Incidence, Risk Factors, and Morbidity of Acquired Postnatal Cytomegalovirus Infection Among Preterm Infants Fed Maternal Milk in a Highly Seropositive Population

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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 ; Branco de Almeida, Maria Fernanda ; Mussi-Pinhata, Marisa Marcia

• Document type: Journal article
• Source: Clinical Infectious Diseases; v. 63, n. 7, p. 929-936, OCT 1 2016.
• Web of Science Citations: 5

Abstract

Preterm infants born to mothers with high cytomegalovirus (CMV) seroprevalence are as frequently infected as those born to mothers with lower seroprevalence. CMV infection contributes to an uneven clinical course, severe stages of retinopathy of prematurity (ROP), and even death.Methods.aEuro integral A cohort of 188 a parts per thousand currency sign30-week-old infants was monitored from admission to discharge. CMV-DNA, hematology, liver enzymes, neutralizing antibodies, and CMV-DNA-lactia were tested periodically. Results.aEuro integral Mothers of 157 infants (83.5%) were CMV-seropositive. A total of 24/157 (15.3%) infants became infected (95% confidence interval {[}CI], 9.8-22.6), particularly those of lower gestational age (GA; relative risk {[}RR], 2.32; 95% CI, 1.01-5.34 for 23-26 weeks). Low (< 1:64) neutralizing antibody titers were similarly detected in CMV-infected and uninfected infants. Mean DNA-lactia in mothers was higher in CMV-infected than in uninfected infants (5.34 log vs 4.60 log). Clinical findings suggestive of CMV disease were similar in CMV-infected (50.0%) and CMV-uninfected (51.1%) infants. Although transitory, > 2 laboratory test abnormalities occurred more frequently among CMV-infected (39.1%) than CMV-uninfected (2.1%) infants. More severe stages of retinopathy of prematurity (ROP) were found among CMV-infected infants (adjusted RR, 2.51; 95% CI, 1.07-5.91). Although deaths were more frequent among infected infants, none of the deaths could be directly attributed to CMV. Conclusions.aEuro integral Postnatal CMV infection acquired by exposure to raw maternal milk is very frequent among extremely premature newborns, being facilitated by high DNA-lactia and lower GA, regardless of maternally acquired neutralizing antibody levels. The association with advanced stages of ROP is a concern and needs to be further explored in larger studies. (AU)

• FAPESP's process: 07/07315-6 - Perinatal or early postnatal infection with cytomegalovirus (CMV) in preterm newborn infants fed with non processed maternal milk
• Grantee: Marisa Marcia Mussi
• Support Opportunities: Regular Research Grants