Breast Milk-acquired Cytomegalovirus Infection in Premature or Very Low Birth Weight Infants: A Systematic Review.

BACKGROUND

Premature and very low birth weight infants are at a greater risk of acquiring postnatal cytomegalovirus (CMV) infection and developing symptomatic disease, including a sepsis-like syndrome. This systematic review was designed to assess the burden of breast milk-acquired CMV infection and disease in premature or very low birth weight infants born to CMV-positive mothers.

METHODS

Studies reporting data on preterm infants born before 32 weeks of gestation and/or with birth weight less than 1500 g, published between 2002 and 2022, were included. Random effects meta-analysis was performed using R software.

RESULTS

Fourteen studies were included in the present review. The proportion of CMV seropositivity among the tested mothers was 75.9% (95% confidence interval [CI] 68.2-82.2), and 82.1% (95% CI 68.9-90.5) of seropositive mothers excreted CMV in breast milk. The proportion of infants acquiring postnatal CMV from CMV immunoglobulin (Ig)G-positive mothers was estimated to be 14.7% (CI 95% 9.6-21.8). Of all infants with postnatal CMV infection, 29.6% (CI 95% 20.8-40.1) presented with sepsis-like symptoms. Breast milk-handling methods varied widely among studies.

CONCLUSIONS

We found a high CMV seropositivity and a high rate of CMV excretion in the breast milk of mothers of premature and very low birth weight infants. In these high-risk infants, the benefits of untreated breast milk should be considered, along with the risk of CMV transmission and severe disease.