Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk

Chiavarini, Manuela; Bragetti, P; Sensini, Alessandra; Cenci, Elio; Castronari, Roberto; Rossi, Marta J; Fantauzzi, Ambra; Minelli, Liliana

doi:10.1186/1824-7288-37-6

Cited by 39 publications

(44 citation statements)

References 19 publications

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“…Infectious virus and CMV DNA and RNA have been isolated from cellassociated and whey fractions in the breast milk of 40% to 97% of CMVseropositive lactating women. [7][8][9][10][11][12][13][14][15][16][17] In the United States, an estimated 58% of pregnancies occur among CMVseropositive women. 19 Because few data exist on the incidence of breast milk-acquired CMV infection and disease among premature infants, we conducted a systematic review and meta-analysis of studies reporting on postnatal CMV infection and disease presumably acquired via consumption of breast milk among very low birth weight (VLBW) and premature infants born to CMV-seropositive women but uninfected at birth.…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Systematic Reviewmentioning

confidence: 99%

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

et al. 2013

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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 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.

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Section: Resultsmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

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

et al. 2013

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“…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) .…”

Section: Resultsmentioning

confidence: 99%

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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“…Los factores de riesgo relacionados con la transmisión son la magnitud de la carga viral, la excreción viral precoz en la leche, la duración de la lactancia y los métodos de preservación de la leche. 2,5,[10][11][12] E l c i t o m e g a l o v i r u s e s u n v i r u s l á b i l que puede ser eliminado por altas o bajas temperaturas. La congelación a -12 º C reduce el riesgo de transmisión, pero no lo elimina por completo.…”

Section: -8unclassified

Infección sintomática por citomegalovirus a través de la lactancia materna en un niño de 45 días

et al. 2015

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Arch Argent Pediatr 2015;113(3):e145-e148 / e145Presentación de casos clínicos RESUMEN La infección posnatal o adquirida por citomegalovirus en el recién nacido se transmite por secreciones cervicales maternas en el parto, lactancia materna o transfusión de hemoderivados. La leche materna es la principal fuente de infección. Las manifestaciones clínicas dependen de la edad gestacional y el peso de nacimiento. Son más vulnerables los nacidos prematuros y de bajo peso. La infección posnatal, generalmente, es asintomática y suele resolverse de manera espontánea sin necesidad de tratamiento antiviral; el riesgo de secuelas a largo plazo es menor que en la infección congénita. Describimos el caso de un niño de 45 días de vida, nacido de término con peso adecuado para su edad gestacional, con un cuadro clínico muy poco frecuente caracterizado por plaquetopenia grave, secundario a una infección posnatal por citomegalovirus. Detallamos su forma de presentación, evolución clínica, diagnóstico y la terapéutica empleada. Palabras clave: infecciones por citomegalovirus, leche materna. ABSTRACTPostnatal infection or acquired cytomegalovirus in the newborn is transmitted by maternal cervical secretions at birth, breastfeeding, blood transfusion or biological fluids. Breast milk is the main source of infection. Clinical manifestations depend on the gestational age and birth weight, premature and low birth weight newborn being more vulnerable. Postnatal infection usually resolves spontaneously without antiviral treatment; the risk of long-term sequelae is lower than in congenital infection. We describe the case of a 45 days old male patient, term newborn appropriate for gestational age, with a very rare condition characterized by severe thrombocytopenia secondary to postnatal cytomegalovirus infection. We detail its symptoms, clinical evolution, diagnosis and treatment employed.

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Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk

Cited by 39 publications

References 19 publications

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

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

Breast Milk-Transmitted Cytomegalovirus Infection in Preterm Infants

Infección sintomática por citomegalovirus a través de la lactancia materna en un niño de 45 días

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