Prevention of postnatal cytomegalovirus infection in preterm infants

Sharland, Mike; Khare, Milind; Bedford-Russell, A

doi:10.1136/fn.86.2.f140

Cited by 47 publications

(49 citation statements)

References 2 publications

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“…However, no studies performed to date had evaluated the effects of frozen-thawed breast milk in a clinical context. Taken together, 22,29,32,33 these data and our results suggest that frozen-thawed breast milk reduces CMV transmission rates, although differences between ethnic groups and endemic CMV strains must also be taken into account.…”

Section: Discussionmentioning

confidence: 63%

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Transmission of cytomegalovirus via breast milk in extremely premature infants

et al. 2010

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Objective: We prospectively evaluated the rate of postnatal cytomegalovirus (CMV) transmission through breast milk in extremely premature infants to address the impact of CMV infection on preterm infants during lactation.Study Design: A total of 25 mothers and 27 infants (two sets of twins) with birth weights <1000 g and/or gestational ages <28 weeks were enrolled in the study. They were mostly fed frozen-thawed breast milk. Breast milk, serum and urine samples were collected every 2 weeks and screened for CMV infection using the real-time polymerase chain reaction.Result: All of the 21 CMV-seropositive mothers had detectable CMV DNA in their breast milk, with a peak at 4 to 6 weeks postpartum. CMV infection was confirmed in only one infant (4.3%) who displayed almost no clinical symptoms. Conclusion:At our institutes, we mainly use frozen-thawed breast milk. We found low CMV transmission rates even in extremely premature infants, and the CMV-positive infant did not develop serious symptoms.

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Section: Discussionmentioning

confidence: 63%

“…20,32 Hamprecht et al 34 reported on the reduction of breast milk CMV infectivity by three methods: freeze-thawing, Holder pasteurization and short-time heating for 5 s at 72 1C. CMV infectivity was eliminated in only 1 of 10 samples by freezing milk, but completely eliminated by both Holder pasteurization and short-time heating.…”

Section: Discussionmentioning

confidence: 99%

Transmission of cytomegalovirus via breast milk in extremely premature infants

et al. 2010

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“…Immunoglobulin does not prevent infection but may modify disease (25). Two other studies report CMV transmission from freeze-preserved breast milk: in one preliminary report one infant out of 18 infants (Ͻ32 weeks) had a subclinical infection (26); in another study 3 of 30 infants (Ͻ34 weeks) were infected without clinical symptoms (17).…”

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confidence: 99%

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

Forsgren

2004

Pediatr Res

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“…Recently, routine freezing of breast milk at Ϫ20°C was recommended to prevent transmission of CMV from breast milk of seropositive mothers to uninfected preterm infants (11). This study was also based on previous data of CMV cryoinactivation (8,9).…”

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confidence: 99%

Cytomegalovirus (CMV) Inactivation in Breast Milk: Reassessment of Pasteurization and Freeze-Thawing

Hamprecht¹,

Maschmann

Müller³

et al. 2004

Pediatr Res

189

152

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Breast-feeding mothers frequently transmit cytomegalovirus (CMV) to preterm infants of very low birth weight. Current recommendations for prevention of virus transmission are based on data published 20 y ago in the context of human milk banking. Two recent clinical trials examined storage of breast milk at Ϫ20°C to reduce virus transmission. However, in both studies, CMV transmission occurred. Using sensitive tools like quantitative PCR, CMV pp67 late mRNA assay, and a high-speed, centrifugation-based microculture assay for quantification of CMV infectivity, we reassessed the virological and biochemical characteristics of freeze-storing breast milk at Ϫ20°C, compared it with traditional Holder pasteurization (30 min at 62.5°C), and a new short-term pasteurization (5 s at 72°C) based on the generation of a milk film. Both heat treatment procedures were able to destroy viral infectivity and pp67 RNA completely. Preliminary results showed short-term heat inactivation below 72°C was less harmful in reducing the activity of marker enzymes than Holder pasteurization. Freezing breast milk preserved the biochemical and immunologic quality of the milk; however, late viral RNA and viral infectivity was also preserved. Breast-feeding in premature infants is beneficial (1). However, breast-feeding of a high-risk group of preterm infants (birth weight Ͻ1000 g, gestational age at birth Ͻ30 wk) may be associated with symptomatic CMV infection (2,3). If CMV transmission from breast milk to preterm infants is clinically important, then prevention of virus transmission will be critical (4).Recent recommendations for virus inactivation in human milk by freezing, which destroys the virus (5,6), are still based on three studies that evaluated freezing for viral decontamination of stored milk in the context of human milk banking 20 y ago (7-9). Only two studies analyzed the effect of storage at Ϫ20°C using naturally infected milk specimens (8,9). Storage of milk for 3 d at Ϫ20°C reduced the viral titre by more than 99% (9), and storage of naturally infected milk specimens for 7 d or longer at Ϫ20°C eliminated infectivity (8). On the other hand, CMV survived when the milk sample was frozen at

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Prevention of postnatal cytomegalovirus infection in preterm infants

Cited by 47 publications

References 2 publications

Transmission of cytomegalovirus via breast milk in extremely premature infants

Transmission of cytomegalovirus via breast milk in extremely premature infants

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

Cytomegalovirus (CMV) Inactivation in Breast Milk: Reassessment of Pasteurization and Freeze-Thawing

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