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

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
PEDIATRICS (Impact Factor: 5.47). 05/2013; 131(6). DOI: 10.1542/peds.2013-0076
Source: PubMed


Very low birth weight (VLBW) and premature infants are at risk for developing postnatal cytomegalovirus (CMV) disease, including CMV-related sepsis-like syndrome (CMV-SLS) for which estimates [corrected] in the United States are lacking.

We performed a systematic review and meta-analysis to estimate the pooled proportions (and 95% confidence intervals) of VLBW and premature infants born to CMV-seropositive women with breast milk-acquired CMV infection and CMV-SLS. We combined these proportions with population-based rates of CMV seropositivity, breast milk feeding, VLBW, and prematurity to estimate annual rates of breast milk-acquired CMV infection and CMV-SLS in the United States.

In our meta-analysis, among 299 infants fed untreated breast milk, we estimated 19% (11%-32%) acquired CMV infection and 4% (2%-7%) developed CMV-SLS. Assuming these proportions, we estimated a rate of breast milk-acquired CMV infection among VLBW and premature infants in the United States of 6.5% (3.7%-10.9%) and 1.4% (0.7%-2.4%) of CMV-SLS, corresponding to 600 infants with CMV-SLS in 2008. Among 212 infants fed frozen breast milk, our meta-analysis proportions were 13% (7%-24%) for infection and 5% (2%-12%) for CMV-SLS, yielding slightly lower rates of breast milk-acquired CMV infection (4.4%; 2.4%-8.2%) but similar rates of CMV-SLS (1.7%; 0.7%-4.1%).

Breast milk-acquired CMV infection presenting with CMV-SLS is relatively rare. Prospective studies to better define the burden of disease are needed to refine guidelines for feeding breast milk from CMV-seropositive mothers to VLBW and premature infants.

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    • "Disease is typically not observed in term infants, but can be a substantial problem for low birth weight premature infants [13] [14]. Because of the virtual elimination of transfusion-associated CMV heralded by the advent of leukofiltration of blood products [15], essentially all CMV infections in premature infants are acquired from maternal breast milk [16] [17] [18]. As is the case for congenital CMV infections, many breast milk-acquired infections in premature infants are asymptomatic, but a substantial percentage can produce severe, occasionally lifethreatening disease, which can manifest as viremia, neutropenia , thrombocytopenia, hepatitis, pneumonia, enteritis, "
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