Capretti Maria Grazia, Lanari Marcello, Lazzarotto Tiziana, Gabrielli Liliana, Pignatelli Sara, Corvaglia Luigi, Tridapalli Elisabetta, Faldella Giacomo
Department of Obstetrical, Gynecological, and Pediatric Sciences, Operative Unit of Neonatology, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy.
J Pediatr. 2009 Jun;154(6):842-8. doi: 10.1016/j.jpeds.2008.12.046. Epub 2009 Feb 23.
To assess the risk of post-natal cytomegalovirus (CMV) transmission to very low birth weight (VLBW) infants fed with their mother's fresh milk.
Prospective, observational study of 80 VLBW infants and their 68 mothers. Infants' urine and their own mother's fresh breast milk were tested for CMV by means of culture tests once a week until discharge. CMV in infected milk and urine were genotyped. The clinical course, laboratory findings, and outcome of infants infected with CMV at 2 years of age are reported.
Fifty-three mothers (78%) were CMV-seropositive at delivery. CMV was detected in the milk of 21 of 53 seropositive mothers (40%), and CMV was in the urine in 9 of 26 infants (35%) fed with CMV-positive milk. The same gN-genotype was found in milk and urine. Three infected infants <28 weeks gestational age (GA) had a mild sepsis-like illness. Five more infants had neutropenia, conjugated hyperbilirubinaemia, or both. Post-natal CMV infection occurred in 1 of 19 infants with a GA<28 weeks who were treated at birth with intravenous immunoglobulin versus 3 of 5 non-treated infants (P < .02). Symptomatic CMV infection was associated with bronchopulmonary dysplasia. No neurosensorial sequelae were found at 2 years of corrected age.
CMV infection via fresh human milk is mild, self-limiting, and without sequelae. Very-low GA and pre-existing chronic diseases are associated with symptomatic infection.
评估极低出生体重（VLBW）婴儿食用其母亲的新鲜母乳后发生产后巨细胞病毒（CMV）传播的风险。
对80名极低出生体重婴儿及其68名母亲进行前瞻性观察研究。每周一次通过培养试验检测婴儿尿液及其母亲的新鲜母乳中的CMV，直至出院。对感染乳汁和尿液中的CMV进行基因分型。报告2岁时感染CMV的婴儿的临床病程、实验室检查结果及转归。
53名母亲（78%）分娩时CMV血清学阳性。53名血清学阳性母亲中有21名（40%）的乳汁中检测到CMV，食用CMV阳性乳汁的26名婴儿中有9名（35%）尿液中检测到CMV。乳汁和尿液中发现相同的gN基因型。3名胎龄<28周（GA）的感染婴儿患有轻度败血症样疾病。另有5名婴儿出现中性粒细胞减少、结合胆红素血症或两者皆有。19名出生时接受静脉注射免疫球蛋白治疗的胎龄<28周的婴儿中有1名发生产后CMV感染，而5名未治疗的婴儿中有3名发生感染（P<.02）。有症状的CMV感染与支气管肺发育不良有关。矫正年龄2岁时未发现神经感觉后遗症。
通过新鲜人乳感染CMV是轻度、自限性的，且无后遗症。极低胎龄和既往存在的慢性疾病与有症状感染有关。
