新生儿先天性巨细胞病毒 (cCMV) 感染筛查:普遍筛查、定向筛查、扩展定向筛查,还是非此即彼?

Neonatology today Pub Date : 2024-08-01
Mark R Schleiss
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摘要

先天性巨细胞病毒(cCMV)感染是美国最常见的神经发育后遗症病因。与 cCMV 相关的最常见的长期残疾是感音神经性听力损失(SNHL)。在患有 cCMV 相关性 SNHL 的儿童中,超过 40% 将通过新生儿听力筛查 (NHS)。因此,为了最大限度地识别有 SNHL 风险的婴儿,有充分的理由进行普遍的 cCMV 筛查。早期识别 cCMV 还能使一些婴儿及时开始接受抗病毒治疗,从而改善临床疗效。新生儿先天性感染必须在出生后 21 天内确诊,因为超过这个时间点的 CMV 感染通常是产后感染,通常是通过母乳喂养感染。尽管许多倡导者热衷于普及 cCMV 筛查(1-3),但其他专家表示,在获得更多成本效益证据之前,他们对接受这样的政策建议还很犹豫。此外,由于大多数感染 cCMV 的婴儿并无症状,且预后良好,神经发育结果正常,因此有人担心普遍筛查可能会让无症状 cCMV 感染婴儿的父母过度焦虑(4)。本综述探讨了不同 cCMV 筛查方法的利弊,强调要提高新生儿科医生在临床实践中对新兴方法的认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Newborn Screening for Congenital Cytomegalovirus (cCMV) Infection: Universal, Targeted, Expanded-Targeted, or None-of-the-Above?

Congenital cytomegalovirus (cCMV) infection is the most common cause of neurodevelopmental sequelae in the United States (US). The most common long-term disability associated with cCMV is sensorineural hearing loss (SNHL). Among children with cCMV-associated SNHL, over 40% will pass their newborn hearing screen (NHS). Therefore, to maximize the identification of infants at risk for SNHL, there is a strong rationale for universal cCMV screening. Early identification of cCMV also allows for the timely commencement of antiviral therapies for some infants, which in turn can improve clinical outcomes. Congenital infection must be diagnosed in the newborn infant in the first 21 days of life since demonstration of CMV infection beyond this time point commonly reflects postnatal acquisition, typically from breastfeeding. Although many advocates are enthusiastic about universal cCMV screening (1-3), other experts express hesitancy in embracing such a policy recommendation until there is more evidence of cost-effectiveness. Moreover, since most infants with cCMV are asymptomatic and have a good prognosis for normal neurodevelopmental outcomes, there is concern that universal screening may raise undue anxiety for parents of infants with asymptomatic cCMV infection (4). This review considers the pros and cons of different cCMV screening approaches, emphasizing enhancing awareness of new and emerging approaches for neonatologists in clinical practice.

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