极低出生体质量早产儿经母乳获得性巨细胞病毒感染临床特征及随访情况分析

Clinical features of breast milk acquired cytomegalovirus infection in preterm infants with very low birth weight and follow-up situation

目的对极低出生体质量早产儿经母乳获得性巨细胞病毒(CMV)感染的临床特征以及随访情况进行分析。方法收集2018年1月至2019年1月我院新生儿科80例极低出生体质量早产儿的临床资料,分析极低出生体质量早产儿母乳获得性巨细胞病毒感染的发病率、临床特征以及随访至早产儿半岁。结果 80例极低出生体质量早产儿中经母乳获得性巨细胞病毒感染20例,感染率为25.00%;感染组出生时体质量、出生时胎龄、母乳CMV阳性率、血小板及中性粒细胞均低于非感染组(P<0.05),而谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)水平明显高于非感染组(P<0.05);感染组早产儿中血小板减少症所占百分比均明显高于非感染组(P<0.05);多因素Logistic回归分析结果显示,出生时胎龄<28周、母乳CMV阳性可能是极低出生体质量早产儿CMV感染的危险因素(P=0.025、0.039);随访早产儿半岁时,感染组早产儿的体质量、身长均低于非感染组(P<0.05),而两组早产儿预后情况比较,差异无统计学意义(P>0.05)。结论母乳CMV阳性喂养早产儿会增加转氨酶增加、血小板与中性粒细胞减少症的发生率,早产儿出生6个月时预后较好。

Objective To analyze clinical features of breast milk acquired cytomegalovirus(CMV) infection in preterm infants with very low birth weight(VLBW) and follow-up situation. Methods The clinical data of 80 VLBW preterm infants in neonatology department of the hospital from January 2018 to January 2019 were collected. The incidence and clinical features of breast milk acquired CMV infection in VLBW preterm infants were analyzed. And they were followed up till they were half a year old. Results In 80 VLBW preterm infants, there were 20 cases with breast milk acquired CMV infection,with infection rate of 25.00%. The weight and gestational age at birth, positive rate of breast milk CMV, platelet and neutrophils in infection group were lower than those in non-infection group(P<0.05), while levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TBIL) were significantly higher than those in non-infection group(P<0.05). The proportions of preterm infants with and thrombocytopenia in infection group were significantly higher than those in non-infection group(P<0.05). The results of multivariate Logistic regression analysis showed that gestational age at birth less than 28 weeks and positive breast milk CMV may be risk factors of CMV infection in VLBW preterm infants(P=0.025, 0.039). The preterm infants were followed up till they were half a year old. The weight and length of preterm infants in infection group were lower than those in non-infection group(P<0.05). There was no significant difference in prognosis between the two groups(P>0.05). Conclusion The positive CMV breast feeding for preterm infants will increase levels of transaminase and platelet and incidence of neutropenia. Their prognosis is better when they are half a year old.