| Part 1Analysis of the status of cytomegalovirus infection in infants and related factorsObjective:To understand the seroprevalence and infection of cytomegalovirus in infants,to explore the clinical symptoms and risk factors of cytomegalovirus infection in infants of different ages,and to provide clinical reference to reduce the rate of cytomegalovirus infection in infants.Methods:To retrospectively analyze the data of all 4938 children aged 0-1 years who attended the pediatric outpatient or inpatient departments of Inner Mongolia Maternal and Child Health Care Hospital from January 2020 to December 2022 who underwent chemiluminescence testing for TORCH to understand the seroprevalence of HCMV in infants in the region,and to analyze the clinical characteristics and associated risk factors of HCMV infection with laboratory tests,general data and clinical symptoms.Results:(1)Serological antibody detection: The total positive rate of 4938 children was94.01%(4642/4938),93.86%(4635/4938)for total IgG antibody and 8.10%(400/4938)for total IgM antibody.The children were divided into four groups according to age: ≤28 days group,28 days to March,March to June and June to 1 year old.There were significant differences in the positive rates of HCMV-IgG antibody and IgM antibody among different age groups(P<0.05),the positive rate of HCMV-IgG antibody in June-1 year old group was79.79%(75/94),and higher than 90% in the other three groups.The positive rate of HCMV-IgM antibody in infants at 6 months of age increased gradually with the increase of age,and decreased at 6 months to 1 years of age.The highest HCMV-IgM antibody level was38.61%(156/404)in the March-6 months group,and the highest IgM positive ratio was 51.75%(207/400)in the 28d-3 months group.There was no significant difference in the positive rates of HCMV-IgG and IgM between male and female(P>0.05).(2)Analysis of risk factors associated with HCMV in infants: cases with positive HCMV-IgM test were selected,and 222 IgM-positive children were selected as the infected group according to the exclusion criteria,and 100 cases with negative IgM and IgG antibodies were randomly selected in the control group.The rates of breastfeeding and vaginal delivery in the infected group were higher than those in the control group(P<0.05).Multifactorial analysis revealed that breastfeeding and transvaginal delivery were independent risk factors for HCMV infection.the OR(95% CI)was 0.537(0.330-0.875)and 2.760(1.474~5.170),respectively.(3)Differences in clinical symptoms: 222 children with HCMV infection had multiple systems or symptoms at the same time.145 cases(65.32%)had respiratory symptoms,among which 139 cases(62.61%)were pneumonia.101 cases(45.50%)developed digestive system symptoms,including 38 cases(17.12%)of hyperbilirubinemia,26 cases(11.71%)of liver damage,26 cases(11.71%)of gastroenteritis,11 cases of diarrhea,and 10 cases of other gastrointestinal symptoms.The circulatory system was followed by myocardial damage in 70cases(31.53%).59 cases(26.58%)developed hematological diseases,including anemia in 22cases(9.91%)and neutropenia in 20 cases(9.01%).13 cases(5.86%)had central system disease.There were 9 cases of eye disease,4 cases of hearing abnormality and 23 cases of developmental abnormality.The incidence of hyperbilirubinemia and intracranial hemorrhage was higher in children ≤28 days of age(P<0.05),the incidence of pneumonia and myocardial damage was higher in children aged 28 days to 6 months(P<0.05),the incidence of stunting was higher in June-1 year age group than in other age groups(P<0.05),there was no significant difference in other symptoms among the three groups(P>0.05).There was no significant difference in the involvement of single system,two systems and three or more systems among the three age groups(P>0.05).(4)Brain imaging: Abnormal results were found in 32 of 71 cases,with an abnormal rate of 45.07%.Among them,subependymal cyst,extracerebral space widening and lateral ventricle widening were more common.Conclusion:(1)The positive rate of HCMV serologic antibodies was as high as 94.01% in infants up to 1 year of age,and the positive rate was higher than 90% in infants up to 6 months of age due to fetal transmission of HCMV-IgG antibodies,with the lowest rate of IgG antibody positivity from 6 months to 1 year of age.the positive rate of IgM antibodies increased with age up to 6 months of age,and decreased by 6 months-1 year of age,with positive cases concentrated in 28 days-6 months,and 3 months-6 Infants aged 3 months to 6 months are most susceptible to infection.(2)Breastfeeding and vaginal delivery are independent risk factors for HCMV infection in infants within 1 year of age.It is necessary to strengthen maternal and infant management during the postnatal period and cultivate good hygiene practices to reduce the rate of HCMV infection.(3)HCMV infection in infants within 1 year of age can involve multiple systems and present several symptoms at the same time,with pneumonia being the most common cause of individual symptoms,followed by myocardial damage,hyperbilirubinemia,liver damage,gastroenteritis,and also hematologic,central nervous system,hearing,and ocular disorders.The clinical symptoms vary by age.28-day-old children have a higher incidence of hyperbilirubinemia and intracranial hemorrhage,28-day-6-month-old children have a higher incidence of pneumonia and myocardial damage,and 6 months-1 year-old children have a higher incidence of developmental delay.28-day-6-month-old children have more complex clinical symptoms or diseases caused by infection,and multi-system involvement often occurs.Infants with HCMV infection need to be alert for hearing abnormalities and neurodevelopmental abnormalities,and examination of cranial imaging can help diagnose the effects of HCMV infection on the central nervous system.Part 2Potential association of congenital cytomegalovirus infection in high-risk fetuses with ultrasound and abnormal pregnancy outcomesObjective:To understand the rate of congenital cytomegalovirus infection in high-risk fetuses during pregnancy,to analyze the relationship between infection and ultrasound abnormalities,and to explore the impact of fetal cytomegalovirus infection on pregnancy outcome.Methods:One hundred and sixty-eight pregnant women at high risk of pregnancy who attended Inner Mongolia Maternal and Child Health Care Hospital for prenatal diagnosis from November 2020 to January 2023 were selected,and HCMV DNA in amniotic fluid after 21 weeks was detected by fluorescence quantitative polymerase chain method(PCR),and its correlation with infection was analyzed in combination with ultrasound results to explore the impact of infection on pregnancy outcome.Results:(1)Fetal amniotic fluid testing: 168 high-risk fetuses were tested for HCMV DNA in amniotic fluid,and the overall cCMV infection rate was 2.38%(4/168).126 cases had abnormal ultrasound and 4 cases were positive,with a positive rate of 3.17%.42 cases had no abnormal ultrasound and 0 cases were positive.(2)Ultrasound abnormalities and cCMV: the rate of cCMV infection in fetuses with abnormal ultrasound was 3.17%(4/126),and the rate of cCMV infection in fetuses with no abnormal ultrasound was 0%(0/42),the difference was not statistically significant compared with each other(Fisher’s exact probability method,P>0.05).In 126 fetuses,there were 38 cases of CNS abnormalities and 7.89%(3/38)of cCMV infection;1.14%(1/88)of non-CNS cCMV infection,and the difference was not statistically significant(Fisher’s exact probability method,P>0.05).Among the central nervous system anomalies,there were 26 cases of central system anomalies only and 12 cases combined with non-central nervous system anomalies,and the cCMV infection rates were 0%(0/26)and 25%(3/12),respectively,and the differences were statistically significant(Fisher exact probability method,P<0.05)compared with each other.(3)Pregnancy outcome of fetal cCMV infection: 4 fetuses with cCMV infection,3terminated pregnancies,1 full-term delivery with no abnormal growth and development.3infected fetuses with central combined with non-central ultrasound abnormalities had adverse pregnancy outcome in 2 cases and 1 infected fetus with non-central system abnormalities had adverse pregnancy outcome.There were 2 cases of high amniotic fluid HCMV DNA load,both with adverse pregnancy outcome,and 2 cases of low load,1 with adverse pregnancy outcome.Conclusion:In this study,the rate of cCMV infection in high-risk fetuses was 2.38%,the rate of cCMV infection in fetuses with abnormal ultrasound was 3.17%,and no cCMV infection was detected in ultrasound without abnormalities.cCMV infection is associated with abnormal central nervous system ultrasound,and when fetal central system ultrasound abnormalities combined with other non-central multisystem ultrasound abnormalities are detected during pregnancy,fetal cCMV infection is more likely and the risk of adverse pregnancy outcome is increased.Ultrasound combined with amniotic fluid HCMV-DNA load testing can help diagnose fetal cCMV status and assist clinicians in providing more rational genetic counseling and fertility guidance to pregnant women. |
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