Literature review and an italian hospital experience about post-natal cmv infection acquired by breast-feeding in very low and/or extremely low birth weight infants

Research output: Contribution to journalReview articlepeer-review

Abstract

Breastfeeding is recommended for all neonates due to a known variety of beneficial effects, but infants can be infected by cell-associated bacteria and viruses from breast milk, such as cyto-megalovirus (CMV). The majority of CMV-seropositive breastfeeding women have a viral, self-re-stricted reactivation, can shed the virus in the milk for about 12 weeks after delivery, and can trans-mit the infection to their offspring. Post-natal CMV-infected term infants are mainly asymptomatic, while very low birth weight (VLBW, <1500 g) and extremely low birth weight (ELBW, <1000 g) infants may present with severe disease, short-term sequelae ranging from abnormalities in laboratory indexes to sepsis-like syndrome, and long-term sequelae such as developmental problems. Thus, the use of thermally treated maternal milk for VLBW/ ELBW infants may be indicated to prevent/re-duce the risk of CMV transmission. Different techniques, with varying efficacy in eradicating CMV and maintaining the activity of biological compounds in milk are available: long/short pasteuriza-tion, freeze-thawing, the use of microwaves, and ultraviolet-C irradiation. In our NICU, the use of maternal raw milk is always strongly recommended for term/preterm infants, but to reduce risk of CMV transmission, freeze-thawing mother’s own milk is used in neonates with GA ≤ 30 weeks or/and weight ≤ 1000 g, usually regardless of serological maternal condition, as CMV screening is not routinely offered to pregnant women and the milk of seroimmune mothers is not evaluated for CMV reactivation, as its rate is similar to seroprevalence. Over the last 4 years, we had 10 VLBW/ELBW newborns in our NICU with late-onset sepsis and negative cultures. In these cases, the research of CMV DNA in neonatal urine or saliva, for the diagnosis of post-natal symptomatic infection (once congenital transmission has been excluded) may be useful and not invasive. The take-home message we would like to share is that acquired CMV infection should be considered in VLBW/ELBW infants breastfed by seropositive mothers and presenting severe symptoms—partic-ularly sepsis with negative cultures. This could allow pediatricians to make better-quality diagno-ses, perform supportive therapy, provide antiviral treatment if needed, or establish a “pre-emptive” therapy for these high-risk neonates.

Original languageEnglish
Article number660
Pages (from-to)1-11
Number of pages11
JournalNutrients
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Breastfeeding
  • Post-natally acquired cytomegalovirus
  • Preterm infants

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics

Fingerprint

Dive into the research topics of 'Literature review and an italian hospital experience about post-natal cmv infection acquired by breast-feeding in very low and/or extremely low birth weight infants'. Together they form a unique fingerprint.

Cite this