title: High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk.
abstract: BACKGROUND
  Very immature preterm infants are at risk of developing symptomatic or severe infection if cytomegalovirus is transmitted via breast milk. It is still a matter of debate whether human cytomegalovirus (HCMV) infection may lead to long-term sequelae.
  
  
  OBJECTIVE
  We hypothesized that symptomatic and severe HCMV infection transmitted via breast milk affects extremely immature infants at a very high rate.
  
  
  METHODS
  In 2012, untreated breast milk was fed to extremely low birth weight infants after parental informed consent was obtained. We retrospectively analyzed data on HCMV infection of infants born in 2012 between 22 and 24 weeks of gestation.
  
  
  RESULTS
  17 infants were born to HCMV IgG-seropositive mothers. 11 (65%) of these were diagnosed with symptomatic infection. In all cases, thrombocytopenia was the reason to analyze the infant's urine. HCMV infection was diagnosed at a median time of 12 weeks after birth. In 5 (45%) infants, thrombocytopenia was the only symptom and resolved without antiviral therapy or platelet transfusion. 6 (55%) infants developed sepsis-like disease with mildly elevated CRP values and showed signs of respiratory failure. 3 (27%) were able to be stabilized on CPAP, 3 (27%) had to be intubated and mechanically ventilated. 4 children were treated with ganciclovir and/or valganciclovir. 55% failed otoacoustic emissions and/or automated auditory brainstem response testing at discharge.
  
  
  CONCLUSIONS
  In very immature infants born at the border of viability and suffering from multiple preexisting problems, HCMV infection may trigger a severe deterioration of the clinical course.
authors.affiliation: Department of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Mehler
authors.forename: André
authors.initials: A
authors.lastname: Oberthuer
authors.forename: Ruth
authors.initials: R
authors.lastname: Lang-Roth
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001942:Breast Feeding; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000628:therapy / Q000635:transmission*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D062071:Infant, Extremely Premature; D008895:Milk, Human / Q000821:virology*; D017713:Platelet Transfusion; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents