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Breast Milk-acquired Cytomegalovirus Infection in Premature or Very Low Birth Weight Infants: A Systematic Review
Joana Valente Dias1,2,3, Mónica Marçal1,4, Madalena Tuna1,4
1From the Neonatal Intensive Care Unit, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
Insights
Cytomegalovirus (CMV) is common in mothers of premature infants. Breast milk can transmit CMV, leading to sepsis-like symptoms in these vulnerable newborns.
Area of Science:
- Neonatalogy
- Infectious Diseases
- Public Health
Background:
- Premature and very low birth weight infants face increased risks of postnatal cytomegalovirus (CMV) infection.
- CMV infection can manifest as a sepsis-like syndrome in these vulnerable infants.
- This review focuses on CMV infection acquired through breast milk in preterm infants born to CMV-positive mothers.
Conclusions:
- Significant CMV transmission risk via breast milk to high-risk infants.
- High CMV seropositivity and excretion rates observed in mothers of preterm infants.
- Balancing breast milk benefits against CMV transmission risks is crucial for these infants.
Background:
Premature and very low birth weight infants are at a greater risk of acquiring postnatal cytomegalovirus (CMV) infection and developing symptomatic disease, including a sepsis-like syndrome. This systematic review was designed to assess the burden of breast milk-acquired CMV infection and disease in premature or very low birth weight infants born to CMV-positive mothers.
Methods:
Studies reporting data on preterm infants born before 32 weeks of gestation and/or with birth weight less than 1500 g, published between 2002 and 2022, were included. Random effects meta-analysis was performed using R software.
Results:
Fourteen studies were included in the present review. The proportion of CMV seropositivity among the tested mothers was 75.9% (95% confidence interval [CI] 68.2-82.2), and 82.1% (95% CI 68.9-90.5) of seropositive mothers excreted CMV in breast milk. The proportion of infants acquiring postnatal CMV from CMV immunoglobulin (Ig)G-positive mothers was estimated to be 14.7% (CI 95% 9.6-21.8). Of all infants with postnatal CMV infection, 29.6% (CI 95% 20.8-40.1) presented with sepsis-like symptoms. Breast milk-handling methods varied widely among studies.
Conclusions:
We found a high CMV seropositivity and a high rate of CMV excretion in the breast milk of mothers of premature and very low birth weight infants. In these high-risk infants, the benefits of untreated breast milk should be considered, along with the risk of CMV transmission and severe disease.
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