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

ArticleinPEDIATRICS 131(6) · May 2013with41 Reads
DOI: 10.1542/peds.2013-0076 · Source: PubMed
Background: 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. Methods: 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. Results: 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%). Conclusions: 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.
    • "The probability of infection and disease from CMV in children born full-term is very low, probably due to the transfer of antibodies against the virus during pregnancy. The only situations in which breastfeeding in seropositive mothers would be contraindicated is in premature babies or babies born with a weight of less than 1.5 kg (Lanzieri et al., 2013), in which, CMV infection may cause hepatopathy, thrombocytopenia, neutropaenia, petechiae, respiratory distress syndrome and the " sepsis-like " syndrome. For other infections from the same family, as for example the herpes simplex virus or the varicella zoster virus, breastfeeding is only advised against in cases in which the mother's infection is very recent, for example, in the case of herpetic lesions on the mother's breasts or cracked nipples. "
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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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