要
Abstract
Background The clinical manifestations of postnatal cytomegalovirus(pCMV)infection in preterm infants are diverse and often difficult to recognize,yet it may have adverse effects on the prognosis of preterm infants.Research on the clinical features and prognosis of pCMV infection in very preterm infants is currently limited.Objective To describe the dynamic changes in clinical features and discharge outcomes of pCMV infection in very preterm infants,providing evidence for the development of screening,prevention,and treatment guidelines for pCMV infection in this population.Design A retrospective nested case-control study.Methods This study included very preterm infants admitted to the NICU at Fudan University Children's Hospital from January 2019 to December 2022.The cohort was divided into two groups based on whether CMV infection occurred after the first 21 days of life:the pCMV group and the control group.After matching baseline information between the two groups using propensity score matching(1∶3),dynamic trends in clinical indicators,such as hematologic parameters and liver function,were compared.A Poisson regression model was used to compare the incidence rates of bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),and other short-term outcomes between the two groups.Main outcome measures Changes in multi-system clinical features,incidence rates of BPD and ROP.Results After propensity score matching,82 cases in the pCMV group and 246 cases in the control group were included,with no significant differences in baseline characteristics.Ten days before pCMV infection onset,platelet count(PLT)in the pCMV group began to show a decreasing trend(-10 d,P=0.004),and the PLT level remained lower than in the control group.Concurrently,the absolute lymphocyte(LY)count was persistently higher than in the control group(-3 d,P=0.018),and γ-glutamyl transferase(γ-GT)showed an increasing trend(-3dto+3d,P=0.013).The incidence of severe BPD(RR=1.586,95％CI:1.065-2.362)and ROP ≥ stage Ⅲ(RR=3.658,95％CI:1.596-8.384)were higher in the pCMV group compared to the control group.The pCMV group had a longer hospitalization duration compared to the control group(81.6 days vs 69.6 days,P＜0.001),but no significant differences were found between the two groups in terms of total duration of invasive mechanical ventilation,discharge weight Z-score,or hearing screening results before discharge.Conclusion Changes in multi-system clinical features,such as decreased PLT levels and elevatedγ-glutamyl transferase,appeared before the diagnosis of pCMV infection.pCMV infection in very preterm infants is associated with increased respiratory support,higher incidence of severe ROP,and prolonged hospitalization.关键词
早产儿/巨细胞病毒感染/支气管肺发育不良/早产儿视网膜病Key words
Premature infants/Cytomegalovirus infection/Bronchopulmonary dysplasia/Retinopathy of prematurity
