Low birth weight infants at increased risk of CMV transmitted through breast milk

מתוך medicontext.co.il
NEW YORK (Reuters Health) – Extremely low-birth weight infants are at high risk of acquiring a symptomatic cytomegalovirus (CMV) infection when they receive breast milk from CMV-positive mothers, according to a report by German investigators.

Dr. Jens Maschmann and colleagues, from the University of Tubingen, characterized the seroprevalence and transmission rate of postnatal CMV and the clinical symptoms of infection in 170 very low birth weight infants over a 3-year period. The infants' feedings were supplemented with breast milk from their mothers.

No CMV transmission occurred in the 80 infants who received milk from CMV-negative mothers. Transmission also did not occur in three infants whose mothers were CMV-positive but did not shed CMV DNA into their milk.

CMV was transmitted to 33 of the 87 infants who received CMV-containing milk, the authors note. Furthermore, roughly half of these infants developed clinically important manifestations such as hepatopathy, neutropenia, thrombocytopenia, and sepsis-like deterioration.

Logistic regression analysis revealed that birth weight and the age at initial virus detection were both inversely associated with the risk of symptomatic infection, the authors note in the December 15th issue of Clinical Infectious Diseases.

To prevent postnatal CMV transmission, breast milk must be processed to inactivate the CMV without reducing the milk's beneficial properties. Holder treatment and freezing are only partially effective in this regard. The gold standard is short-term pasteurization, but the components required for this procedure are not commercially available.

"The dilemma of how to treat the milk of CMV seropositive mothers is still unsolved, but we think that, for more than psychological reasons, the use of the mother's own breast milk should not be refused," Dr. Maschmann's team emphasizes.

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