Clinical presentation and transmission of postnatal cytomegalovirus infection in preterm infants

Lee, Jun Eon; Han, Yunghsiang S.; Sung, Tae-Jung; Kim, Dong Hyun; Kwak, Byung Ok

doi:10.3389/fped.2022.1022869

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Table 2 presents the vertical transmission rates of CMV observed in the present and previous studies (Omarsdottir et al, 2015;Hernandez-Alvarado et al, 2021;Lee et al, 2022a). In our study, the overall CMV positivity rate in maternal breast milk and neonatal urine samples was 57.8 and 5.2%, respectively.…”

Section: Transmission Ratesupporting

confidence: 65%

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants

Song,

Kim,

Kwak

et al. 2023

Front. Microbiol.

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Human cytomegalovirus (CMV) transmitted through breast milk poses fatal risks to preterm infants. However, current molecular assay systems often do not accommodate breast milk samples. In this study, we evaluated the analytical and clinical performance of the measurement procedure of CMV load in breast milk utilizing the Cobas CMV test on the Cobas 6,800 system. This was enabled by incorporating a simple independent sample preparation procedure before the application of samples on the automated assay system. Clinical data from electronic medical records were retrospectively analyzed. Breast milk samples from mothers of preterm infants born before 33 weeks of gestation were screened for CMV using the automated assay system. CMV positivity rates in breast milk and neonatal samples and the CMV transmission rate were calculated. Furthermore, to validate the analytical accuracy of the overall measurement procedure with newly obtained residual breast milk samples, the linearity of the measurement procedure was assessed, and a simplified sample preparation method was validated against a conventional method. The CMV positivity rates in maternal breast milk and neonatal samples were 57.8 and 5.2%, respectively. The CMV transmission rate through breast milk was 7.7%. No significant differences in gestational age or birth weight were found between the CMV-negative and CMV-positive neonates. The linearity of the procedure was observed within a range of 1.87–4.73 log IU/mL. The simplified sample preparation method had an equivalent or even improved CMV detection sensitivity than the conventional method. Incorporating a simple independent sample preparation procedure effectively resolved any potential issues regarding the application of breast milk on the automated assay system. Our approach contributed to reduced vertical transmission of CMV by providing a convenient and reliable method for the monitoring of breast milk CMV positivity for clinicians.

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Section: Transmission Ratesupporting

confidence: 65%

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants

Song,

Kim,

Kwak

et al. 2023

Front. Microbiol.

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Postnatally acquired cytomegalovirus infection among preterm infants

Puopolo

2024

Current Opinion in Infectious Diseases

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Purpose of review Although there are multiple benefits of mother's own milk feeding for very-low birth weight, low gestation infants, those born to cytomegalovirus (CMV)-seropositive mothers are at risk for acquiring postnatal CMV infection. This review will describe the risk and consequences of postnatal CMV infection among very preterm infants. Recent findings Postnatal CMV may manifest as clinically silent infection or as mild to severe and occasionally fatal disease. The risk of disease is balanced by the health benefits of human milk feeding to preterm infants. Postnatal CMV infection has been associated with increased risks of multiple preterm morbidities such as bronchopulmonary dysplasia, necrotizing enterocolitis and neurodevelopmental impairment, but current evidence is limited by the selection bias inherent to reporting in case series and retrospective cohort studies. Summary Knowledge gaps exist regarding the risk–benefit balance of pasteurization to inactivate CMV in fresh breast milk, as well as the optimal dosing, duration and efficacy of treating infected infants with antiviral medications. Multicenter, prospective studies are urgently needed to accurately determine the true burden that postnatal CMV infection presents to very preterm infants. Such studies will inform the need for preventive strategies and treatment guidance.

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Congenital and Postnatal Cytomegalovirus: Case Series and State of the Science for Neonatal Providers

Salemi,

McLean,

Jnah

2024

Neonatal Network

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Cytomegalovirus (CMV), a beta-herpes virus, is the most common viral infection in infants. Transmission may occur congenitally (cCMV) or postnatally (pCMV). Early detection and intervention are crucial in reducing morbidities, notable developmental delays, and sensorineural hearing loss. However, more than 90% of infants are asymptomatic at birth. Treatment involves intravenous ganciclovir or the oral prodrug, valganciclovir, drugs usually reserved for use with symptomatic infants because of the toxicity profile. Research currently supports standardized antenatal CMV screening and treatment of affected pregnant patients with hyperimmune globulin as well as vaccination against CMV in unaffected pregnant patients, although widespread adoption is lacking. Standardized postnatal CMV screening is a proven, cost-effective way to detect and diagnose CMV and optimize outcomes across the lifespan. This article presents a case series of cCMV and pCMV and a review of the state of science of CMV as well as promising scientific advances that are on the horizon.

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Clinical presentation and transmission of postnatal cytomegalovirus infection in preterm infants

Cited by 3 publications

References 34 publications

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants

Postnatally acquired cytomegalovirus infection among preterm infants

Congenital and Postnatal Cytomegalovirus: Case Series and State of the Science for Neonatal Providers

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