Untreated breast milk linked to CMV transmission

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1. Infants fed untreated breast milk were more likely to acquire cytomegalovirus (CMV) infection than those fed frozen milk.

2. Infants fed either frozen or untreated breast milk showed no difference in risk of acquiring CMV-related sepsis like syndrome (CMV-SLS).   

Study Rundown: Breast milk provides numerous benefits to premature infants, but also allows for transmission of infections. Full-term infants acquire protective antibodies in the third trimester, but pre-term infants may be at higher risk of developing CMV disease and CMV-related sepsis-like syndrome (CMV-SLS) through breastfeeding. Results from this systematic review and meta-analysis found that premature and very low birth weight (VLBW) infants fed breast milk from CMV-seropositive mothers were at risk for postnatal CMV infection and CMV-SLS. Frozen breast milk has been linked to decreased CMV titers, though it does not completely eliminate the virus. This review found that infants fed frozen breast milk rather than untreated milk were less likely to acquire CMV infection, although the risk of developing CMV-SLS was similar among both groups. This review was limited by a lack of control groups and small sample size.  Breast feeding continues to provide substantial nutritional and immunologic benefits for full-term and premature or VLBW infants alike; however, more research must be conducted to determine if these benefits outweigh the risks of CMV transmission through seropositive mothers’ breast milk.

Click to read the study in Pediatrics

Relevant Reading: Transmission of cytomegalovirus to preterm infants through breast milk.

Study Author, Tatiana Lanzieri, MD, MPH, talks to 2 Minute Medicine: Medical Epidemiologist, Centers for Disease Control & Prevention, National Center for Immunization and Respiratory Diseases, Divison of Viral Diseases. 

“Breast milk provides many benefits to VLBW and preterm infants and is recommended by the American Academy of Pediatrics. However, VLBW and preterm infants fed breast milk from CMV-seropositive mothers are at risk of postnatal CMV infection, which in a minority can result in CMV sepsis-like syndrome and longer hospitalizations. Our meta-analysis suggests that the risk of breast milk-acquired CMV infection is lower if infants are fed frozen breast milk compared to untreated breast milk but the risk of CMV-SLS appears to be similar in both groups. Our review highlights the need for more robust studies of breast milk-acquired CMV infection and disease in the United States to assist healthcare providers and parents in assessing the risk of CMV transmission and the benefits of breast milk for VLBW and premature infants.” 

In-Depth [systematic review study]: 17 studies were included in this review and meta-analysis, identifying a total of 695 infants born to and fed breast milk from CMV-seropositive mothers. Of these infants, 43% (299/695) were fed untreated breast milk, 30.5% (212/695) were fed frozen breast milk, and 26% (184/695) were fed combinations of untreated, frozen, or pasteurized breast milk. Infants fed untreated breast milk were significantly more likely to be infected with CMV and acquire CMV-related symptoms than infants fed frozen breast milk (19% vs. 13%; 10% vs. 7%, respectively). However, there was no significant difference in rate of CMV-SLS diagnosis between those fed untreated and frozen breast milk. Combining meta-analysis results to US population-based data yielded similar results. Infants fed untreated breast milk both acquired CMV infection and developed CMV symptoms more readily than infants fed frozen breast milk (6.5% vs. 4.4%; 3.4% vs. 2.4%, respectively). CMV-SLS rates remained comparable between those fed untreated compared to frozen milk (1.4% vs. 1.7%).

By Cordelia Y. Ross and Leah H. Carr

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