Transmission of cytomegalovirus via breast milk in extremely premature infants

Abstract

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.

Breast Milk–Acquired Cytomegalovirus Infection and Disease in VLBW and Premature Infants

“…Among infants who were uninfected at birth, postnatal CMV infection was determined through collection of infants' urine weekly, biweekly, or monthly until 8 to 12 weeks of age, and analysis by polymerase chain reaction, 8,9,11,12,14,16,25,26,28,31 viral culture, 8,10,11,13,27,28 or shell vial assay. 10,16,27,29,30 Ofthe17studies,5includedinfantsfedwith untreated breast milk, [8][9][10][11]26 6 included infants fed breast milk that was frozen at temperatures of 2 18°C to 220°C for .24 hours or 72 hours, 12-15,27,28 5 included infants fed untreated breast milk in combination with frozen breast milk and/or pasteurized breast milk from donors, 17,25,[29][30][31] and in 1 study it was unclear whether the infants were given untreated or treated milk. 16 REVIEW ARTICLE (27) 75 ( Overall, 695 infants born to and fed breast milk from CMV-seropositive mothers were identified in the 17 studies, with a median of 38 infants per study (range: 7-90) ( Table 1).…”

“…The 17 studies included in this review were published from 2001 to 2011 (Table 1). [8][9][10][11][12][13][14][15][16][17][25][26][27][28][29][30][31] Nine studies were conducted in Europe (Germany, Italy, France, United Kingdom, and Sweden), 4 in Asia (Japan and Taiwan), 2 in North America (Canada and United States), 1 in South America (Brazil), and 1 in the Middle East (Israel).…”

“…Mothers were tested for IgG and IgM antibodies in 9 studies 8,9,11,[13][14][15]26,28,31 and for IgG antibodies in 4 studies 10,12,25,30 ; 4 studies did not report which serological tests were performed. 16,17,27,29 Studies varied regarding infant inclusion criteria, more commonly specifying a birth weight cutoff of ,1500 g (7 studies) or gestational age ,32 weeks (6 studies) ( Table 1).…”

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

“…Other studies re ported a CMV transmission rate of 2.5% to 15% when FT BM is used [29][30][31] . While HP is highly effective at removing viable CMV, it may inactivate biologically active components such as Igs, enzymes, hormones, growth factors, cytokines, and heat-labile vitamins 6,32) .…”

Incidence and Impact of CMV Infection in Very Low Birth Weight Infants

“…2 Premature infants who acquire the infection from breast milk can become acutely ill, but more often the infection is clinically silent and carries little risk of long-term sequelae. [10][11][12][13][14][15] Prematurity is another major health burden of infancy. In a recent large study of very low birth weight (VLBW) infants with birth weights of 501 to 1500 g in the United States, mortality rates were ∼13%, and .40% of survivors suffered a major associated morbidity, including sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), periventricular leukomalacia, and retinopathy of prematurity.…”