Postnatally acquired cytomegalovirus infection in extremely premature infants: how best to manage?

Abstract

Postnatal cytomegalovirus (pCMV) infection is a common viral infection typically occurring within the first months of life. pCMV refers to postnatal acquisition of CMV rather than postnatal manifestations of antenatal or perinatal acquired CMV. pCMV is usually asymptomatic in term infants, but can cause symptomatic disease in preterm (gestational age <32 weeks) and very low birth weight (<1500 g) infants resulting in sepsis, pneumonia, thrombocytopaenia, neutropaenia, hepatitis, colitis and occasionally death. There are significant uncertainties regarding the management of premature infants with pCMV disease which is in part due to our limited understanding of the natural history of this disease. This review describes the current epidemiology and clinical manifestations of pCMV disease which should alert clinicians to test for CMV and also outlines a strategy to manage the condition.

Postnatally cytomegalovirus‐infected infant with repeated bacterial sepsis

“…reported that microwave irradiation at 500 W for 40 s is a practical method for the prevention of CMV infection via breast milk 5 . Based on this case, we started Holder pasteurization (63 °C for 30 min) of breast milk to completely inactivate CMV for extremely premature infants from mothers in whom CMV infection was not completely excluded, although it may reduce the nutritional, immunological, and endocrinological properties 2 …”

Impact of breast milk‐acquired cytomegalovirus infection in premature infants: Pathogenesis, prevention, and clinical consequences?

“…In breast milk-acquired pCMV, antiviral therapy in symptomatic infants may be useful in reduction of the severity of symptoms and the duration of illness. 81 Other potential interventions that could be conceived of would include administration of high-titer anti-CMV immune globulin to high-risk infants, or therapeutic vaccination of lactating mothers of VLBW premature infants, toward the goal of augmenting CMV immunity in milk. This approach would require licensure of a CMV vaccine, and elucidation of the aspects of protective immunity that prevent pCMV transmission to VLBW infants.…”

“…Since recent reports have emerged in cCMV that long‐term oral nucleoside therapy improves neurodevelopmental outcomes, the use of these agents may be of considerable therapeutic importance for pCMV infection, if the impact on neurodevelopmental outcomes can be confirmed in future prospective studies. In breast milk‐acquired pCMV, antiviral therapy in symptomatic infants may be useful in reduction of the severity of symptoms and the duration of illness 81 . Other potential interventions that could be conceived of would include administration of high‐titer anti‐CMV immune globulin to high‐risk infants, or therapeutic vaccination of lactating mothers of VLBW premature infants, toward the goal of augmenting CMV immunity in milk.…”

“…The recent licensure of point-of-care diagnostic assays for saliva-based screening could be useful in identifying VLBW infants that acquire CMV infection in this setting, and such infants could be managed and monitored expectantly for emergence of CMV disease and/or sequelae 80. Other strategies for management, such as ensuring exclusion of cCMV by newborn dried blood spot analysis and monitoring infants with clearcut pCMV acquisition for end-organ complications, deserve future evaluation 81. 3.2 | Antiviral therapyAnother aspect of control of pCMV that remains even less clear is the role of antiviral therapy with ganciclovir or immune globulin for the prevention or therapy of breast milk-acquired infection.…”

Retrospectively diagnosing congenital cytomegalovirus infections in symptomatic infants is challenging

“…infections is critical, as the long-term complications and treatment recommendations differ significantly. [10][11][12] Proving a congenital CMV infection requires the detection of viral shedding or the presence of viral deoxyribonucleic acid (DNA) in the newborn infant within 3 weeks of birth. 10,11 If CMV is detected later in life, it could be the result of either congenital CMV or postnatal CMV infections.…”