Severe neonatal gastrointestinal diseases such as necrotizing enterocolitis or spontaneous intestinal perforation are potentially lethal conditions which predominantly occur in preterm infants. Cytomegalovirus (CMV), which is known to cause congenital and acquired infections in the newborns, has also been implicated in such severe gastrointestinal diseases in premature infants. However, the pathogenic role of CMV and effect of antiviral therapy in severe gastrointestinal disease in premature neonates is currently unclear. We present an infant, born at 26-weeks’ gestation, presented with progressive dyspepsia and abdominal distention after the closure of the symptomatic patent ductus arteriosus at the day of life (DOL) 4, requiring the emergent surgery for ileal perforation at the DOL8. After the surgery, abdominal symptoms persisted and the second emergent surgery was performed for the recurrent ileal perforation at DOL17. Even then the abdominal symptoms prolonged and pathological examination in the affected intestine at the second surgery showed CMV inclusion body. Immunoreactivity for CMV antigen was detected in the specimen at the first surgery on DOL8. Blood and urinary CMV-DNA were detected at DOL28. CMV-DNA was also detected in the dried umbilical cord which was obtained within a week from birth. A 6-week course of intravenous ganciclovir (12mg/kg/day) was started at DOL34 and then symptoms resolved along with decreasing blood CMV-DNA. Pathological findings characteristic of CMV were not detected in the resection specimen at the ileostomy closure at DOL94. These observations indicate that anti-CMV therapy may be beneficial for some premature infants with severe CMV-associated gastrointestinal diseases and warrants further studies focusing on pathogenic role, diagnosis, treatment and prevention of this underrecognized etiology of severe gastrointestinal diseases particularly in premature neonates.
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机译：严重的新生儿胃肠道疾病，如坏死性肠炎或自发性肠道穿孔是潜在的致命条件，主要发生在早产儿。已知在新生儿中引起先天性和获得的感染的巨细胞病毒（CMV）也涉及过早婴儿的这种严重的胃肠道疾病。然而，CMV的致病作用和抗病毒治疗在早产新生儿的严重胃肠疾病中的作用目前不清楚。我们呈现出一个婴儿，出生于26周的妊娠，呈现出在寿命当天（DOL）4的有症状专利导管动脉杆菌之后呈进的渐进功能和腹部，需要在DOL8处于肠壁穿孔的紧急手术。手术后，腹部症状持续存在，并对DOL17进行复发性髂骨穿孔进行第二次出苗手术。即使腹部症状延长和病理检查在第二次手术中的受影响的肠道显示CMV包涵体。在DOL8上的第一个手术的标本中检测到CMV抗原的免疫反应性。在DOL28检测到血液和尿CMV-DNA。在从出生后一周内获得的干燥的脐带中也检测到CMV-DNA。在DOL34开始，在DOL34开始6周的静脉内常规静脉（12mg / kg /天），然后随着血液CMV-DNA的降低，症状分解。在DOL94的Eleostomy闭合的切除试样中未检测到CMV的病理发现。这些观察结果表明，抗CMV治疗可能对一些严重的CMV相关胃肠疾病的过早婴儿有益，并且需要进一步研究，其关注于致病作用，诊断，治疗和预防这种严重的胃肠疾病的这种额外的胃肠疾病的病因，特别是在早产的新生儿中。
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