Division of Neonatology, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Pediatr Infect Dis J. 2009 Oct;28(10):891-4. doi: 10.1097/INF.0b013e3181a55c52.
Breast milk is the main source of postnatal human cytomegalovirus (HCMV) infection. The aim of this study was to assess the relationship between HCMV load in breast milk and viral transmission to very low birth weight (VLBW) infants.
Breast-fed VLBW infants who were born to HCMV-seropositive mothers and who were managed in a neonatal intensive care unit were enrolled in the study. Blood from mothers and infants was tested for HCMV antibodies after birth. Breast milk was collected for viral culture and HCMV load measurement. Urine from the babies was obtained for HCMV-DNA detection. Symptoms of HCMV infection were recorded and evaluated by neonatologists.
Of the 23 evaluated mothers during a 1-year period, 19 were HCMV seropositive; 17 of the women had detectable HCMV-DNA in their breast milk whey. Of the 23 infants born to the 19 seropositive mothers, 8 infants of 8 mothers had HCMV-DNA detected in the urine, indicating that they were infected, even though the breast milk was always frozen prior to feeding. Three infected infants had symptoms. At 4 weeks after delivery, the median viral load in breast milk from mothers of the 8 infected infants was significantly higher than that from mothers of the 15 noninfected infants (P = 0.04). HCMV was detectable in breast milk for a significantly longer period in mothers of infected infants (7.5 vs. 2.6 weeks P = 0.03).
High HCMV load and prolonged virus excretion in breast milk are maternal risk factors for viral transmission to VLBW infants.
母乳是人类巨细胞病毒（HCMV）产后感染的主要来源。本研究旨在评估母乳中 HCMV 载量与极低出生体重（VLBW）婴儿病毒传播之间的关系。
研究纳入了在新生儿重症监护病房中接受母乳喂养的 HCMV 血清阳性母亲所生的 VLBW 婴儿。在出生后，对母婴的血液进行 HCMV 抗体检测。采集母乳进行病毒培养和 HCMV 载量测量。婴儿的尿液用于 HCMV-DNA 检测。新生儿医生记录和评估 HCMV 感染的症状。
在为期 1 年的时间里，对 23 位母亲进行了评估，其中 19 位母亲 HCMV 血清学阳性；17 位母亲的母乳乳清中可检测到 HCMV-DNA。在 19 位血清学阳性母亲所生的 23 名婴儿中，8 名婴儿的尿液中检测到 HCMV-DNA，表明他们感染了病毒，尽管在喂养前母乳总是被冷冻。3 名感染婴儿出现症状。在分娩后 4 周时，8 名感染婴儿的母亲的母乳中病毒载量中位数明显高于 15 名未感染婴儿的母亲（P = 0.04）。感染婴儿的母亲母乳中 HCMV 可检测时间明显更长（7.5 周 vs. 2.6 周，P = 0.03）。
母乳中 HCMV 载量高和病毒持续排出时间长是母亲将病毒传播给 VLBW 婴儿的危险因素。
