ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ NHIỄM CYTOMEGALOVIRUS Ở TRẺ SƠ SINH TẠI BỆNH VIỆN NHI ĐỒNG 1

Abstract

Background: Cytomegalovirus (CMV) infection in neonates can result in severe sequelae, particularly involving hearing impairment and neurodevelopmental delay. In certain cases, CMV infection may lead to severe respiratory failure, profound thrombocytopenia, and poorly responsive hepatic injury to conventional therapy, thereby increasing the risk of mortality or long-term complications. A thorough understanding of the characteristics of CMV infection in neonates is essential for clinical practice. Objectives: To determine the percentage of clinical features, laboratory findings, and treatment outcomes of CMV infection in neonates at Children's Hospital 1, especially in cases of moderate to severe CMV infection. Methods: Case series from January 1, 2022, to March 31, 2025, at Children's Hospital 1, utilizing urinary CMV DNA for diagnosis and administering treatment exclusively to neonates with moderate to severe CMV infection. Results: There were 42 cases of CMV infection in neonates during the study period. The median gestational age was 30,0 weeks (27,0 – 33,0 weeks), median birth weight was 1165 g (1000 – 1800 g), and the proportion of  preterm infants was 85,7%. The main clinical symptoms were jaundice (45,2%), hearing impairment (40,5%), hepatomegaly (26,2%), and microcephaly (23,8%). The main laboratory findings were thrombocytopenia (69,0%), elevated liver enzymes (57,1%), direct hyperbilirubinemia (47,6%), and neutropenia (28,6%). Among these, severe respiratory failure requiring mechanical ventilation accounted for 31%, while severe thrombocytopenia (< 50×10⁹/L) was observed in 33.3% of cases. The median urinary CMV DNA load was 3,5×10⁵ copies/mL (6,9×10⁴ – 2,0×10⁶). Antiviral therapy was administered in 85,7% of neonates, with a median treatment duration of 42,0 days; among them, 36.1% experienced antiviral-related complications. The mortality rate was 14.3%, reflecting the severity of the disease. Conclusion: This study highlights the importance of utilizing urinary CMV DNA for diagnostic confirmation and restricting antiviral therapy to neonates with moderate to severe CMV infection, thereby optimizing the management and monitoring of infants at high risk for complications, including respiratory failure, severe thrombocytopenia, hearing loss, and poorly responsive hepatic injury.