Cytomegalovirus in Breast Milk: Reassessment of Pasteurization and Freeze-Thawing

Forsgren, Marianne

doi:10.1203/01.pdr.0000143155.84802.a3

Cited by 31 publications

(23 citation statements)

References 26 publications

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“…Pasteurization, although capable of completely inactivating CMV, unfortunately inactivates some of the salutary components of milk. [17][18][19][20] Therefore, the AAP recommends fresh maternal breast milk for routine feeding in premature infants.…”

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Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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Human cytomegalovirus (CMV) infection may be acquired in very low birth weight and extremely low birth weight (ELBW) infants from breast milk. The clinical relevance of such infections is uncertain. There is no consensus on whether screening breast milk for CMV, freezing/pasteurizing milk before feeding, or performing virological monitoring on at-risk infants is warranted. We describe an ELBW infant who acquired CMV postnatally from breast milk and developed CMV sepsis syndrome and clinical evidence of necrotizing enterocolitis (NEC) at ∼5 weeks of age. The availability of serial dried blood spots from day of life (DOL) 4 to 21, coincidentally obtained for a metabolic study, provided the novel opportunity to retrospectively test for and quantify the magnitude of CMV DNAemia. DNAemia was present for several weeks before the onset of severe CMV disease, first being noted on DOL 18 and increasing in magnitude daily to 4.8 log10 genomes/mL on DOL 21, approximately 8 days before the onset of abdominal distension and 15 days before the onset of CMV sepsis syndrome and NEC. After surgical resection, supportive care, and ganciclovir therapy, the infant recovered. This case underscores the importance of including CMV infection in the differential diagnosis of sepsis and NEC in premature infants. This case also suggests the value of prospective virological monitoring in at-risk low birth weight and ELBW infants. Future studies should examine the potential utility of preemptive monitoring for, and possibly treatment of, CMV DNAemia in premature infants, which may herald the onset of serious disease.

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Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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“…[5][6][7] In premature infants, the transmission of protective maternal antibodies starting within the 29th gestational week is missing, which puts them at high risk for symptomatic infection transmitted via breast milk. 8 In a study of CMVseropositive mothers, in 87% of the cases, virus was detectable in breast milk with transmission occurring in 22,8% premature infants and leading symptomatic disease in 0-34.5% of them. 7 Studies have shown that 'Holder' pasteurization (pasteurization for 30 min at 62.5 1C) or freezing breast milk at À20 1C may reduce CMV viral titers and infectivity.…”

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confidence: 99%

Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

et al. 2011

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Cytomegalovirus (CMV) infection is the most common intrauterine and perinatal viral infection. Postnatal CMV infection is acquired mainly from breast milk and may cause severe illness in preterm infants. We report an extremely low birth weight infant who presented with a sepsis-like syndrome and multiple organ involvement, notably hepatitis and pneumonitis, and treated with ganciclovir without adverse effect or relapse. Journal of Perinatology (2012) 32, 72-74; doi:10.1038/jp.2011 Keywords: postnatal; cytomegalovirus; infection; low birth weight infant Introduction Acquisitiıon of cytomegalovirus (CMV) may occur by either prenatal infection in utero, resulting in congenital CMV infection, or by perinatal acquisition, during either the labor and delivery process, via blood transfusion or by breast milk. There is considerable evidence showing that the shedding of the virus into breast milk is the main source of postnatal CMV infection in infants. 1,2 Most acquired CMV infections in term infants are asymptomatic or manifest as a self-limited disease. In premature neonates, postnatal CMV infection can lead potentially lifethreatening problems. Only few cases of postnatal CMV multisystem infection with severe course have been reported. 3,4 Treatment of the postnatal CMV infection of the premature neonate and therapeutic options remain controversial. We report an extremely low birth weight infant with postnatal CMV infection presented with sepsislike symptoms, hepatitis, pneumonitis, and showed recovery under antiviral treatment. CaseA 24-year-old mother was admitted to the hospital with premature rupture of membranes and chorioamnionitis. At 28 gestation weeks, a male infant weighing 880 g was delivered by cesarean section. The baby received surfactant replacement, high-frequency oscillation ventilation for refractory respiratory failure. Enteral feeding with breast milk was initiated at day of life (DOL) 1. On DOL 35, he was still on nasal continuous positive airway pressure, and his respiratory condition deteriorated with the increase of tracheal secretions. He had also distended abdomen with hepatomegaly, diminished activity and gray pallor of the skin. Laboratory analysis showed pancytopenia, increased C-reactive protein, direct bilirubin (15.8 mg dl À1 at the highest) and liver enzymes levels (aspartate aminotransferase, alanine aminotransferase and g-glutamyl transpeptidase levels were 354, 148 and 236 U l À1 at the highest, respectively). Chest X-ray revealed new alveolar infiltrations. Broad-spectrum antibiotics were initiated after obtaining cultures from blood, cerebrospinal fluid, tracheal aspirate and urine. CMV immunoglobulin M and immunoglobulin G were positive. By the quantitative PCR analysis of CMV DNA copy numbers in plasma, urine and tracheal aspiration samples were 2 Â 10 6 , 1.7 Â 10 6 and 3.7 Â 10 6 copies ml À1 , respectively. Cerebrospinal fluid was negative for CMV DNA. PCR testing for CMV on specimen of blood in Guthrie card taken on DOL 8 for neonatal screening was negative. The mother was ...

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“…Bebeğin immatürlüğünün artması ve anne sütündeki whey proteininde viral DNA'nın bulunması, virüse maruziyet süresi, semptomatik CMV enfeksiyonu açısından önemli risk faktörleridir (1,4). Bebeğin immatürlüğü arttıkça kazanılmış CMV enfeksiyonu riskinin artış nedeni 29. gebelik haftasında başlayan maternal koruyucu antikorların geçişi bu haftadan önce doğan prematürelerde olmaması ile açıklanabilir (13).…”

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Aquired Cytomegalovirus Infection of Extremely Low Birth Weight Infant

Alan¹,

Okulu²,

Karbuz³

et al. 2013

jcp

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ÖZETAnne sütü, özellikle prematürelerde kazanılmış sitomegalovirüs (CMV) enfeksiyonu için majör kaynaktır ve anne sütünden kazanılan CMV enfeksiyonu seropozitif anne bebeklerinde görülmektedir. Türkiye'de annelerin çoğunluğunun seropozitif olmasına karşın prematüre bebeklerde yaşamı tehdit eden akkiz CMV enfeksiyonu yalnızca vaka sunumları şeklinde çok az olguda bildirilmektedir. Preterm semptomatik anne sütü kaynaklı CMV enfeksiyonunun tedavisi klinik bulguların ağırlığına göre yapılmalıdır. Postnatal 111. gününde menenjit-sepsis tanısı alan, anne sütünden kazanılan CMV enfeksiyonu tanımlanan ancak yaşamı tehdit eden çoklu organ yetmezliği gelişmemesi nedeniyle antiviral tedavi verilmeyen prematüre bir bebek literatür bilgileri eşliğinde sunulmuştur. Preterm bebeklerde etken saptanmayan sepsis kliniği, açıklanamayan trombositopeni, karaciğer enzim yüksekliği ve direkt bilirübinemi varlığında kazanılmış CMV enfeksiyonu akla getirilmelidir. (Gün cel Pe di at ri 2013; 11: 138-41) Anah tar ke li me ler: Prematüre bebek, kazanılmış sitomegalovirus enfeksiyonu SUM MARYBreast milk is a major source for acquired cytomegalovirus infection especially in premature infants and acquired CMV infection occurs in infants whose mothers were seropositive for CMV. Although most of mothers of premature infants are seropositive in Turkey, acquired life-threatening breast milk acquired CMV infection was reported occasionally. Treatment of preterm with symptomatic breast milk acquired CMV infection should be done according to the severity of clinical signs. In this report, a preterm case with a diagnosis of breast milkacquired CMV meningitis and sepsis without multiorgan failure on the 111th day of life, who did not require antiviral therapy was presented and discussed in the context of the acquired CMV literature. In preterm babies, when there is sepsis with no apparent causes, unexplained thrombocytopenia, elevated liver transaminases and direct hyperbilirubinemia acquired CMV infection should be suspected. (Jo ur nal of Cur rent Pe di at rics 2013; 11: 138-41)

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Cytomegalovirus in Breast Milk: Reassessment of Pasteurization and Freeze-Thawing

Cited by 31 publications

References 26 publications

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

Aquired Cytomegalovirus Infection of Extremely Low Birth Weight Infant

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