Is Maternal Cytomegalovirus compatible with breastfeeding? Do we have alternatives for Maternal Cytomegalovirus?

Maternal Cytomegalovirus

September 28, 2017 (Very Low Risk)

Cytomegalovirus (CMV) is a virus that belongs to herpesvirus family. Between 30 and 100% of adults become infected throughout their lives. The infection is usually asymptomatic or very mild without treatment required. Once overcome, the virus remains latent within the body to be reactivated occasionally.
Only intrauterine congenital infection has a higher rate of severe disease.



CMV is found in 50 to 97% of breastmilk samples obtained from healthy women, yet only 15 to 19% of infants become infected, and only 4% develope symptoms which may be generally fairly mild and no treatment is required (Jang 2016, Martins 2016, Romero 2015, García 2015, Lanzieri 2013, Kurath 2010). 

More serious infections have been reported (Sordelli 2015) that happened in less than 1% of at-term infants.



As lower the gestational age as greater the probability of appearance of symptomatic cases (Martins 2016, Yoo 2015), although in some series no differences between premature infants and term infants were found (Lanzieri 2013).



On very preterm births, mostly among infants with an age lower than 30 weeks and a birthweight lower than 1,000 g, CMV infection acquired through breastmilk may cause more severe symptoms that would require treatment with Ganciclovir (Mehler 2014, Okulu2012, Lombardi 2012). However, frequency rate is usually very low without occurrence of neurological and / or other long-term sequelae (Jim 2015, Bevot 2012), albeit some authors have detected small differences on some neurologic developmental scales (Goelz 2013).

Since some cases of especially serious infections have been reported in premature infants (Anne 2016, Oulu 2012, Chiavarini 2011), some authors recommend infant feeding by using frozen and / or pasteurized breastmilk (Romero 2015, Chiavarini 2011); Others believe that an individual decision must be made according to the clinical circumstances of every premature infant (Lombardi 2012).
By freezing breastmilk the CMV content is reduced (Balcells 2016), but not eliminated (Omarsdottir 2015). Pasteurization does eliminate viral load in breastmilk (Yoo 2015), however, it affects bioactive and nutrient factors of breastmilk (Lombardi 2012) and the risk for necrotizing enterocolitis may be increased (Stock 2015).
 


There is a widespread consensus on that breastfeeding is not contraindicated on full-term infants whose mothers are CMV-positive on serologic tests.
 For most authors and scientific societies, fresh breastmilk is preferred for the routine feeding of all newborns, including preterm infants (AAP 2012, Kurath 2010), since the benefits of breastmilk outweigh the risks for clinical disease and / or neurological sequelae and because the risk associated to severe CMV disease through breast milk has been overestimated (Resch 2013).


See below the information of this related product:
Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Maternal CMV

References

  1. Balcells C, Botet F, Gayete S, Marcos MÁ, Dorronsoro I, de Alba C, Figueras-Aloy J; Castrillo Study Group.. Vertically transmitted cytomegalovirus infection in newborn preterm infants. J Perinat Med. 2016Abstract
  2. Anne-Aurélie L, Souad B, Leila K. Clinical Findings and Autopsy of a Preterm Infant with Breast Milk-Acquired Cytomegalovirus Infection. AJP Rep. 2016Abstract
  3. Martins-Celini FP, Yamamoto AY, Passos DM, do Nascimento SD, Lima EV, Di Giovanni CM, Quadrado ER, Barta R, Aragon DC, do Prado SI, de Almeida MF, Mussi-Pinhata MM. Incidence, Risk Factors, and Morbidity of Acquired Postnatal Cytomegalovirus Infection Among Preterm Infants Fed Maternal Milk in a Highly Seropositive Population. Clin Infect Dis. 2016Abstract
  4. Jang HL, Cho JY, Kim MJ, Kim EJ, Park EY, Park SA, Kim IY, Choi YS, Bae CW, Chung SH. The Experience of Human Milk Banking for 8 Years: Korean Perspective. J Korean Med Sci. 2016Abstract
  5. Garcia-Loygorri MC, De Luis D, Torreblanca B, March GA, Bachiller MR, Eiros JM. La leche materna como vehículo de transmisión de virus. [Beast Milk as vehicle of transmission of virus]. Nutr Hosp. 2015Abstract Full text (link to original source) Full text (in our servers)
  6. Stock K, Griesmaier E, Brunner B, Neubauer V, Kiechl-Kohlendorfer U, Trawöger R. Pasteurization of breastmilk decreases the rate of postnatally acquired cytomegalovirus infections, but shows a nonsignificant trend to an increased rate of necrotizing enterocolitis in very preterm infants--a preliminary study. Breastfeed Med. 2015Abstract
  7. Romero-Gómez MP, Cabrera M, Montes-Bueno MT, Cendejas-Bueno E, Segovia C, Pastrana N, Mingorance J, Omeñaca F. Evaluation of cytomegalovirus infection in low-birth weight children by breast milk using a real-time polymerase chain reaction assay. J Med Virol. 2015Abstract
  8. Omarsdottir S, Casper C, Navér L, Legnevall L, Gustafsson F, Grillner L, Zweygberg-Wirgart B, Söderberg-Nauclér C, Vanpée M. Cytomegalovirus infection and neonatal outcome in extremely preterm infants after freezing of maternal milk. Pediatr Infect Dis J. 2015Abstract
  9. Sordelli N, Sapia E, Delgado M, Mistchenko A, Dastugue M. [Symptomatic cytomegalovirus infection through breastfeeding in a 45 days old boy]. Arch Argent Pediatr. 2015Abstract
  10. Yoo HS, Sung SI, Jung YJ, Lee MS, Han YM, Ahn SY, Chang YS, Park WS. Prevention of Cytomegalovirus Transmission via Breast Milk in Extremely Low Birth Weight Infants. Yonsei Med J. 2015Abstract
  11. Jim WT, Chiu NC, Ho CS, Shu CH, Chang JH, Hung HY, Kao HA, Chang HY, Peng CC, Yui BH, Chuu CP. Outcome of Preterm Infants With Postnatal Cytomegalovirus Infection via Breast Milk: A Two-Year Prospective Follow-Up Study. Medicine (Baltimore). 2015Abstract Full text (link to original source) Full text (in our servers)
  12. Mehler K, Oberthuer A, Lang-Roth R, Kribs A. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk. Neonatology. 2014Abstract
  13. Goelz R, Meisner C, Bevot A, Hamprecht K, Kraegeloh-Mann I, Poets CF. Long-term cognitive and neurological outcome of preterm infants with postnatally acquired CMV infection through breast milk. Arch Dis Child Fetal Neonatal Ed. 2013Abstract
  14. Lanzieri TM, Dollard SC, Josephson CD, Schmid DS, Bialek SR. Breast milk-acquired cytomegalovirus infection and disease in VLBW and premature infants. Pediatrics. 2013Abstract Full text (link to original source) Full text (in our servers)
  15. Resch B. The dilemma of breastfeeding very low birth weight infants at risk for symptomatic cytomegalovirus infection. J Matern Fetal Neonatal Med. 2013Abstract Full text (link to original source) Full text (in our servers)
  16. Red Book. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, Red Book 2012
  17. Okulu E, Akin IM, Atasay B, Ciftçi E, Arsan S, Türmen T. Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant. J Perinatol. 2012Abstract
  18. Bevot A, Hamprecht K, Krägeloh-Mann I, Brosch S, Goelz R, Vollmer B. Long-term outcome in preterm children with human cytomegalovirus infection transmitted via breast milk. Acta Paediatr. 2012Abstract
  19. AAP. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012Abstract Full text (link to original source) Full text (in our servers)
  20. Lombardi G, Garofoli F, Manzoni P, Stronati M. Breast milk-acquired cytomegalovirus infection in very low birth weight infants. J Matern Fetal Neonatal Med. 2012Abstract Full text (link to original source) Full text (in our servers)
  21. Chiavarini M, Bragetti P, Sensini A, Cenci E, Castronari R, Rossi MJ, Fantauzzi A, Minelli L. Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk. Ital J Pediatr. 2011Abstract
  22. Kurath S, Halwachs-Baumann G, Müller W, Resch B. Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review. Clin Microbiol Infect. 2010Abstract Full text (link to original source) Full text (in our servers)