CMV-Infektionen bei Neugeborenen: Prävalenz, Diagnostik und Therapie

Zusammenfassung

Infektionen mit Cytomegalieviren fordern sowohl den Geburtshelfer als auch den Pädiater heraus. Sie sind die häufigste Ursache einer kongenitalen Virusinfektion. Die Feten von seronegativen Schwangeren belastet das Risiko der bleibenden Organschädigung bei Primärinfektion. Seropositive Schwangere übertragen zwar seltener das Virus intrauterin, sie reaktivieren jedoch postnatal die Virusreplikation und übertragen das Virus über die Muttermilch, vor allem auch auf sehr unreife Frühgeborene.

In dieser Übersichtsarbeit werden aus Sicht des Neonatologen die Auswirkungen der intrauterinen und der postpartalen Virusübertragung auf das Neugeborene behandelt.

Die klinischen Symptome und die Langzeitauswirkungen der CMV-Infektionen des Neugeborenenalters sind unterschiedlich in Abhängigkeit vom Infektionszeitpunkt. Auch die Prävalenz der Infektion, der diagnostische Zugang, sowie die Ansätze zur Prävention und Behandlung sind verschieden.

Abstract

Infections with cytomegalovirus (CMV) are still a challenge for obstetricians as well as pediatricians. CMV is the most common congenital virus infection. In the case of a primary infection, the fetus of a seronegative pregnant woman is exposed to the risk of permanent organ damage. The intrauterine transmission rate in CMV-seropositive women is low but postnatal reactivation and transmission by breast milk occur more frequently, especially in premature babies. In this review we discuss the consequences of intrauterine and postpartum transmission from a neonatological point of view. With regard to the severity of the symptoms and possible long-term consequences, the time of infection with CMV is of great importance. Prevalence, diagnostic tools, and possible options for treatment or prevention differ for each mode of CMV infection.

CMV-Infektion - kongenital - postnatal - Neugeborene

Cytomegalovirus - Intrauterine infection - Postnatal infection - Neonate

Literatur

• 1 Scholz H. Häufigkeit der konnatalen Zytomegalie in der Bundesrepublik Deutschland.  Monatsschr Kinderheilkd. 2000;  148 887-90
• 2 Halwachs-Baumann G, Genser B, Danda M, Engele H, Rosegger H, Folsch B, Maurer U, Lackner H, Truschnig-Wilders M. Screening and diagnosis of congenital cytomegalovirus infection: a 5-y study.  Scand J Infect Dis. 2000;  32 137-42
• 3 Barbi M, Binda S, Primache V, Clerici D. Congenital cytomegalovirus infection in a northern Italian region. NEOCMV Group.  Eur J Epidemiol. 1998;  14 791-96
• 4 Casteels A, Naessens A, Gordts F, De Catte L, Bougatef A, Foulon W. Neonatal screening for congenital cytomegalovirus infections.  J Perinat Med. 1999;  27 116-21
• 5 Ahlfors K, Ivarsson S A, Harris S. Report on a long-term study of maternal and congenital cytomegalovirus infection in Sweden. Review of prospective studies available in the literature.  Scand J Infect Dis. 1999;  31 443-57
• 6 Teele R L, Hernanz-Schulman M, Sotrel A. Echogenic vasculature in the basal ganglia of neonates: a sonographic sign of vasculopathy.  Radiology. 1988;  169 423-26
• 7 Shackelford G D, Fulling K H, Glasier C M. Cysts of the subependymal germinal matrix: sonographic demonstration with pathologic correlation.  Radiol. 1983;  149 117-21
• 8 Shefer-Kaufman N, Mimouni F B, Stavorovsky Z, Meyer J J, Dollberg S. Incidence and clinical significance of echogenic vasculature in the basal ganglia of newborns.  Am J Perinatol. 1999;  16 315-19
• 9 Frank J L. Sonography of intracranial infection in infants and children.  Neuroradiol. 1986;  28 440-51
• 10 Larroche J C. Subependymal pseudo-cysts in the newborn.  Biol Neonate. 1972;  21 170-183
• 11 Makhoul I R, Zmora O, Tamir A, Shahar E, Sujov P. Congenital subependymal pseudocysts: own data and meta-analysis of the literature.  Isr Med Assoc J. 2001;  3 178-83
• 12 Ben-Ami T, Yousefzadeh D, Backus M, Reichmann B, Kessler A, Hammerman-Rozenberg C. Lenticulostriate vasculopathy in infants with infections of the central nervous system sonographic and Doppler findings.  Pediatr Radiol. 1990;  20 575-79
• 13 Halwachs-Baumann G, Genser B, Pailer S, Engele H, Rosegger H, Schalk A, Kessler H H, Truschnig-Wilders M. Human cytomegalovirus load in various body fluids of congenitally infected newborns.  J Clin Virol 25 Suppl. 2002;  3 81-7
• 14 Noyola D E, Demmler G J, Nelson C T, Griesser C, Williamson W D, Atkins J T, Rozelle J, Turcich M, Llorente A M, Sellers-Vinson S, Reynolds A, Bale J F Jr, Gerson P, Yow M D. Houston Congenital CMV Longitudinal Study Group. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection.  J Pediatr. 2001;  138 325-31
• 15 Ivarsson S A, Lernmark B, Svanberg L. Ten-year clinical, developmental, and intellectual follow-up of children with congenital cytomegalovirus infection without neurologic symptoms at one year of age.  Pediatrics. 1997;  99 800-3
• 16 Boppana S B, Pass R F, Britt W J, Stagno S, Alford C A. Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality.  Pediatr Infect Dis J. 1992;  11 93-9
• 17 Fowler K B, McCollister F P, Dahle A J, Boppana S, Britt W J, Pass R F. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection.  J Pediatr. 1997;  130 624-30
• 18 Fowler K B, Dahle A J, Boppana S B, Pass R F. Newborn hearing screening: will children with hearing loss caused by congenital cytomegalovirus infection be missed?.  J Pediatr. 1999;  135 60-4
• 19 Barbi M, Binda S, Caroppo S, Primache V, Dido P, Guidotti P, Corbetta C, Melotti D. CMV gB genotypes and outcome of vertical transmission: study on dried blood spots of congenitally infected babies.  J Clin Virol. 2001;  21 75-79
• 20 Nigro G, Scholz H, Bartmann U. Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two-regimen experience.  J Pediatr. 1994;  124 318-22
• 21 Whitley R J, Cloud G, Gruber W, Storch G A, Demmler G J, Jacobs R F, Dankner W, Spector S A, Starr S, Pass R F, Stagno S, Britt W J, Alford D Jr, Soong S, Zhou X J, Sherrill L, FitzGerald J M, Sommadossi J P. Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.  J Infect Dis. 1997;  175 1080-86
• 22 Fowler S L. A light in the darkness: predicting outcomes for congenital cytomegalovirus infections.  J Pediatr. 2000;  137 4-6
• 23 Vochem M, Hamprecht K, Jahn G, Speer C P. Transmission of cytomegalovirus to preterm infants through breast milk.  Pediatr Infect Dis J. 1998;  17 53-8
• 24 Ahlfors K, Ivarsson S A. Cytomegalovirus in breast milk of Swedish milk donors.  Scand J Infect Dis. 1985;  17 11-16
• 25 Peckham C S, Johnson C, Ades A, Pearl K, Chin K S. Early acquisition of cytomegalovirus infection.  Arch Dis Child. 1987;  62 780-85
• 26 Zhang M G. The cross-section study of CMV isolation in infants' urine and mothers' breast milk.  Zhong Liu Xing Bing Xue Za Zhi. 1990;  11 226-28
• 27 Stagno S, Reynolds D, Pass R, Alford C. Breast milk and the risk of cytomegalovirus infection.  N Engl J Med. 1980;  302 1073-76
• 28 Yeager A S, Palumbo P E, Malachowski N, Ariagno R L, Stevenson D K. Sequelae of maternally derived cytomegalovirus infections in preterm infants.  J Pediatr. 1983;  102 918-22
• 29 De Cates C R. Acquisition of cytomegalovirus infection by premature neonates.  J Infect. 1994;  28 25-30
• 30 Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer C P, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding.  Lancet. 2001;  357 513-18
• 31 Seibold-Weiger K, Vollmer B, Schmitz-Salue C, Hamprecht K, Speer C P. Sind bei postnatal über die Muttermilch CMV-infizierten Frühgeborenen langfristig Auswirkungen auf Entwicklung und Hörvermögen zu erwarten? Abstract.  Z Geburtsh Neonatol. 2001;  205 Suppl: 1 3
• 32 Bryant P, Morley C, Garland S, Curtis N. Cytomegalovirus transmission from breast milk in premature babies: does it matter?.  Arch Dis Child Fetal Neonatal Ed. 2002;  87 F75-7
• 33 Lucas A, Morley R, Cole T J, Gore S M, Lucas P J, Crowle P, Pearse R, Boon A J, Powell R. Early diet in preterm babies and developmental status at 18 months.  Lancet. 1990;  335 1477-81
• 34 Schanler R J, Shulman R J, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortfied human milk versus preterm formula.  Pediatrics. 1999;  103 1150-57
• 35 Fewtrell M S, Morley R, Abbott R A, Singhal A, Isaacs E B, Stephenson T, MacFadyen U, Lucas A. Double-blind, randomized trial of long-chain polyunsaturated fatty acid supplementation in formula fed to preterm infants.  Pediatrics. 2002;  110 73-82
• 36 Cosmi E, Mazzocco M, La Torre R, Ligi P, Sali E, Nigro G. Therapy or prevention of fetal infection by cytomegalovirus with immunoglobulin infusion in pregnant women with primary infection.  Acta Biomed At Parm. 2000;  71 Suppl 1 547-51
• 37 Pass R F, Fowler K B, Boppana S. Progress in cytomegalovirus research. In Landini MP, eds Proceedings of the Third International Cytomegalovirus Workshop. Bologna, Italy; June 1991 London; Excerpta Medica 1991 pp 3-10