Observational Study of Cytomegalovirus from Breast Milk and Necrotising Enterocolitis

Overview

Journal Arch Dis Child Fetal Neonatal Ed

Specialties Gynecology & Obstetrics
Pediatrics

Date 2019 Jul 22

PMID 31326920

Citations 13

Authors

Ravi Mangal Patel

Neeta Shenvi

Andrea Knezevic

Michael Hinkes

George W Bugg

Sean R Stowell

John D Roback

Kirk A Easley

Cassandra Josephson

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the relationship between cytomegalovirus (CMV) exposure from breast milk and risk of necrotising enterocolitis (NEC).

Design: Secondary analysis of a multicentre, observational cohort study. Maternal breast milk and infant serum or urine were serially evaluated by nucleic acid testing at scheduled intervals for CMV. Infants with evidence of congenital infection were excluded. Competing-risks Cox models, with adjustment for confounders, were used to evaluate the relationship between breast milk CMV exposure or postnatal CMV infection and NEC.

Setting: Three neonatal intensive care units in Atlanta, Georgia.

Patients: Infants with a birth weight≤1500 grams.

Exposures: Maximal CMV viral load in breast milk in the first 14 days after birth or postnatal CMV infection. Two different approaches were used to assess the timing of onset of CMV infection (midpoint or early).

Main Outcome Measures: NEC, defined as Bell stage II or greater.

Results: Among 596 enrolled infants, 457 (77%) were born to CMV seropositive mothers and 33 developed postnatal CMV infection (cumulative incidence 7.3%, 95% CI 5.0% to 10.1%). The incidence of NEC was 18% (6/33) among infants with CMV infection, compared with 7% (37/563) among infants without infection (adjusted cause-specific HR (CSHR): 2.81; 95% CI 0.73 to 10.9 (midpoint); 6.02; 95% CI 1.28 to 28.4 (early)). Exposure to higher breast milk CMV viral load was associated with a higher risk of NEC (adjusted CSHR per twofold increase 1.28; 95% CI 1.06 to 1.54).

Conclusions: CMV exposure from breast milk may be associated with the development of NEC in very low birth weight infants.

Citing Articles

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A Case of an Extremely Preterm Infant with Intussusception Triggered by Acquired Cytomegalovirus Infection.

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T-cell receptor excision circles and postnatal cytomegalovirus infection in very low birth weight infants.

Towne A, Patel R, Shenvi N, Easley K, Saakadze N, Josephson C J Perinatol. 2024; 44(7):1058-1060.

PMID: 38844518 DOI: 10.1038/s41372-024-02023-0.

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Park H, Kim D, Shin A, Jeong E, Son S, Ahn J Appl Microbiol Biotechnol. 2023; 107(22):6789-6798.

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