Yonsei Med J.  2015 Jul;56(4):998-1006. 10.3349/ymj.2015.56.4.998.

Prevention of Cytomegalovirus Transmission via Breast Milk in Extremely Low Birth Weight Infants

• Yoo HS
• Sung SI
• Jung YJ
• Lee MS
• Han YM
• Ahn SY
• Chang YS
• Park WS

• KMID: 2366341
• DOI: http://doi.org/10.3349/ymj.2015.56.4.998

Abstract

PURPOSE
Extremely low birth weight infants (ELBWIs) have a high risk of acquiring cytomegalovirus (CMV) infection via breast milk and consequently developing serious symptoms. We evaluated whether freeze-thawing or pasteurization could prevent postnatal CMV infection transmitted through breast milk in ELBWIs.
MATERIALS AND METHODS
Medical records of 385 ELBWIs with whole milk feeding, and freeze-thawed or pasteurized breast milk feeding were reviewed retrospectively. Postnatally acquired CMV infection was defined as an initial negative and a subsequent positive on follow-up urine CMV DNA polymerase chain reaction screening tests. The incidence, clinical characteristics, symptoms, sequelae, and long-term outcome at corrected age [(CA): 2 years of CMV infection] were analyzed.
RESULTS
While no infant developed CMV infection with whole milk (0/22) or pasteurized breast milk (0/62) feeding, postnatal CMV infection was diagnosed in 8% (27/301) of ELBWIs who were fed freeze-thawed breast milk. Gestational age in the CMV group was significantly lower than the control group. In 82% (22/27) of cases, CMV infection was symptomatic and was associated with increased ventilator days and > or =moderate bronchopulmonary dysplasia (BPD). Neurodevelopmental outcome and growth status at CA 2 years were not different between the study groups. Lower gestational age and freeze-thawed breast milk feeding >60% of total oral intake during the first 8 postnatal weeks were independent risk factors for acquiring postnatal CMV infection. BPD (> or =moderate) was the only significant adverse outcome associated with this CMV infection.
CONCLUSION
Pasteurization but not freeze-thawing of breast milk eradicated the postnatal acquisition of CMV infection through breast milk.

Keyword

Cytomegalovirus; infant, extremely low birth weight; milk, human; pasteurization; freezing

MeSH Terms

Adult
Breast Feeding
Bronchopulmonary Dysplasia
Cytomegalovirus/*isolation & purification
Cytomegalovirus Infections/epidemiology/prevention & control/*transmission
Female
Gestational Age
Humans
Incidence
Infant
*Infant, Extremely Low Birth Weight
Infant, Newborn
Infectious Disease Transmission, Vertical/*prevention & control
Male
Milk, Human/chemistry/*virology
Polymerase Chain Reaction
Pregnancy
Pregnancy Complications, Infectious/diagnosis
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Diagram showing enrollment and follow up of study patients during period I and II. ELBWI, extremely low birth weight infant; CMV, cytomegalovirus.

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