The Retrospective Cohort Study Of Effect Factors, Clinical Feature Of Perinatal Cytomegalovirus Infection In Infants

Part1Clinical Study about Impact Factors of PerinatalCytomegalovirus Infection with Multivariate AnalysisObjectiveA retrospective cohort study was designed to investigate theepidemiologic data of perinatal cytomegalovirus (CMV) infection, to analyse the riskfactors of perinatal CMV infection in infants and to reduce the incidence rate of that.MethodThe cohort study related to clinical data of patients with perinatal CMVinfection was performed in our pediatric ward from Jan2011to Dec2012. Bycomparing the difference between perinatal CMV infection patients(case group) withnon-CMV infection patient(control group) during the same period, the multivariatelogistic regression analysis was used for risk factors statistics of perinatal CMVinfection after single factor analysis such as t-test, single factor variance analysis andChi-squared test.Results There were complete results of325cases in the cohort study, with109cases and216cases in cases group and control group respectively, and the case ratiowas1:2. The single factor analysis showed that risk factors included sex, relationshipbetween gestational age and birth weight, way of birth, premature rupture ofmembranes (PROM), feeding practices, whose mother with gestational diabetesmellitus (GDM), upper respiratory infection during pregnancy and smoking history aswell as low socioeconomic status. The factors (SGA, vaginal delivery, PROM andbreast feeding) are identified as the independent risk factor of CMV infection bylogistic regression and OR(95%CI) were3.630（1.520，8.665），1.845（1.107，3.075），1.851（1.020，3.359）and1.992（1.155，3.569）respectively.Conclusion Vaginal delivery, PROM and breast feeding are the high risk factors toperinatalCMV infection, and SGA should be paid more attention aboutmanagement in the perinatal period. Part2Retrospective Study on Clinical Characteristics andDevelopment Assessments of Perinatal CytomegalovirusInfection in Recent5YearsObjective To determine the prevalence, clinical manifestation, therapyandprognosis of perinatal Cytomegalovirus (CMV) infection and the risk factorsinfluenced the curative effect of ganciclovir.Methods The clinical data of237infants with confirmed perinatal CMVinfection was retrospectively reviewed and analysed, who were hospitalized from2008to2012in the Pediatric Ward. As for influence factors of curative effect ofganciclovir, the multivariate logistic regression analysis was used for the statisticalsignigicant variables (≤0.05) after simple factor analysis. Part of patients were donephysical examination and assessed with MDI, PDI and Gsell developmental scalesduring out-patient follow-up.Results Clinical Characteristics and proportion of perinatal CMV infection inhospitalized infants were rarely fluctuating in recent5years. The proportion ofpremature infants (31cases) and SGA (42cases) was occupied13%and17.7%respectively. Most of them were two or more systems involved, and Cytomegalovirushepatitis coupled with pneumonia was the most common clinical type, and19cases were complicated by congenital malformation (8.02%).The percent of infants whoseboth serum CMV-IgM antibody and CMV-DNA in blood or urine were found positivewas3.8%，and only CMV-IgM was found positive and only CMV-DNA was foundpositive was90.3%and5.9%respectively.3cases showed abnormality in brainstemauditory evoked potential (BAEP). Gancyclovir was used in83.1percent of caseswith perinatal CMV infection, most of whom (88.3%) were receiving the therapy ofgancyclovir with good therapeutic effect except for7cases. Abnormal maternalhistory during pregnancy（OR=6.191，95%CI=1.597～24.002）and liver involvementbefore treatment （OR=3.705，95%CI=1.537～8.931）were found to be independentrisk factors for gancyclovir resistant. There was no significant difference on theresults of physical examination and intelligence tests between two groups at the age of6months old and1year old, except that the language development of normal infantswas better than that of patients with perinatal CMV infection(P＜0.05）.Conclusion The epidemiological characteristics of Perinatal CMV infectionremained generally stable in recent5years, and infection was always multisystemicinvolvement, especially in liver and lung. The antiviral efficacy of ganciclovir inCMV infection was obvious and the incidence of the ganciclovir-therapy-related sideeffects was low. Furthermore, abnormal maternal history during pregnancy and liverinvolvement before treatment in infants with CMV infection were independent riskfactors for gancyclovir resistant. Perinatal CMV infection had no obvious impact onhealth and development of infants except for language retardation. Part3Comparison on Clinical Feature between PerinatalCytomegalovirus Infection and Postnatal CytomegalovirusInfectionObjective To investigare the clinical manifestation, therapy and prognosis ofperinatal Cytomegalovirus (CMV) infection and postnatal CMV infectionMethods Restropectively analyzed and compared the clinical data of the406patients with confirmed perinatal CMV infection and postnatal CMV infection, whowas hospitalized from2008to2012in the Pediatric Ward, including generalinformation, clinical manifestation, laboratory results, targeted organic lesions andtreatment.Results In406infants, who occupied1.88percent of total hospitalized infantsduring same period,237were involved in perinatal CMV infection group(58.4%) and169were postnatal CMV infection group(41.6%). The group of perinatal CMVinfection had larger in-patient number, higher adimission rate of NICU or PICU,longer hospital stay and higher hospitalization costs(P＜0.05). The most familiarclinical symptom of perinatal CMV infection was hepatosplenomegaly and jaundice,and that of postnatal CMV infection was dyspnea and petechia. Majority of them weretwo or more systems involved, and the common clinical type of perinatal CMVinfection was CMV hepatitis coupled with pneumonia (43.1%), CMV hepatitiscoupled withmyocardial damage (16.7%) and CMV pneumonia coupled withgastrointestinal tract symptom such as emesis,inappetence and diarrhea (8.7%). As forpostnatal CMV infection, the common clinical type was CMV pneumoniacomplicated byhepatitis (37.1%), CMV pneumoniacomplicated byhematologicalsystem damage (28.3%), CMV pneumonia withmyocardial damage (12.1%) andCMV meningitiscomplicated byhepatitis (3.3%). Futhermore, there is no statisticaldifference on positive rate of CMV-IgM, usage rate of ganciclovir and incidence of the ganciclovir-therapy-related side effects, but the patients with postnatal CMVinfection had favourable prognosis.Conclusion CMV infection was always multisystemic involvement, especially inliver and lung.Hepatobiliary system and respiratory system may be involved by perinatal CMVinfection.Meanwhile; postnatal CMV infection always affects respiratory system andhematological system and has milder clinical symtoms and better prognosis. Thereasons of the difference on prevalence, clinical feature and severity between twogroups are mainly related to routes of infection, time of infection, virulence of CMVand immunity of patients. For both types of CMV infection, the antiviral efficacy ofganciclovir in CMV infection was obvious and the incidence of theganciclovir-therapy-related side effects was low.