Case-control study of symptoms and neonatal outcome of human milk-transmitted cytomegalovirus infection in premature infants.
OBJECTIVE
Preterm infants are at risk of acquiring human cytomegalovirus (CMV) infection through breast milk transmission, possibly leading to serious symptoms, as suggested by previous studies. Over a period of 8.5 years, we compared infants infected postnatally with CMV with noninfected controls to determine whether CMV infection transmitted through breast milk poses serious acute risks.


METHODS
CMV monitoring included maternal serologic testing and biweekly viral culture and polymerase chain reaction in breast milk and infant urine. Clinical and laboratory test findings were assessed retrospectively in infected infants and controls matched for gestational age during the initial hospital stay.


RESULTS
Forty CMV-infected infants met the study criteria. They had lower minimal platelet and neutrophil counts and a higher frequency of C-reactive protein (CRP) elevations to 10 to 20 mg/L than their matched controls (P < or = .001). But no association of CMV infection with bronchopulmonary dysplasia, necrotizing enterocolitis, growth, or CRP elevations to > 20 mg/L was found. Cholestasis appeared in 3 infants in the CMV-infected group, but disappeared within 10 weeks.


CONCLUSIONS
Neonatal symptoms related to postnatal CMV infection were transient and had no affect on neonatal outcome in these infants, in contrast with uncontrolled reports. Whether withholding or pasteurizing breast milk is warranted, however, depends on long-term outcome.
Neuberger
Patrick
P
Department of Neonatology, University Children's Hospital and Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital, Tuebingen, Germany.
Hamprecht
Klaus
K
Vochem
Matthias
M
Maschmann
Jens
J
Speer
Christian P
CP
Jahn
Gerhard
G
Poets
Christian F
CF
Goelz
Rangmar
R
D001942:Breast Feeding / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D002779:Cholestasis / Q000175:diagnosis; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000635:transmission*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D018445:Infectious Disease Transmission, Vertical; D007442:Intubation, Intratracheal; D008297:Male; D008895:Milk, Human / Q000821:virology*; D009504:Neutrophils / Q000378:metabolism; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000378:metabolism
D002097:C-Reactive Protein