Human Breast Milk-acquired Cytomegalovirus Infection: Certainties, Doubts and Perspectives

Abstract

Breast Milk (BM) is the best source of nutrition for newborns, especially if premature. In fact, its beneficial impact on short- and the long-term neonatal outcome has was deeply described.Unfortunately, BM could not be always so safe, especially due to the possible presence of maternal viruses that can be shed and transferred to the breastfed neonate. Among these, Cytomegalovirus (CMV) can potentially lead to a serious and acute illness, mostly in case of low gestational age.Some studies also report the association of CMV-acquired infection to an increased risk of structural and functional brain modifications and neurological impairment.Due to these reasons, a strategy to remove CMV from BM with a minimal or absent impact on its beneficial components would be desirable.Up to now, pasteurization, freezing, ultraviolet- C or microwave irradiation are the available techniques; they show different levels of efficacy and variable effects on BM composition, even if many studies are still needed to fully clarify these implications.In this review, we provide an update of the current evidence about these topics. We focus on the factors promoting CMV shedding through BM; moreover, the possible occurrence of a severe disease in preterm neonates is also described. Finally, we investigate the potential effects showed on BM properties by the strategies that prevent or reduce viral transmission, therefore influencing newborns’ health, and the new techniques which could show a relevant role in the next future, such as metabolomics.

Congenital and Perinatal Cytomegalovirus Infections in the Neonatal Period: Case Series

“…The estimated incidence of congenital CMV infections varies in developed and developing countries with rates in all live births ranging from 0.6 to 0.7% compared to a range between 1 and 5%, respectively. The high rates of estimated incidence in developing countries are associated with the high rates of maternal seroprevalence in these countries (5). The rate of congenital CMV infection from our country was reported as 0.2% (12).…”

“…Infection acquired during the intrapartum period from maternal cervical secretions or in the postpartum period from human milk is not usually associated with clinical illness in term infants. In preterm infants; however, postpartum infection resulting from human milk or from transfusion from CMV-seropositive donors has been associated with hepatitis, interstitial pneumonia, hematologic abnormalities including thrombocytopenia and leukopenia, and a viral sepsis syndrome (5,6). Antiviral therapy with ganciclovir and/or valganciclovir has been reported to be beneficial for improving neurodevelopmental sequelae and hearing outcomes of congenital CMV infection; however, treatment outcomes are not well reported (7,8).…”

How could metabolomics change pediatric health?

“…In conclusion, metabolomics could describe maternal and fetal status in congenital HCMV infection, allowing an early diagnosis and an accurate management [34], and, in our opinion, it could be also applied in the evaluation of breast milk acquired CMV infection [35].…”

High prevalence of breastmilk‐acquired cytomegalovirus infection in jaundiced infants

“…BM is the best source of nutrition for neonates. The American Academy of Pediatrics has reported that BM feeding is very important for babies ≤6 months old, and BM is irreplaceable, particularly in premature infants; thus, CMV infections via BM are worthy of research attention …”

“…The American Academy of Pediatrics has reported that BM feeding is very important for babies ≤6 months old, and BM is irreplaceable, particularly in premature infants; thus, CMV infections via BM are worthy of research attention. 7,8 As a common disease during the neonatal period, neonatal jaundice is mostly a physiological phenomenon during the normal growth process, but is occasionally a clinical manifestation of some latent disease.…”