母乳喂养对极早产儿获得性巨细胞病毒感染的影响

Effects of breast feeding on postnatal cytomegalovirus infections in very premature infants

目的观察母乳喂养极早产儿生后获得性巨细胞病毒(pCMV)感染发生情况,探讨母乳喂养与pCMV感染之间的关系。方法选取2020年6月至2021年6月在该院新生儿重症监护室住院的出生体重<1500 g的极早产儿(胎龄<32周)及其母亲进行回顾性队列研究。极早产儿给予亲母母乳喂养,收集胎龄、出生体重、分娩方式、性别等一般资料,记录母乳喂养量、母乳中巨细胞病毒(CMV)载量和母乳喂养时间,以及临床症状、实验室检查结果和脑干听性诱发电位(aABR)未通过率。结果共纳入77对极早产儿及其母亲,其中血清CMV-IgG阳性母亲64例,CMV-IgG阳性率为83.1%;在血清CMV-IgG阳性母亲分娩的极早产儿中,19例发生pCMV感染,感染率为29.7%,其中3例发生败血症样综合征(SLS)。pCMV感染组极早产儿接受的最大CMV载量明显高于非pCMV感染组[64334(40578~89711)copies/mL vs.23168(4902~53629)copies/mL,P=0.02],且新鲜母乳喂养占比也更高。pCMV感染组极早产儿aABR未通过率明显高于非pCMV感染组(P=0.037),但两组C反应蛋白(CRP)升高、血小板减少症、中性粒细胞减少、胆汁淤积症、肺炎发生率无明显差异(P>0.05)。结论母乳中高CMV载量和高新鲜母乳喂养比可增加极早产儿pCMV感染风险,且pCMV感染极早产儿更易发生SLS和听力损伤。

Objective To observe the incidence of postnatal cytomegalovirus(pCMV)infection in very premature infants fed with breast milk,and to explore the relationship between breast feeding and pCMV infection.Methods A retrospective cohort study was conducted on very premature infants(gestational age<32 weeks)with birth weight less than 1500 g who were hospitalized in the neonatal intensive care unit of this hospital from June 2020 to June 2021 and their mothers.The very premature infants were breast-fed by their mothers.The data of gestational age,birth weight,delivery mode and gender were collected.The amount of breast feeding,cytomegalovirus(CMV)load in breast milk,duration of breast feeding,clinical symptoms,laboratory results and failure rate of auto-auditory brainstem responses(aABR)were recorded.Results A total of 77 pairs of very premature infants and their mothers were enrolled.Among them,including 64 mothers with positive serum CMV-IgG,and the positive rate of CMV-IgG was 83.1%.Among the very premature infants born to CMV-IgG positive mothers,19 cases(29.7%)developed pCMV infection,and three of them developed sepsis-like syndrome(SLS).The very premature infants in the pCMV infection group received a significantly higher maximum CMV load than those in the non-pCMV infection group[64334(40578-89711)copies/mL vs.23168(4902-53629)copies/mL,P=0.02],and the proportion of fresh breastfeeding was also higher.The aABR failure rate of very premature infants in the pCMV infection group was significantly higher than that of infants in the non-pCMV infection group(P=0.037),but there was no significant difference in the incidence of C-reactive protein(CRP)elevation,thrombocytopenia,neutropenia,cholestasis and pneu-monia between the two groups(P>0.05).Conclusion High CMV load in breast milk and high fresh breastfeeding ratio can increase the risk of pCMV infection in very premature infants,and very premature infants with pCMV infection are more likely to develop SLS and hearing loss.