Breastfeeding and HCMV-Infection in the Preterm Infant

Background

According to numerous national, international and WHO guidelines, breast milk feeding is recommended for all newborns, especially preterm infants irrespective of birthweight or gestational age. However, preterm and also term infants are at risk of acquiring Cytomegalovirus (CMV) infection in their first weeks of life through their mother's raw breast milk, because nearly all CMV-IgG-positive mothers (carriers) will reactivate the virus during lactation and excrete it into their breast milk [23] [24] [25] [26] [27] [40].

Meanwhile breastfeeding is thought to have a major impact on the epidemiology of postnatal HCMV infection. Nearly 40 years ago HCMV was isolated from human milk. In 1972, the prevalence of virolactia (presence of infectious virus in milk) in the first three months post partum was reported to be 27%. A few years later HCMV was isolated more often in milk than in colostrum and 58% of the breast-fed term infants became infected. Morbidity among term infants was minimal [1] [2] [3] [4] [5]. In an additional study of unselected postpartum women, 32% (13/41) of seropositive mothers shed virus into breast milk; 69% (9/13) of their infants subsequently became infected. In these initial studies HCMV secretion into breast milk was monitored exclusively by virus culture of unseparated milk specimens. Using PCR technology, the rate of HCMV DNA-lactia at one month after delivery was 92% (12/13) [7] [8] [11].

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