Cytomegalovirus transmission to preterm infants during lactation

Hamprecht, Klaus; Maschmann, Jens; Jahn, Gerhard; Poets, Christian F.; Goelz, Rangmar

doi:10.1016/j.jcv.2007.12.005

Cited by 154 publications

(139 citation statements)

References 49 publications

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“…Frozen-thawed breast milk may decrease the rate of vertical CMV infection and severe disease, although this method cannot completely prevent severe sepsis-like symptoms and necrotizing enterocolitis in rare cases. 5 …”

Section: Discussionmentioning

confidence: 99%

“…4 However, recent studies reporting that postnatal CMV infections in premature infants cause serious clinical symptoms including respiratory compromise, neutropenia, thrombocytopenia, hepatomegaly and septic syndromes have renewed interest in the effects of this pathogen in the immediate postnatal period. [5][6][7] Postnatal CMV infection can be acquired through transfused blood, ingestion of infected body fluids such as maternal cervical secretions during the birthing process and breast milk; shedding of CMV in breast milk may represent the main source of postnatal infections. 1 In premature infants, especially extremely premature infants, breast milk is important because it contains protective nutritional and immunological factors.…”

Section: Introductionmentioning

confidence: 99%

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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: 99%

Section: Introductionmentioning

confidence: 99%

Transmission of cytomegalovirus via breast milk in extremely premature infants

et al. 2010

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“…[5][6][7] In premature infants, the transmission of protective maternal antibodies starting within the 29th gestational week is missing, which puts them at high risk for symptomatic infection transmitted via breast milk. 8 In a study of CMVseropositive mothers, in 87% of the cases, virus was detectable in breast milk with transmission occurring in 22,8% premature infants and leading symptomatic disease in 0-34.5% of them.…”

Section: Discussionmentioning

confidence: 99%

“…7 Studies have shown that 'Holder' pasteurization (pasteurization for 30 min at 62.5 1C) or freezing breast milk at À20 1C may reduce CMV viral titers and infectivity. 5 However, in our unit, fresh breast milk was exclusively used for feeding. Because the high seroprevelance of CMV in our population, 9 and the use of filtered and irradiated blood products, our patient seems to acquire CMV from his mother's breast milk which has high CMV DNA copy.…”

Section: Discussionmentioning

confidence: 99%

Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

et al. 2011

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Cytomegalovirus (CMV) infection is the most common intrauterine and perinatal viral infection. Postnatal CMV infection is acquired mainly from breast milk and may cause severe illness in preterm infants. We report an extremely low birth weight infant who presented with a sepsis-like syndrome and multiple organ involvement, notably hepatitis and pneumonitis, and treated with ganciclovir without adverse effect or relapse. Journal of Perinatology (2012) 32, 72-74; doi:10.1038/jp.2011 Keywords: postnatal; cytomegalovirus; infection; low birth weight infant Introduction Acquisitiıon of cytomegalovirus (CMV) may occur by either prenatal infection in utero, resulting in congenital CMV infection, or by perinatal acquisition, during either the labor and delivery process, via blood transfusion or by breast milk. There is considerable evidence showing that the shedding of the virus into breast milk is the main source of postnatal CMV infection in infants. 1,2 Most acquired CMV infections in term infants are asymptomatic or manifest as a self-limited disease. In premature neonates, postnatal CMV infection can lead potentially lifethreatening problems. Only few cases of postnatal CMV multisystem infection with severe course have been reported. 3,4 Treatment of the postnatal CMV infection of the premature neonate and therapeutic options remain controversial. We report an extremely low birth weight infant with postnatal CMV infection presented with sepsislike symptoms, hepatitis, pneumonitis, and showed recovery under antiviral treatment. CaseA 24-year-old mother was admitted to the hospital with premature rupture of membranes and chorioamnionitis. At 28 gestation weeks, a male infant weighing 880 g was delivered by cesarean section. The baby received surfactant replacement, high-frequency oscillation ventilation for refractory respiratory failure. Enteral feeding with breast milk was initiated at day of life (DOL) 1. On DOL 35, he was still on nasal continuous positive airway pressure, and his respiratory condition deteriorated with the increase of tracheal secretions. He had also distended abdomen with hepatomegaly, diminished activity and gray pallor of the skin. Laboratory analysis showed pancytopenia, increased C-reactive protein, direct bilirubin (15.8 mg dl À1 at the highest) and liver enzymes levels (aspartate aminotransferase, alanine aminotransferase and g-glutamyl transpeptidase levels were 354, 148 and 236 U l À1 at the highest, respectively). Chest X-ray revealed new alveolar infiltrations. Broad-spectrum antibiotics were initiated after obtaining cultures from blood, cerebrospinal fluid, tracheal aspirate and urine. CMV immunoglobulin M and immunoglobulin G were positive. By the quantitative PCR analysis of CMV DNA copy numbers in plasma, urine and tracheal aspiration samples were 2 Â 10 6 , 1.7 Â 10 6 and 3.7 Â 10 6 copies ml À1 , respectively. Cerebrospinal fluid was negative for CMV DNA. PCR testing for CMV on specimen of blood in Guthrie card taken on DOL 8 for neonatal screening was negative. The mother was ...

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“…Postnatal infection can be transmitted through vaginal secretions, contact with infected individuals excreting virus, blood transfusions, or most commonly via breast milk. 1 Usually the course of the disease in term neonates is asymptomatic, whereas in prematures or in immunocompromised infants the disease can lead to a broad spectrum of symptoms, including potentially life-threatening disease. 2 We report the case of postnatal CMV infection in a term neonate.…”

Section: Introductionmentioning

confidence: 99%