High-Dose Cytomegalovirus (CMV) Hyperimmune Globulin and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary CMV Infection
| Autor: | Nigro, G., Adler, S. P., Lasorella, S., Iapadre, G., Maresca, M., Mareri, A., Di Paolantonio, C., Catenaro, M., Tambucci, R., Mattei, I., Carta, G., D'Alfonso, A., Patacchiola, F., Fioroni, M. A., Manganaro, L., Giancotti, A., Pancallo, D., Lauri, S., Liuzzi, G., Di Renzo, G. C., della Torre, B., Lupi, C., Calvario, A., Vimercati, A., Carbonara, S., Gussetti, N., Pisano, P. |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Hyperimmune globulin medicine.medical_specialty Congenital cytomegalovirus infection Cytomegalovirus Viremia Disease 03 medical and health sciences 0302 clinical medicine Pregnancy DNAemia medicine Humans Avidity 030212 general & internal medicine Pregnancy Complications Infectious Seroconversion Child Articles and Commentaries biology business.industry Obstetrics Infant Globulins Odds ratio medicine.disease Infectious Disease Transmission Vertical 030104 developmental biology Infectious Diseases Child Preschool Cytomegalovirus Infections biology.protein Female Pregnant Women business |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background After primary maternal cytomegalovirus (CMV) infection during pregnancy, infants are at risk for disease. Methods Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with primary infection. These women were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range, 1–8 years). One hundred fifty-seven women were treated with an average of 2 doses (range, 1–6 doses) of high-dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae; 31 covariates were tested. Results Four factors predicted fetal infection: a 1.8-fold increase (30% vs 56%) in the rate of congenital infection without HIG (adjusted odds ratio [AOR], 5.2; P < .0001), a 1.8-fold increase (32% vs 56%) associated with maternal viral DNAemia prior to HIG administration (AOR, 3.0; P = .002), abnormal ultrasounds (AOR, 59; P = .0002), and diagnosis of maternal infection by seroconversion rather than avidity (AOR, 3.3; P = .007). Lack of HIG and abnormal ultrasounds also predicted symptoms (P = .001). Long-term sequelae were predicted by not receiving HIG (AOR, 13.2; P = .001), maternal infection in early gestation (odds ratio [OR], 0.9; P = .017), and abnormal ultrasounds (OR, 7.6; P < .003). Prevalence and copy/number of DNAemia declined after HIG. Conclusions Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease and is associated with the resolution of DNAemia. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|