Cytomegalovirus Transmitted From Mother's Own Milk to a Growth-Restricted Extremely Preterm Infant: A Case Report.

BACKGROUND: Mother's own milk (MOM) is considered the optimal nutrition for preterm infants. Unfortunately, MOM can contain human cytomegalovirus (HCMV), which can be transmitted to the infants. Postnatal HCMV infection in very preterm infants can lead to organ failure. CLINICAL FINDINGS: In this case we report cholestasis possibly associated to HCMV transmitted through MOM in a very growth-restricted extremely preterm infant. PRIMARY DIAGNOSIS: The primary diagnosis is postnatal HCMV infection. INTERVENTIONS: The infant was too preterm to be treated with antiviral medication. Instead, he was treated with a diet with no fresh MOM but only freeze-thawed MOM to reduce the viral load. OUTCOMES: Conjugated bilirubin values normalized after the infant was fed freeze-thawed MOM with a reduced viral load and formula. PRACTICE RECOMMENDATIONS: The awareness of HCMV-positive mothers giving birth to extremely preterm infants should be increased. Feeding only freeze-thawed MOM or in combination with fresh MOM should be considered prophylactically to avoid transmission of high viral loads of HCMV to these vulnerable infants.

Transmission of cytomegalovirus in fresh and freeze-thawed mother's own milk to very preterm infants: a cohort study.

OBJECTIVES: The objectives of the study were to clarify: (i) the frequency of human cytomegalovirus (HCMV) transmission, (ii) the association between the viral load in mother's own milk (MOM), the amount of fresh MOM and transmission, and (iii) the frequency of sepsis-like-symptoms (SLS) among infants born to seropositive mothers compared to infants born to seronegative mothers. STUDY DESIGN: This prospective cohort study enrolled very preterm infants (gestational age <32 weeks) from Denmark. Weekly samples of fresh MOM and urine were analyzed for HCMV-DNA. RESULTS: Twenty-six very preterm infants were enrolled. Four acquired an HCMV infection, of which two developed SLS. HCMV-infected infants received MOM with a significant higher viral load compared to the HCMV-uninfected infants. CONCLUSION: A combination of a high viral load and an increased amount of fresh MOM increased the risk of HCMV transmission. SLS was only slightly more common among infants exposed to HCMV positive MOM.