Case-control study of symptoms and neonatal outcome of human milk-transmitted cytomegalovirus infection in premature infants

OBJECTIVE: Preterm infants are at risk of acquiring human cytomegalovirus (CMV) infection through breast milk transmission, possibly leading to serious symptoms, as suggested by previous studies. Over a period of 8.5 years, we compared infants infected postnatally with CMV with noninfected controls to determine whether CMV infection transmitted through breast milk poses serious acute risks. STUDY DESIGN: CMV monitoring included maternal serologic testing and biweekly viral culture and polymerase chain reaction in breast milk and infant urine. Clinical and laboratory test findings were assessed retrospectively in infected infants and controls matched for gestational age during the initial hospital stay. RESULTS: Forty CMV-infected infants met the study criteria. They had lower minimal platelet and neutrophil counts and a higher frequency of C-reactive protein (CRP) elevations to 10 to 20 mg/L than their matched controls (P < or = .001). But no association of CMV infection with bronchopulmonary dysplasia, necrotizing enterocolitis, growth, or CRP elevations to > 20 mg/L was found. Cholestasis appeared in 3 infants in the CMV-infected group, but disappeared within 10 weeks. CONCLUSIONS: Neonatal symptoms related to postnatal CMV infection were transient and had no affect on neonatal outcome in these infants, in contrast with uncontrolled reports. Whether withholding or pasteurizing breast milk is warranted, however, depends on long-term outcome.     

围生期巨细胞病毒感染5年临床总结

目的 研究围生期巨细胞病毒(CMV)感染的的发病情况、临床特征、治疗及影响更昔洛韦疗效的因素。方法 回顾性分析2008~2012年237例临床诊断为围生期CMV感染的住院患儿的临床资料。结果 5年间围生期CMV感染患儿基本特征及占同期总住院患儿的比例无明显差异。患儿多为2个或2个以上系统受累,CMV肝炎合并CMV肺炎(43.1%)为最常见的临床类型。病原学检测结果提示血CMV-IgM及血/尿CMV-DNA均阳性为3.8%,仅血CMV-IgM阳性为90.3%,仅血/尿CMV-DNA阳性为5.9%。197例患儿接受了更昔洛韦治疗,治愈率为88.3%。母孕史异常(OR=6.191,95% CI:1.597~24.002)和用药前患儿肝脏受累(OR=3.705,95% CI:1.537~8.931)是影响更昔洛韦对围生期CMV感染患儿疗效的独立危险因素。结论 围生期CMV感染近5年的流行病学特征较为稳定。CMV常侵犯多个脏器或系统,以肝肺损害最常见。更昔洛韦治疗围生期CMV感染疗效明显;母孕史异常和用药前患儿肝脏受累会增加围生期CMV患儿对更昔洛韦耐药的风险。     

Transmission of cytomegalovirus from mothers to preterm infants by breast milk

OBJECTIVES: To assess the risk of transmission of cytomegalovirus (CMV) by breast milk from CMV-seropositive mothers to their breast-fed preterm infants and to evaluate their outcome. PATIENTS AND METHODS: The study population comprised breast-fed preterm infants with a birth weight of <1,500 g and gestational age of <35 weeks. Venous blood samples from the mothers and infants were tested for CMV IgG and IgM antibodies on the 5th and 30th day after birth. Breast milk was obtained for CMV DNA detection by polymerase chain reaction and viral culture on the 5th day and on the 3rd, 6th and 12th week. Urine samples of the babies were collected at the same time for CMV culture. Neurodevelopmental assessment was done at 6 months of age, corrected for preterm birth. RESULTS: Thirty-eight mothers and 42 infants (including 4 sets of twins) were enrolled in the study. A mother-infant pair was excluded because of inadequate breast milk collection. Thirty-six mothers (97.3%) were CMV-seropositive. CMV DNA of breast milk was detected in 35 seropositive mothers. Six infants of 5 mothers were infected (infected group) at a mean of 77 days after birth, and 34 infants of 31 mothers were not (noninfected group). In all the mothers of the infected group, CMV virus could be cultured from the milk whey. The average maternal CMV IgG on day 5 after delivery was higher in the infected than in the noninfected group. Sepsis-like symptoms and hyperbilirubinemia were more frequently noted in the infected infants than in the noninfected, but the difference was not statistically significant. Neurodevelopmental outcome did not significantly differ between the 2 groups. CONCLUSIONS: The risk of CMV infection in breast-fed premature infants was highest when the mothers shed viable virus in their breast milk. These mothers had high CMV IgG, which may help identify those mother-infant pairs at risk. Inactivation of the virus in milk by freezing may be a way of reducing the transmission of this virus via breast milk.     

Transmission du cytomégalovirus par le lait maternel cru aux enfants prématurés : étude épidémiologique pilote

Transmission of cytomegalovirus (CMV) infection from mothers to preterm infants during breastfeeding may be symptomatic and long term consequences are unknown. This study evaluated the kinetics of CMV load in breastmilk and the rate of postnatal CMV transmission via breastmilk from mothers to their preterm infants.MethodsProspective study of mother-child pairs after preterm delivery before 33 weeks. Exclusion of donor breast milk and of CMV-seropositive blood products. Material used was maternal CMV serostatus, ear swab of the infant at birth, weekly screened breast milk and children's urine by rapid viral culture.ResultsDuring a 5-month period 28 mother-infant pairs with 34 preterm infants were studied. Eighteen women (64.3%) were CMV-seronegative at birth; breastmilk samples and the infants' urine remained CMV-negative. Eight of the 10 seropositive mothers, who had 11 preterm infants, excreted CMV into breast milk (80%). CMV excretion into breast milk was detected during the first week after delivery in 66% cases and was at its peaked between 3 to 5 weeks after delivery. Out of the 7 CMV-exposed infants, CMV transmission was confirmed in only one asymptomatic case. Total quantity of breast milk intake did not seem discriminative for CMV transmission.ConclusionIn CMV-seropositive mothers of preterm infants a high incidence of CMV excretion into breast milk was detected. Despite this high rate, symptomatic infection did not occur. However, potential risk and severity of infection may be difficult to establish. Because breastfeeding is beneficial, new procedures for gentle virus inactivation of seropositive breast milk should be assessed.     

Transmission of cytomegalovirus to extremely preterm infants through breast milk

AIM: To evaluate the rate and clinical expression of postnatal cytomegalovirus (CMV) infection transmitted through breast milk in extremely preterm infants. METHODS: Ten extremely preterm infants and their six mothers were included. Maternal CMV serology was determined. Breast milk samples and urine samples from the infants were screened for CMV. Symptoms and laboratory findings of CMV infected infants were documented. All infants received partly fresh and/or defrosted breast milk. RESULTS: CMV-DNA was found in breast milk in four of five CMV-seropositive mothers. Two infants were infected by CMV. They were the only infants fed with breast milk positive for viral culture. One infant developed hepatic affection concurrent with viral excretion in urine. This infant was later diagnosed with cystic fibrosis. CONCLUSION: This study supports that CMV transmission through breast milk can aggravate the clinical course in extremely preterm infants with preexisting hepatic conditions.     

Perinatal cytomegalovirus infection: commonly occurring but rarely diagnosed

OBJECTIVE: To determine the incidence rate of perinatal cytomegalovirus (CMV) infection and to describe the clinical presentation of this infection in non-transfused term infants attended at a general hospital, in Ribeir?o Preto, SP, Brazil. POPULATION AND METHODS: Thirty four infants free of CMV infection at birth were followed up during the first 4 months of life. Diagnosis of perinatal CMV infection was established by isolating the virus in tissue culture or by polymerase chain reaction DNA amplification (PCR) in urine samples. RESULTS: A 38.2% (13/34) incidence rate of perinatal CMV infection was detected, and only 3 of the infected infants were symptomatic (respiratory tract symptoms in one infant and splenomegaly in two). CONCLUSIONS: The results indicate a high incidence rate of perinatal CMV infection in the studied infants. Clinical symptoms were present in 23% of these patients, stimulating the investigation of this agent as a cause of pneumonitis and splenomegaly.     

Reduced frequency of wheezing respiratory illness in infants with perinatal human immunodeficiency virus-type 1 infection: A model for immunologic and inflammatory mechanisms of airway obstruction?

A multivariate analysis using a logistic regression model evaluated odds ratio (OR) and 95% confidence limits (95% CL) of pediatrician-diagnosed wheezing respiratory illness in 75 infants with perinatal human immunodeficiency virus-type 1 (HIV-1) infection, 205 uninfected infants of HIV-1 infected mothers, and 1780 infants of HIV-1 uninfected mothers. Infants were prospectively followed-up for the first 2 years of life. Covariates were risk factors for wheezing respiratory illness (preterm delivery, low birth weight, maternal smoking, formula feeding, and neonatal respiratory disorders). Maternal use of illicit drugs in pregnancy, antiretroviral treatment in pregnancy, maternal HIV-1-related clinical condition at the time of delivery were also included in the models when infants of HIV-1 infected mothers were taken into account. Although the frequency of risk factors for wheezing respiratory illness was higher in infants of HIV-1 infected than in those of uninfected mothers, HIV-1 infection emerged as a protective factor [OR: 0.001 (95% CL: 0.0001–0.01); p < 0.001]. The frequency of risk factors was similarly high among infants of infected mothers, but OR was lower in HIV-1 infected than in uninfected infants of infected mothers (0.005; 95% CL: 0.0004–0.06; p < 0.001). Finally, OR was higher in uninfected infants of HIV-1 infected mothers (who evidenced a higher frequency of risk factors) than in infants of HIV-1 uninfected mothers (9.97; 95% CL: 4.87–20.40; p < 0.001). Understanding the reason why HIV-1 protects against wheezing respiratory illness could shed light on the immunologic and inflammatory mechanisms of airway obstruction.     

Early acquisition of cytomegalovirus infection.

Two hundred and fifty three infants were screened for cytomegalovirus (CMV) in the urine at birth and were followed up at regular intervals for one year. Twelve per cent (of 249) were excreting virus at 3 months, and 20% (of 234) at 12 months. In all cases infection was subclinical. The major factors determining risk of acquiring infection were the mother''s serological state and whether the infant was breast fed. There was no association with social class, mother''s age, or whether the child had been in a special care baby unit or a postnatal ward. By one year 33% (of 123) of infants of seropositive mothers had acquired CMV infection compared with 4% (of 123) born to seronegative mothers. Twenty per cent (17) of seropositive women who breast fed had virus isolated from their breast milk on at least one occasion, and 76% (13) of their infants became infected. In four mother-infant pairs comparison of CMV isolates from the mother''s milk and the child''s urine was made by restriction endonuclease digestion; in each pair infection had apparently occurred with the same strain of virus. All 13 infected infants followed up for three years were still shedding virus. Infection with CMV is common in infancy, and virus shedding persists for years. Congenital infection cannot be distinguished from acquired infection unless the presence of CMV in the urine is identified within three or four weeks after birth, even when clinical problems suggestive of congenital infection are present.     

Improved outcomes of outborn preterm infants if admitted to perinatal centers versus freestanding pediatric hospitals

OBJECTIVES: To examine whether admission hospital type (13 perinatal centers vs 4 freestanding pediatric hospitals) was associated with differences in risk and illness severity adjusted mortality and morbidity among outborn preterm infants. STUDY DESIGN: Records of singleton outborn infants < or =32 weeks' gestational age (n = 605) admitted to 17 tertiary level neonatal intensive care units participating in the Canadian Neonatal Network for the period 1996 to 1997 were examined. RESULTS: Outborn infants admitted to freestanding pediatric hospitals were at higher risk of death (adjusted odds ratio [AOR], 2.25; 95% confidence interval [CI], 1.20, 4.20), nosocomial infection (AOR, 2.48; 95% CI, 1.64, 3.73), and oxygen dependency at 28 days of age (AOR, 1.77; 95% CI, 1.14, 2.75) when compared with outborn infants admitted to perinatal centers. CONCLUSIONS: After adjustment for perinatal risks and admission illness severity, outborn infants had better outcomes if they were admitted to perinatal centers compared with freestanding pediatric hospitals.     

Cribado universal de infección por citomegalovirus en prematuros de menos de 1.500 g

IntroductionCytomegalovirus (CMV) infection is endemic, and children who attend day care are the most important source of infection.ObjectiveTo establish recommendations based on the medical evidence on the vertical transmission of cytomegalovirus in preterm infants weighing less than 1500 g at birth.BackgroundInfection in pregnant women may be primary or secondary. Although there is fetal infection, 85% of newborn infants are asymptomatic. Symptoms of infection include low birth weight, hepatosplenomegaly, thrombocytopenia, microcephaly and neurological disorders. The prognosis of symptomatic children is very poor, with high mortality and neurological disorders. The virus can be reactivated during breast feeding, and early infection is possible through breast milk, probably with little impact in term infants, although the long-term neurological outcome worsens in preterm infants. The diagnostic method of choice is the identification of CMV in urine; the determination in the first two weeks of life suggests congenital infection; later it can be acquired at birth or through breast milk or contaminated blood transfusion.Conclusion and recommendationDetermine viral DNA at 4-6 weeks of life by protease chain reaction. If it is positive, monitoring of samples from the first days of life and breast milk are mandatory. This should allow the newborn to be classified into three states: “Without CMV infection”, “Congenital CMV infection”, “Acquired CMV infection”.     

Congenital cytomegalovirus infection in preterm and full-term newborn infants from a population with a high seroprevalence rate

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital infections in humans. Prematurity occurs in as many as 34% of infants with symptomatic congenital CMV infection. OBJECTIVE: To determine the clinical presentation and frequency of congenital CMV infection among preterm infants and full-term infants from a population with a high seroprevalence rate. DESIGN/METHODS: A total of 289 preterm infants (median gestational age, 34 weeks; median birth weight, 1,757 g) and 163 term infants (median gestational age, 39 weeks; median birth weight, 3,150 g) sequentially born were included in the study. Serum IgG antibodies to CMV were measured in all mothers. One urine sample was collected within the first 7 days of age from all newborns. Virus isolation in urine samples was performed by tissue culture, and viral DNA was detected by a multiplex PCR. CMV infection was diagnosed in infants with virus excretion detected by both methods on at least two occasions within the first 3 weeks of life. RESULTS: Maternal CMV seropositivity rate was 95.7%. Congenital CMV infection was detected in 6 of 289 (2.1%) (95% confidence interval, 0.84 to 4.68) preterm infants and in 3 of 163 term infants (1.8%) (95% confidence interval, 0.48 to 5.74) (P > 0.05). Four of 6 preterm infants with congenital CMV infection were symptomatic, but none of the term infants was symptomatic (P = 0.16). CONCLUSION: The frequency of congenital CMV infection in preterm newborn infants from mothers with a high seropositive rate was similar to that found in term infants. No significant difference was found between the proportion of symptomatic infants among preterm and term infants. Our finding of symptomatic congenital CMV infection underscores the need of further evaluation of correlates of congenital symptomatic infection in highly immune populations.     

Intrauterine growth and gestational age in preterm infants with cerebral palsy

In a case-control study, gestational age and intrauterine growth of 191 preterm singleton infants 1971–1982 with cerebral palsy were compared to all preterm live-born singletons in Denmark in 1982 (N = 2203). The distribution of gestational age among preterm cases was slightly bimodal with maximum values at 29 and 32 weeks. The risk for cerebral palsy was highest in the infants with gestational age 28–30 weeks (OR = 5.6 (4.0 – 7.8), 95% confidence interval). Birth weight deviation, in the 34–36 weeks infants, expressed as the number of standard deviations from the mean birth weight for gestational age, was more negative in cases than in controls (P < 0.001). The frequency of small for gestational age (SGA) was 13% in cases and 9% in controls (OR = 1.5 (0.96 – 2.3), 95% confidence interval). The odds for cerebral palsy being SGA, was lower in 28–30 weeks (OR = 0.22 (0.06 – 0.86), 95% confidence interval), the same in 31–33 weeks (OR = 0.83 (0.35 – 2.0), 95% confidence interval) and higher in 34–36 weeks (OR = 5.2 (2.9 – 9.5), 95% confidence interval). In conclusion, preterm infants with cerebral palsy are born earlier than other preterm infants. Small for gestational age is associated with cerebral palsy in preterm infants only above 33 weeks.     

Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis

OBJECTIVES: To compare the effect of donor breast milk with infant formula in preterm infants. Separate comparisons with formula were made for donor breast milk that was: (1) given as a sole diet; (2) given as a supplement to mother's own breast milk; and (3) fortified with macronutrients and micronutrients. The main outcomes were death, necrotising enterocolitis (NEC), infection, growth and development. DATA SOURCES: Electronic databases-Cochrane, CENTRAL, MEDLINE, EMBASE, CINAHL, and HMIC: DH. REVIEW METHODS: Systematic review and meta-analysis of trials and observational studies of preterm or low birthweight infants. RESULTS: Seven studies (including five randomised controlled trials), all from the 1970s and 1980s, fulfilled the inclusion criteria. All studies compared the effect of sole donor breast milk with formula (combined n = 471). One of these also compared the effect of donor breast milk with formula given as a supplement to mother's own milk (n = 343). No studies examined fortified donor breast milk. A meta-analysis based on three studies found a lower risk of NEC in infants receiving donor breast milk compared with formula (combined RR 0.21, 95% CI 0.06 to 0.76). Donor breast milk was associated with slower growth in the early postnatal period, but its long-term effect is unclear. CONCLUSION: Donor breast milk is associated with a lower risk of NEC and slower growth in the early postnatal period, but the quality of the evidence is limited. Further research is needed to confirm these findings and measure the effect of fortified or supplemented donor breast milk.     

婴幼儿巨细胞病毒感染的临床特点及转归

目的研究巨细胞病毒(CMV)感染住院婴幼儿的临床发病特点及疾病转归。方法对符合CMV感染的87例婴幼儿从感染CMV后的发病时间,CMV侵袭器官所致器官相应损害的临床发病类型,实验室及相关影像学检查包括头颅B超,胸部X线及脑干视、听觉诱发电位检查及疾病转归进行综合分析。结果87例CMV感染婴幼儿中先天性CMV感染占27.6%,围生期CMV感染占62.0%,生后CMV感染占16.6%;CMV肝炎是最常见的临床类型,发生率为41.3%,其中脾大发生率10.3%,多数患儿预后好,好转率80.5%;中枢神经系统异常的发生仅见于先天性和围生期感染患儿,本组神经系统异常发生率20.4%;先天性CMV感染中全身性感染占16.7%,围生期全身性感染占1.8%,生后感染者无全身性感染发生;先天性CMV感染的死亡率12.5%,围生期感染的死亡率1.85%。结论CMV感染是导致婴幼儿肝炎综合征的重要原因,是造成婴幼儿神经系统后遗症不可忽视的因素;先天性CMV感染中全身性感染病死率高,预后差。     

Incidence and clinical outcome of cytomegalovirus transmission via breast milk in preterm infants ≤31 weeks

Aim: To evaluate incidence, timing and clinical relevance of acquired human cytomegalovirus (HCMV) infection in preterm infants.
Methods: The prospective longitudinal study included preterm infants ≤31 weeks. Congenital HCMV infection was excluded by negative HCMV culture from urine or by HCMV-PCR-negative umbilical cord blood. Infants from HCMV-IgG-positive mothers received thawed frozen breast milk until 33 weeks. Urine samples were obtained weekly for HCMV culture. Data were collected regarding clinical course and milk-intake.
Results: Twenty-nine mothers (29/48, 60%) of 35 infants were HCMV-IgG-positive. Five of 35 infants (14%) excreted HCMV in urine. Three of five children remained asymptomatic. One child developed a respirator-dependent HCMV pneumonia, the other child an upper airway infection and a transient thrombocytopenia. HCMV infected children had a significant longer hospital stay (median 96 vs. 73 days, p = 0.025) and received more formula milk (89 vs. 44 mL/kg/day, p = 0.04). Mothers of infected children had significantly higher HCMV-IgG levels than those of non-infected children (mean 1557 vs. 921 AU/mL, p = 0.048).
Nineteen of 48 mothers (40%) with 23 infants were HCMV-IgG-negative. These children remained HCMV negative.
Conclusion: Feeding preterm infants ≤31 weeks of HCMV-IgG-positive mothers with thawed frozen breast milk until 33 completed weeks does not prevent symptomatic HCMV infection in all cases. These infections can be associated with a prolonged hospital stay.     

Häufigkeit der konnatalen Zytomegalie in der Bundesrepublik Deutschland

Introduction. Cytomegalovirus (CMV) is the leading cause of congenital infection. 90–95% of infected infants are free of symptoms at birth and 5–10% are suffering from symptomatic disease. Methods. Between 1.11.1997 and 31.10.1999 clinical, laboratory and demographic data were monthly collected from standardized case reports. A congenital CMV infection was documented by isolation of virus, antigen or DNA in the first or second week of life and serologically. Results. There were 65 infants with congenital symptomatic CMV disease and 32 infants with presumtive congenital CMV disease. 45 out of 97 children were foreigners. 34 patients were treated with ganciclovir. In 13 of them the indication for virostatic treatment did not seem to be correct. Conclusion. The prevalence rate of congenital CMV infection in Germany is about 2/1000 infants. A virostatic therapy should be initiated in children with symptomatic CMV disease within the first 2 weeks of life.     

新生儿重症监护病房的院内感染638例分析

目的调查NICU院内感染的发生情况,探讨其危险因素,为院内感染的防控提供依据。方法对我科2003年5月至2004年12月,住院的638例新生儿进行院内感染的监控,并进行分析和总结。结果638例新生儿中74例发生88次院内感染,发生率为11．6％;住院日相关的院内感染率为14．9／1000NICU病例一天;导管相关血行感染率为18／1000血管内导管一天（2／111）;呼吸机相关肺炎发生率为63．3／1000机械通气一天（15／237）;平均开始出现感染时间（7．98±4．58）d。发生院内感染者比未感染者的胎龄及出生体重低、住院时间延长。新生儿发生院内感染的危险因素包括胃肠外营养、出生体重≤1500g及呼吸机治疗等（P〈0．05）。感染部位中,以肺炎占首位（45．4％）。院内感染病死率为4．1％。入院后有细菌定植者较无定植者院内感染率高（Х^2=79．7,P〈0．001）。结论充分了解NICU中新生儿发生院内感染的高危因素、尽量减少肠外营养及侵袭性操作的次数和时间、明确NICU中患儿个体细菌的定植情况将有助于控制院内感染并对临床合理用药提供参考。     

Short duration of skin-to-skin contact: effects on growth and breastfeeding

AIM: To compare weight gain and head growth in very-low-birthweight (VLBW, <1501 g) infants with or without exposure to short duration of skin-to-skin contact (STSC) during their stay in a neonatal intensive care unit. METHODS: Stable VLBW infants were randomised into either STSC or control group. Parents of the STSC group were encouraged to provide STSC for at least 1 h daily. RESULTS: One hundred and forty-six infants were randomised, but only 126 were enrolled (STSC group: n = 64; Controls: n = 62). Infants in the STSC group had better mean weekly increase in head circumference (1.0 cm (SD = 0.3) vs. 0.7 cm (SD = 0.3); P < 0.0001) and higher breastfeeding rate at discharge (29.7% vs. 14.5%; P = 0.04). Although the mean duration of maternal education was longer in STSC (13.0 vs. 12.1 years; P = 0.04) than in controls, linear regression analysis showed that the significant predictors associated with weekly head growth were exposure to STSC (unstandardised coefficient: 0.2; 95% confidence intervals (CI): 0.1, 0.3; P < 0.0001) and head circumference of infants at the time of enrollment (unstandardised coefficient: -0.05; 95% CI: -08, -0.03; P < 0.0001); the number of years of maternal education was not a significant predictor. Logistic regression analysis showed that the only significant predictors of successful breastfeeding at discharge were receiving expressed breast milk at enrollment (adjusted OR: 4.1; 95% CI: 1.4, 11.7; P = 0.009) and receiving expressed breast milk during intervention period (adjusted OR: 8.3; 95% CI: 2.8, 24.4; P < 0.0001); exposure to STSC and maternal education were not significant predictors. CONCLUSION: Exposure to short duration of STSC may promote head growth in VLBW infants.     

Postnatally acquired cytomegalovirus infection via breast milk: effects on hearing and development in preterm infants

BACKGROUND: In preterm infants there is a high risk of transmission of cytomegalovirus (CMV) via breast milk from seropositive mothers with reactivation of the virus during lactation. There is little information about the long term sequel of early postnatally acquired CMV infection in pre-term infants. This study aimed to investigate whether there was an increased frequency of impaired neurodevelopmental outcome and sensorineural hearing loss in preterm infants with postnatally acquired CMV infection through transmission by CMV-positive breast milk. METHODS: Twenty-two preterm infants [median birth weight, 1020 g (range, 600 to 1870 g); median gestational age, 27.6 weeks (range, 23.6 to 32 weeks] with early postnatally acquired CMV infection by breast-feeding (onset of viruria between Days 23 and 190 postnatally) were compared with 22 CMV-negative preterm infants individually matched for gestational age, birth weight, gender, intracranial hemorrhage and duration of ventilation. At 2 to 4.5 years of age, follow-up assessments were conducted consisting of neurologic examination, neurodevelopmental assessment and detailed audiologic tests. RESULTS: None of the children had sensorineural hearing loss. There was no difference between the groups with regard to neurologic, speech and language or motor development. CONCLUSION: The results of this study suggest that early postnatally acquired CMV infection via CMV-positive breast milk does not have a negative effect on neurodevelopment and hearing in this group of patients. Because we studied a small number of infants, further follow-up studies are warranted in preterm infants with early postnatally acquired CMV infection.     

Hiv-specific secretory IgA in breast milk of HIV-positive mothers is not associated with protection against HIV transmission among breast-fed infants

OBJECTIVES: To test whether secretory immunoglobulin A (sIgA) to human immunodeficiency virus (HIV) antigens in breast milk of HIV-positive women is associated with protection against HIV transmission among breast-fed infants. STUDY DESIGN: Nested, case-control design in which HIV-specific sIgA was measured in breast milk collected from 90 HIV-positive women enrolled in a study in Lusaka, Zambia. Milk samples were selected to include 26 HIV-positive mothers with infected infants (transmitters) and 64 mothers with uninfected infants (nontransmitters). RESULTS: HIV-specific sIgA was detected more often in breast milk of transmitting mothers (76.9%) than in breast milk of nontransmitting mothers (46.9%, P = .009). There were no significant associations between HIV-specific sIgA in breast milk and other maternal factors, including HIV RNA quantities in breast milk, CD4 count, and plasma RNA quantities. CONCLUSIONS: HIV-specific sIgA in breast milk does not appear to be a protective factor against HIV transmission among breast-fed infants.