Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants

Abstract

Background Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed. Methods To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995–1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine. Results Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003). Conclusions Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU. Clinical Trials Registration NCT01178905.

New short-term heat inactivation method of cytomegalovirus (CMV) in breast milk: impact on CMV inactivation, CMV antibodies and enzyme activities

“…In conclusion, our experiments demonstrate that short-term heat treatment for 5 s at a ramp temperature of 62°C may be the best compromise between the competing goals of CMV inactivation on one side, and preservation of enzyme activity and CMV-antibody binding and neutralisation capacity on the other side. To be on the very safe side concerning CMV inactivation, temperatures of 66°C and above should be used, although the wild-type experiments showed complete CMV inactivation beyond 60°C for 5 s. However, this study only provides in vitro data, but clinical CMV inactivation studies have also been successfully performed at 62°C for 5 s, even with larger amounts of up to 50 mL breast milk per pasteurisation procedure 33. The machine used for our experiments is commercially available and in clinical use in several German level 3 neonatal units capable of pasteurising up to 95 mL of breast milk per procedure.…”

Refractory Ileal Perforations in a Cytomegalovirus-Infected Premature Neonate Resolved After Ganciclovir Therapy

“…Since delay of diagnosis of CMV infection and initiation of treatment may limit the efficacy of anti-viral therapy in neonates with such end-organ diseases, particularly in which CMV is regarded as a rare causative etiology ( 20 ), development and implementation of screening programs for identification of congenital CMV infection, using maternal serologic testing and potentially newborn blood spots obtained for the metabolic screen, could aid in identifying CMV as a causative etiology for severe end-organ diseases and improving outcome in the affected infants ( 5 , 8 , 28 ). Since postnatal infection of CMV from fresh breast milk also cause such severe illnesses in neonates ( 4 , 6 , 29 ), the technique including pasteurization of breast milk from CMV-seropositive mother may also be an option for high risk infants as extremely preterm infants considering the potential benefit of fresh human milk vs. the risk of CMV transmission ( 30 , 31 ). Finally, the ultimate control of CMV disease in newborns will most likely depend upon the development of an effective vaccine, which, if administered to young women prior to their child-bearing years, could reduce the burden associated with this important public health problem even in premature infants ( 32 ).…”

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

“…However, short-term pasteurisation (5 s at 62°C) may be a viable alternative. In a prospective interventional cohort study of 87 preterm infants <32 weeks,15 only 2 out of 87 infants (2.3%) had a pCMV transmission in the pasteurisation group, compared with 17 out of 83 (20.5%) in a historical control group.…”