Incidence of Postnatal CMV Infection among Breastfed Preterm Infants: a Systematic Review and Meta-analysis

Area of Science:

• Neonatalogy
• Infectious Diseases
• Public Health

Background:

• Cytomegalovirus (CMV) is a common virus that can be transmitted through breast milk.
• Preterm infants, especially those born to CMV-seropositive mothers, are at increased risk of postnatal CMV infection.
• Breast milk is a primary source of postnatal CMV transmission in this vulnerable population.

Purpose of the Study:

• To systematically review and meta-analyze the incidence of breast milk-acquired CMV infection in preterm infants.
• To evaluate the risk factors associated with CMV infection via breast milk in this population.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane Library.
• Inclusion of studies reporting CMV status and breastfeeding in preterm infants.
• Meta-analysis of data from 19 studies, including 2,502 newborns.

Main Results:

• The overall incidence of postnatally acquired CMV infection in breastfed preterm infants from CMV-seropositive mothers was 16.5%.
• CMV infection rates varied by milk preparation: 26% with fresh, 11% with freeze-thawed, and 8% with combined fresh/freeze-thawed milk.
• CMV shedding into breast milk was observed in 80.5% of CMV-seropositive mothers.

Conclusions:

• Breast milk-acquired CMV infection is a significant concern in preterm infants of CMV-seropositive mothers.
• Fresh breast milk is associated with a higher CMV infection rate compared to freeze-thawed or combined preparations.
• Cautious recommendation for using freeze-thawed breast milk over fresh for preterm and VLBW infants pending further research.