فهرست مطالب faezeh haghighi

Congenital CMV infection constitutes the main cause of sensory neural hearing loss (SNHL) worldwide. The rate of CMV induced SNHL is not well documented in developing countries like Iran. Therefore, this prospective follow up study was aimed to evaluate this rate among neonates with congenital CMV infection.

Infants with congenital CMV infection who were admitted to Neonatal Intensive Care Units and infected infants who were identified in 2 other prospective screening studies in our region were enrolled. Audiological follow up was performed for all the cases. Antiviral therapy was administered for the newborns in case of having severe symptoms.

A total of 22 infants with congenital CMV infection were entered into the study, of which, 8 and 14 had symptomatic and asymptomatic congenital CMV infection, respectively. In total, 3 of 22 infants had SNHL (13.6%; 95% CI: 2.8-39.8), 2 of 8 with symptomatic cCMV infection (25.0%; 95% CI: 3-90) and 1 of 14 with asymptomatic cCMV infection (7.1%; 95% CI: 0.1-39). No association was found between SNHL and risk factors related to CMV in newborns. In conclusion, the findings of this study revealed that the rate of congenital CMV induced SNHL is high among neonates how born in our region. Severe sequelae of congenital CMV infection indicate the need for screening for CMV infection at birth to reduce the risk of CMV complications and the financial load of treatment imposed on health care and treatment systems in the country.

 Cytomegalovirus (CMV) can vertically transmit from infected mothers to fetuses and causes congenital infection in newborns. Unfortunately, there have been limited data available on the prevalence of congenital CMV (cCMV) infection among Iranian neonates at higher risk of infection.

 The current study aimed to assess the prevalence of cCMV infection among hospitalized neonates in Tehran, Iran, and investigate the diagnostic values of CMV polymerase chain reaction (PCR) on Guthrie cards in comparison to those reported for urine specimens.

 This cross-sectional study was carried out on the hospitalized neonates with 3 weeks of age. The urine specimens and Guthrie cards were taken from each eligible newborn. Total nucleic acid was extracted from the samples and tested by PCR for the presence of CMV deoxyribonucleic acid. The cCMV infection was confirmed in the newborns, and the infected neonates underwent further evaluation.

 Out of 224 newborns, CMV infection was identified in 11 neonates (4.9%). There were no factors in association with cCMV infection. The sensitivity and specificity of dried blood spot (DBS) samples for the identification of newborns with cCMV infection were 90% and 99%, respectively.

 A significant number of hospitalized neonates in the present study were infected with cCMV infection. The results of the current study revealed that Guthrie cards had adequate sensitivity for the identification of CMV infection in the hospitalized newborns. Since symptomatic newborns with cCMV infection have a higher chance for the development of early- or late-onset sequelae of infection, it is recommended to diagnose and treat this group of newborns.

Cytomegalovirus (CMV) constitutes the most common viral cause of congenital infections in newborns worldwide. There are a significant number of asymptomatic newborns with congenital CMV infection in Iran, which may develop long-term sequelae of infection. Unfortunately, limited data exsists from Iran on the rate of congenital CMV infection among neonates. The current study was aimed to investigate the prevalence of congenital CMV infection among Iranian neonates by testing Guthrie cards.

Guthrie cards were collected from infants within 2 weeks of life, and total DNA was extracted from samples by thermal shock and evaluated for CMV DNA using nested-PCR assay. CMV infection in newborns was confirmed through a commercial CMV PCR kit. Infected infants underwent further evaluation at the hospital.

CMV infection was identified in four of 1174 infants (0.34%) which is approximately 3 cases per 1000 live births. Infected infants were asymptomatic at birth and had a normal hearing status similar to other children. There were no factors in relation with CMV infection among newborns.

According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our population, educating and effective counseling by obstetricians/ gynecologists to the pregnant women are recommended.

 Pregnant women with Chlamydia trachomatis and Neisseria gonorrhoeae infections can vertically transmit these microorganisms to their newborns through the birth canal and cause neonatal conjunctivitis secondary to sexually transmitted infections.

 In this cross-sectional study, we aimed to evaluate the prevalence of C. trachomatis and N. gonorrhoeae infections among pregnant women attending a hospital in Tehran, and also determine the vertical transmission rate of these two organisms to the eyes of newborns after vaginal delivery.

 Endocervical and conjunctival swabs were collected from pregnant women and their newborns within 24 hours after birth. Demographic and clinical data of participants were obtained using a questionnaire and from the hospital records. Then, DNA was extracted and tested by a multiplex PCR assay to detect C. trachomatis and N. gonorrhoeae in specimens.

 Genital infections of C. trachomatis and N. gonorrhoeae were detected in 9.6% (11 of 125) and 1.6% (2 of 125) of pregnant women, respectively. Among newborns, ocular infection with C. trachomatis was detected in 2 (1.6%), and no case of N. gonorrhoeae infection was found. Both infected infants were born from asymptomatic infected women. Therefore, the vertical transmission rate of C. trachomatis infection was calculated as 18.1%. Our results also revealed that ocular C. trachomatis infection in neonates is significantly in association with genital C. trachomatis infection in pregnant women (OR = 0.16, 95% CI = 0.03 - 0.7, P = 0.002).

 Pregnant women with asymptomatic infection of C. trachomatis have a key role in the distribution of chlamydial conjunctivitis in newborns. Since ocular prophylaxis in neonates is not effective for chlamydial conjunctivitis, therefore education and screening of pregnant women, as well as treatment of infected cases, remain as the best approach for controlling the disease.