Josephson Cassandra D, Caliendo Angela M, Easley Kirk A, Knezevic Andrea, Shenvi Neeta, Hinkes Michael T, Patel Ravi M, Hillyer Christopher D, Roback John D
Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia2Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia3Aflac Cancer Center and Bloo.
Department of Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.
JAMA Pediatr. 2014 Nov;168(11):1054-62. doi: 10.1001/jamapediatrics.2014.1360.
Postnatal cytomegalovirus (CMV) infection can cause serious morbidity and mortality in very low-birth-weight (VLBW) infants. The primary sources of postnatal CMV infection in this population are breast milk and blood transfusion. The current risks attributable to these vectors, as well as the efficacy of approaches to prevent CMV transmission, are poorly characterized.
To estimate the risk of postnatal CMV transmission from 2 sources: (1) transfusion of CMV-seronegative and leukoreduced blood and (2) maternal breast milk.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, multicenter birth-cohort study was conducted from January 2010 to June 2013 at 3 neonatal intensive care units (2 academically affiliated and 1 private) in Atlanta, Georgia. Cytomegalovirus serologic testing of enrolled mothers was performed to determine their status. Cytomegalovirus nucleic acid testing (NAT) of transfused blood components and breast milk was performed to identify sources of CMV transmission. A total of 539 VLBW infants (birth weight, ≤ 1500 g) who had not received a blood transfusion were enrolled, with their mothers (n = 462), within 5 days of birth. The infants underwent serum and urine CMV NAT at birth to evaluate congenital infection and surveillance CMV NAT at 5 additional intervals between birth and 90 days, discharge, or death.
Blood transfusion and breast milk feeding.
Cumulative incidence of postnatal CMV infection, detected by serum or urine NAT.
The seroprevalence of CMV among the 462 enrolled mothers was 76.2% (n = 352). Among the 539 VLBW infants, the cumulative incidence of postnatal CMV infection at 12 weeks was 6.9% (95% CI, 4.2%-9.2%); 5 of 29 infants (17.2%) with postnatal CMV infection developed symptomatic disease or died. A total of 2061 transfusions were administered among 57.5% (n = 310) of the infants; none of the CMV infections was linked to transfusion, resulting in a CMV infection incidence of 0.0% (95% CI, 0.0%-0.3%) per unit of CMV-seronegative and leukoreduced blood. Twenty-seven of 28 postnatal infections occurred among infants fed CMV-positive breast milk (12-week incidence, 15.3%; 95% CI, 9.3%-20.2%).
Transfusion of CMV-seronegative and leukoreduced blood products effectively prevents transmission of CMV to VLBW infants. Among infants whose care is managed with this transfusion approach, maternal breast milk is the primary source of postnatal CMV infection.
clinicaltrials.gov Identifier: NCT00907686.
产后巨细胞病毒（CMV）感染可导致极低出生体重（VLBW）婴儿出现严重发病和死亡情况。该人群产后CMV感染的主要来源是母乳和输血。目前这些传播途径所致风险以及预防CMV传播方法的效果尚不清楚。
评估产后CMV从两种来源传播的风险：（1）输注CMV血清学阴性且经过白细胞滤除的血液；（2）母亲的母乳。
设计、地点和参与者：2010年1月至2013年6月在佐治亚州亚特兰大的3个新生儿重症监护病房（2个学术附属医院和1个私立医院）进行了一项前瞻性多中心出生队列研究。对纳入研究的母亲进行CMV血清学检测以确定其状态。对输注的血液成分和母乳进行CMV核酸检测（NAT）以识别CMV传播来源。共有539例未接受过输血的VLBW婴儿（出生体重≤1500 g）及其母亲（n = 462）在出生后5天内纳入研究。婴儿在出生时进行血清和尿液CMV NAT以评估先天性感染，并在出生至90天、出院或死亡之间的另外5个时间点进行CMV NAT监测。
输血和母乳喂养。
通过血清或尿液NAT检测到的产后CMV感染的累积发生率。
462名纳入研究的母亲中CMV血清阳性率为76.2%（n = 352）。在539例VLBW婴儿中，12周时产后CMV感染的累积发生率为6.9%（95%CI，4.2% - 9.2%）；29例产后CMV感染的婴儿中有5例（17.2%）出现症状性疾病或死亡。共对57.5%（n = 310）的婴儿进行了2061次输血；没有CMV感染与输血相关，导致每单位CMV血清学阴性且经过白细胞滤除的血液的CMV感染发生率为0.0%（95%CI，0.0% - 0.3%）。28例产后感染中有27例发生在食用CMV阳性母乳的婴儿中（12周发生率，15.3%；9信区间，9.3% - 20.2%）。
输注CMV血清学阴性且经过白细胞滤除的血液制品可有效预防CMV传播给VLBW婴儿。在采用这种输血方法管理护理的婴儿中，母亲的母乳是产后CMV感染的主要来源。
clinicaltrials.gov标识符：NCT00907686。
