Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk

Jim, Wai-Tim; Chiu, Nan-Chang; Ho, Che‐Sheng; Shu, Chyong-Hsin; Chang, Jui‐Hsing; Hung, Han-Yang; Kao, Hsin-An; Chang, Hung‐Yang; Peng, Chun-Chih; Yui, Bey-Hwa; Chuu, Chih‐Pin

doi:10.1097/md.0000000000001835

Cited by 49 publications

(75 citation statements)

References 33 publications

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“…Among the few studies reporting longer--term follow--up of premature infants (<1500g birth weight) with postnatal CMV acquisition, some found no significant differences in outcomes compared to controls, while others suggested mild neurocognitive impairments 31--33 . Unlike congenital CMV infection, no sensorineural hearing loss has been found 31,33 .…”

Section: CMVmentioning

confidence: 97%

Transmission of CMV, HTLV-1, and HIV through breastmilk

Prendergast

Goga

Waitt

et al. 2019

The Lancet Child & Adolescent Health

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Breastfeeding is a critical child survival intervention. The potential for transmission of some viral infections from mother-to-child, however, presents the dilemma of how best to interpret the benefits and risks of breastfeeding in different settings. Here, we compare the transmission dynamics, risk factors and outcomes of infection with three chronic viruses transmitted through breast milk: cytomegalovirus (CMV), human T-cell lymphotropic virus type 1 (HTLV-1), and human immunodeficiency virus (HIV). We provide an overview of current intervention approaches and discuss scientific, policy and programming gaps in our understanding of these major global infections. Key messages: • Three viruses are known to be transmitted through breastfeeding and to result in chronic infection: CMV, HTLV-1 and HIV. • CMV transmission through breast milk mostly leads to subclinical infection, except in preterm infants in whom severe clinical disease can occur; the best preventive and treatment approaches in this group remain unclear and more data are needed on long-term sequelae. • HTLV-1 is restricted to specific geographic foci and can be transmitted from mother-to-child through breastfeeding in 10-25% of cases; the best preventive strategy is avoidance or shortening of breastfeeding where safe alternatives are available. • The absolute transmission risk of HIV through breastfeeding in the context of suppressive maternal antiretroviral therapy is now low, even over extended periods. • Guidance for infant feeding for women living with HIV varies by setting: in low-and middle-income countries, breastfeeding with suppressive ART and adherence support is recommended, while in high-income settings formula feeding is advised.

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Section: CMVmentioning

confidence: 97%

Transmission of CMV, HTLV-1, and HIV through breastmilk

Prendergast

Goga

Waitt

et al. 2019

The Lancet Child & Adolescent Health

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“…Some follow-up studies indicated poor neurocognitive outcome in adolescents born preterm with postnatal CMV infection 43,44) . In contrast, other studies showed that preterm infants might not have an increased risk for neurological sequelae after CMV postnatal infection 9,45) .…”

Section: Resultsmentioning

confidence: 57%

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

Gang

Chang

2018

Neonatal Med

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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.

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“…About 30%‐50% of neonatal CMV infections are caused by recurrent infection in pregnant women, and the pathogenesis of BM‐acquired CMV infection may be relevant to immunodeficiency of the infants. The BM‐acquired CMV infection rates in premature and low‐birthweight infants differ among countries; however, there are few data about BM‐acquired CMV infection in jaundiced neonates . Our study results show that the BM CMV‐DNA (+) rate was 32.67% (98/300 cases) and the BM‐acquired CMV infection rate was 18.37% (18/98 cases) among the 300 pathologically jaundiced infants.…”

Section: Discussionmentioning

confidence: 64%

High prevalence of breastmilk‐acquired cytomegalovirus infection in jaundiced infants

Hou¹,

Liu²,

Fan³

et al. 2020

Clinical Laboratory Analysis

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Background Our objective was to evaluate the prevalence and different diagnostic methods of breastmilk (BM)‐acquired cytomegalovirus (CMV) infection in a pathologically jaundiced cohort. Methods A total of 400 infants confirmed with pathological jaundice at The People's Hospital of Qingyang City were screened for BM‐acquired CMV infection between February 2018 and February 2019. A total of 300 infants were finally enrolled in our study. CMV infection was confirmed by detecting both CMV‐DNA in various samples using FQ‐PCR and CMV‐IgM with chemiluminescence. Clinical and other laboratory data were collected from these infants during their hospitalization or regular visits. Results Ninety‐eight (32.67%) subjects were confirmed to be BM CMV‐DNA–positive, and 18 (18.37%) were diagnosed with a BM‐acquired CMV infection. All 18 (100%) infants with a BM‐acquired CMV infection were CMV‐DNA–positive in urine, while 5 (27.78%) cases and 11 (61.11%) cases were confirmed in plasma and peripheral blood mononuclear cells (PBMCs), respectively. Only 6 (33.33%) infants were CMV‐IgM–positive. Birthweight, direct bilirubin, aspartate aminotransferase, and the viral load in BM of the BM‐acquired CMV group were higher than those in the non‐infected group (P < .05). Low birthweight and viral load in BM were risk factors for BM‐acquired CMV infection. Detecting CMV‐DNA in urine samples exhibited better performance than the other methods for screening BM‐acquired CMV infections. Conclusions Our study found a high prevalence of BM‐acquired CMV infection in jaundiced infants, and detecting CMV‐DNA in a urine sample was the most sensitive method for disease screening.

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Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk

Cited by 49 publications

References 33 publications

Transmission of CMV, HTLV-1, and HIV through breastmilk

Transmission of CMV, HTLV-1, and HIV through breastmilk

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

High prevalence of breastmilk‐acquired cytomegalovirus infection in jaundiced infants

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