Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

Abstract

Purpose: The purpose of this study is to describe the rate of cytomegalovirus (CMV) virolactia, and the prevalence of breast milk (BM)-transmitted postnatal CMV infection among premature infants after freeze-thawing (FT) and Holder pasteurization (HP) of breast milk. Methods: This is a single-center, retrospective study of 312 infants born at less than 32 weeks of gestation, or with a birth weight less than 1,500 g from January 2013 to June 2017. All infants were screened for CMV-specific immunoglobulin (Ig) G and IgM at birth. Initial CMV specific polymerase chain reaction (PCR) and CMV culture were performed on mothers' BM and babies' urine within the first 21 days of life. FT and HP of BM was used to prevent the transmission of CMV. For the surveillance of postnatal CMV infection, CMV culture and CMV specific PCR of urine from babies were repeated one to two months after the initial screening. Screening for viremia and viruria was performed if postnatal CMV infection was suspected. Results: Among 178 BM samples obtained from mothers of CMV-IgG-seropositive infants, 80 (44.9%) were CMV PCR positive. CMV deoxyribonucleic acid (DNA) was detected in five of the 22 BM samples (22.7%) obtained from the mothers of CMV-IgG seronegative infants. When CMV DNA load in BM was measured before and after HP, various results were shown. Sixty-three infants out of 232 (27.2%) were evaluated for postnatal CMV infection and four infants out of 63 (6.3%) were infected. Conclusion: Interventions to prevent BM-transmitted CMV infection can reduce the chance of postnatal CMV infection, but not completely eliminate it.

Clinical presentation and transmission of postnatal cytomegalovirus infection in preterm infants

“…Some studies have reported poor neurocognitive outcomes in adolescents born preterm with pCMV infection. In contrast, other studies have shown that preterm infants might not have an increased risk for neurological sequelae, and the differences in neurocognitive outcome could only be detected in higher ages, >6 years ( 2 , 8 , 12 , 16 , 18 , 30 , 31 ). Further research is required to understand the disease burden and establish guidelines for the prevention and management of pCMV infection in preterm infants from CMV-seropositive mothers.…”

“…The maternal CMV-IgG positivity rate was reported to be in the range 52%–97% ( 8 ). In Korea, ≥80% of women have CMV antibodies by childbearing age, and the CMV transmission rate from mothers to preterm infants through breast milk is estimated to be high ( 18 , 19 ).…”