title: Breast milk-acquired cytomegalovirus infection and disease in VLBW and premature infants.
abstract: BACKGROUND
  Very low birth weight (VLBW) and premature infants are at risk for developing postnatal cytomegalovirus (CMV) disease, including CMV-related sepsis-like syndrome (CMV-SLS) for which estimates [corrected] in the United States are lacking.
  
  
  METHODS
  We performed a systematic review and meta-analysis to estimate the pooled proportions (and 95% confidence intervals) of VLBW and premature infants born to CMV-seropositive women with breast milk-acquired CMV infection and CMV-SLS. We combined these proportions with population-based rates of CMV seropositivity, breast milk feeding, VLBW, and prematurity to estimate annual rates of breast milk-acquired CMV infection and CMV-SLS in the United States.
  
  
  RESULTS
  In our meta-analysis, among 299 infants fed untreated breast milk, we estimated 19% (11%-32%) acquired CMV infection and 4% (2%-7%) developed CMV-SLS. Assuming these proportions, we estimated a rate of breast milk-acquired CMV infection among VLBW and premature infants in the United States of 6.5% (3.7%-10.9%) and 1.4% (0.7%-2.4%) of CMV-SLS, corresponding to 600 infants with CMV-SLS in 2008. Among 212 infants fed frozen breast milk, our meta-analysis proportions were 13% (7%-24%) for infection and 5% (2%-12%) for CMV-SLS, yielding slightly lower rates of breast milk-acquired CMV infection (4.4%; 2.4%-8.2%) but similar rates of CMV-SLS (1.7%; 0.7%-4.1%).
  
  
  CONCLUSIONS
  Breast milk-acquired CMV infection presenting with CMV-SLS is relatively rare. Prospective studies to better define the burden of disease are needed to refine guidelines for feeding breast milk from CMV-seropositive mothers to VLBW and premature infants.
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. tmlanzieri@cdc.gov
authors.forename: Tatiana M
authors.initials: TM
authors.lastname: Lanzieri
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Dollard
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Josephson
authors.forename: D Scott
authors.initials: DS
authors.lastname: Schmid
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Bialek
mesh_terms: D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000635:transmission*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000276:immunology*; D019102:Infant, Very Low Birth Weight / Q000276:immunology*; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000821:virology*; D016036:Seroepidemiologic Studies; D014481:United States / Q000453:epidemiology
keywords: breast milk; cytomegalovirus; premature infant; sepsis-like syndrome; very low birth weight infant