A Case of an Extremely Preterm Infant with Intussusception Triggered by Acquired Cytomegalovirus Infection.

Intussusception is a common cause of intestinal obstruction in infants aged 6-18 months. However, intussusception in preterm neonates (IPN) is an exceedingly rare disorder. The etiology of IPN remains unclear, but common prenatal injuries, such as those causing intestinal hypoxia/hypoperfusion, dysmotility, and strictures, have been proposed as possible contributing factors. Diagnosis is often delayed because the symptoms closely resemble those of necrotizing enterocolitis (NEC). Given the divergent treatments for IPN and NEC, establishing an early and accurate diagnosis is crucial. IPN is predominantly located in the small intestine (91.6%), and ultrasonography proves useful in its diagnosis. We present a case of a very preterm infant who developed intussusception triggered by acquired cytomegalovirus (aCMV) infection, necessitating surgical treatment. The cause of intussusception in this case was diagnosed as aCMV enteritis because no organic lesions were observed in the advanced part of the intussusception. The presence of CMV was confirmed by CMV-DNA-PCR examination of the resected intestinal tract. Intestinal edema and decreased intestinal peristalsis due to aCMV enteritis are likely the primary causes of the intussusception.

Postnatal cytomegalovirus infection and pulmonary vascular disease in extremely premature infants: A case series.

BACKGROUND: Pulmonary vascular disease (PVD) is a major determinant of both morbidity and mortality in extremely low birth weight infants. It is biologically plausible that postnatal cytomegalovirus (pCMV) infection may lead to PVD in premature infants secondary to pneumonitis or via derangement of pulmonary vascular development directly through endothelial dysfunction. Uncertainty remains, however, regarding thresholds for intervention in premature infants with cardiorespiratory instability and presumed CMV infection likely secondary to the limited understanding of the natural history of the disease. METHODS/RESULTS: We describe four cases of premature infants with clinical and echocardiography features of PVD, in the setting of postnatally acquired CMV. All patients had atypical PVD trajectories, refractory to vasodilator treatment, which improved after initiation of CMV treatment. CONCLUSION: We highlight the need to consider postnatally acquired CMV infection in patients with PVD non-responsive to standard pulmonary vasodilator therapies or disease severity which is out of proportion of the usual clinical trajectory. Treatment of extremely premature infants with CMV-associated PVD may have positive impact on cardiorespiratory health, although duration of therapy remains uncertain.

Incidence of respiratory viruses in preterm infants submitted to mechanical ventilation

Os objetivos do estudo foram determinar a incidência de infecção por vírus respiratórios em crianças pré-termo externas submetidas à ventilação mecânica e avaliar os padrões clínico, laboratorial e radiológico das infecções virais entre crianças pré-termo internadas em unidade de cuidados intensivos neonatal (NICU) com insuficiência respiratória aguda de qualquer tipo. Setenta e oito crianças pré-termo externas foram estudadas de Novembro de 2000 a Setembro de 2002. Os recém-nascidos foram classificados em dois grupos: com infecção viral (Grupo I) e sem infecção viral (Grupo II). Vírus respiratórios foram diagnosticados em 23 crianças pré-termo (29,5%); o vírus mais importante foi o sincicial respiratório (VSR) (14,1%), seguido pelo vírus influenza A (10,2%). Rinorréia, sibilância, vômitos e diarréia, pneumonia, atelectasia e infiltrado intersticial foram significativamente mais freqüentes nos recém-nascidos com infecção viral hospitalar. Houve correlação entre infecção viral hospitalar e valores baixos de proteína C-reativa. Dois pacientes com infecção mista do Grupo I faleceram durante a internação. Em conclusão, o VSR foi vírus mais incidente nestes pacientes com infecção nosocomial do trato respiratório inferior. Foi observado que, embora a maioria das infecções respiratórias virais tenham tido uma evolução favorável, alguns pacientes apresentaram quadro clínico grave e prolongado, principalmente quando houve infecção bacteriana ou fúngica concomitante.

Infección precoz posnatal por citomegalovirus en un gran prematuro / Early postnatal infection due to cytomegalovirus in an extremely low-birth weight premature infant

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