Perinatal or early postnatal infection with cytomegalovirus (CMV) in preterm newborn infants fed with non processed maternal milk

• Grant number: 07/07315-6
• Support Opportunities: Regular Research Grants
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Marisa Marcia Mussi
• Grantee: Marisa Marcia Mussi
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

Although human milk bring several advantages for preterm infants feeding, mainly to those of very low birth weight, it has been recognized that it can represent a source of CMV transmission. Potentially, Infection by this agent can cause disease such as liver disease, worsening respiratory function, neutropenia, trombocytopenia and deterioration of the clinical condition - sepsis like syndrome. CMV seropositivity is high among Brazilian women of fertile age. Estimates show that 90 to 95% of pregnant women have already been infected by this virus. It is known that approximately 98% of seropositive women shed CMV in milk. This excretion, which can begin after delivery, is detected in most nursing women with high virolactia by 4-6 weeks after birth. It is likely that findings from studies performed in developed countries, with lower seroprevalence rates, that has suggested the need of avoidance of own milk of seropositive mothers to their preterm babies without previous processing, are not applicable to the CMV epidemiology in our country. Study done by our research group has shown that even low gestational age preterm infants receive neutralizing maternal antibodies in proportional amounts to maternal levels. Brazilian women are naturally boosted due to the frequent exposition and reinfection with CMV, and their antibody levels available for transplacental transference are high. It is likely that feeding preterm babies with raw maternal milk will not harm these infants.This study aim to evaluate the frequency and relevance of CMV postnatal infection in preterm infants with <32 weeks of gestational age who receive non pasteurized human milk obtained from the seropositive women. Also, we intend to verify the effect of DNAlactia and infant neutralizing antibodies on the incidence of CMV infection, and on clinical and laboratory findings of CMV-infected infants. Preterm infants with <32 weeks of gestational age will be evaluated at beginning of feeding with maternal raw milk and weekly until hospital discharge. CMV infection will be diagnosed by detection of CMV-DNA on saliva. Infected babies will be compared to uninfected ones, and babies born to CMV-seronegative mothers. Clinical findings, laboratory findings related to possible effects of CMV on different body sites, DNAlactia showing the exposition extent, and anti-CMV antibody levels passively acquired will be compared among groups.The study hypotheses are the following:1) Perinatal or early post-natal CMV infection in Brazilian preterm infants born to CMV-seropositive women and cared for in neonatal intensive care units has modest clinical effect during the hospitalization period, and does not justify the substitution of raw maternal milk by pasteurized human milk. 2) Occurrence of infection and disease during the hospitalization of preterm infants is associated to higher DNAlactia and/or to lower titers of passively acquired neutralizing antibodies and/or the lower own neutralizing antibody production. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

MARTINS-CELINI, FABIA PEREIRA; YAMAMOTO, APARECIDA YULIE; PASSOS, DEBORA MANZIONE; DO NASCIMENTO, SUELY DORNELLAS; LIMA, EDINEIA VACILOTO; DI GIOVANNI, CELIA MARA; SEVILLA QUADRADO, ELLEN REGINA; BARTA, ROBERTA; ARAGON, DAVI CASALE; DO PRADO, SEILA ISRAEL; et al. Incidence, Risk Factors, and Morbidity of Acquired Postnatal Cytomegalovirus Infection Among Preterm Infants Fed Maternal Milk in a Highly Seropositive Population. Clinical Infectious Diseases, v. 63, n. 7, p. 929-936, OCT 1 2016. (07/07315-6)