Breast milk-acquired cytomegalovirus infection and disease in VLBW and premature infants

Tatiana M. Lanzieri, Sheila C. Dollard, Cassandra D. Josephson, Scott Schmid, Stephanie R. Bialek

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)e1937-e1945
JournalPediatrics
Volume131
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Breast milk
  • Cytomegalovirus
  • Premature infant
  • Sepsis-like syndrome
  • Very low birth weight infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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