Breast Milk-Acquired Cytomegalovirus Infection and Disease in Very Low Birth Weight and Premature Infants

• Type of Material: Article
• Authors: Tatiana M Lanzieri, Centers for Disease Control and Prevention; Sheila C Dollard, Centers for Disease Control and Prevention; Cassandra Josephson, Emory University; D Scott Schmid, Centers for Disease Control and Prevention; Stephanie Bialek, Emory University
• Language: English
• Date: 2013-06-01
• Publisher: American Academy of Pediatrics
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013, American Academy of Pediatrics
• Final Published Version (URL): http://dx.doi.org/10.1542/peds.2013-0076
• Title of Journal or Parent Work: Pediatrics
• Volume: 131
• Issue: 6
• Start Page: E1937
• End Page: E1945
• Grant/Funding Information: No external funding was used for this study.
• Keywords: Life Sciences & Biomedicine; PRETERM INFANTS; PREVENTION; UNITED-STATES; TERM; BIRTH-WEIGHT INFANTS; MOTHER; Pediatrics; sepsis-like syndrome; cytomegalovirus; TRANSMISSION; breast milk; very low birth weight infant; POPULATION; RISK; STORAGE; premature infant; Science & Technology

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 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.