母乳冷冻后极早产儿的巨细胞病毒感染与新生儿结局

Cytomegalovirus infection and neonatal outcome in extremely preterm infants after freezing of maternal milk.

作者信息

Omarsdottir Soley, Casper Charlotte, Navér Lars, Legnevall Lena, Gustafsson Frida, Grillner Lena, Zweygberg-Wirgart Benita, Söderberg-Nauclér Cecilia, Vanpée Mireille

机构信息

From the *Experimental Cardiovascular Research, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden; †Unit of Neonatology, Children's Hospital, Paul Sabatier University, Toulouse, France; ‡Department of Clinical Science, Intervention and Technology, §Department of Neonatology, ¶ Department of Women's and Children's Health, ‖Department of Microbiology, Tumor and Cell Biology, and **Department of Clinical Microbiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.

出版信息

Pediatr Infect Dis J. 2015 May;34(5):482-9. doi: 10.1097/INF.0000000000000619.

DOI:10.1097/INF.0000000000000619

PMID:25879648

Abstract

BACKGROUND

Cytomegalovirus (CMV) infection acquired from breast milk can cause serious illness in extremely preterm (EPT) infants (<28 weeks). Some neonatal centers freeze maternal milk (MM) to prevent CMV transmission; however, this practice is controversial. In this study, we assessed the CMV transmission rate and neonatal outcome in EPT infants after routine freezing of all MM.

METHODS

EPT infants (n = 140) and their mothers were randomized to the intervention group (only freeze-thawed MM) or the control group (combined fresh and freeze-thawed MM). Freeze-thawed MM was frozen at -20°C for ≥3 days before thawing. Mothers had serological tests for CMV, and MM was analyzed for CMV by polymerase chain reaction and CMV culture. Infants underwent CMV screening with urine analysis by CMV-polymerase chain reaction and CMV culture until 12 weeks of age.

RESULTS

Congenital CMV infection was detected in 2% of screened infants. The CMV transmission rate in infants fed with CMV-DNA positive milk was 8% (3 of 37) in the intervention group and 6% (2 of 33) in controls. All infants infected by CMV were asymptomatic. The final per-protocol analysis included 56 infants in the intervention group and 65 controls. Neonatal mortality was comparable between the groups (7% vs. 6%). Neonatal morbidity was similar, except for late onset Candida sepsis, which was more frequent in the controls (12% vs. 0%).

CONCLUSIONS

Routine freezing of all MM did not affect the rate of CMV transmission but may help to prevent fungal sepsis in EPT infants. This observation merits further investigation.

摘要

背景

从母乳中获得的巨细胞病毒（CMV）感染可导致极早产儿（<28周）患重病。一些新生儿中心冷冻母乳以预防CMV传播；然而，这种做法存在争议。在本研究中，我们评估了所有母乳常规冷冻后极早产儿的CMV传播率和新生儿结局。

方法

将极早产儿（n = 140）及其母亲随机分为干预组（仅冻融母乳）或对照组（新鲜母乳与冻融母乳混合）。冻融母乳在-20°C冷冻≥3天，然后解冻。母亲进行CMV血清学检测，母乳通过聚合酶链反应和CMV培养进行CMV分析。婴儿通过CMV聚合酶链反应和CMV培养进行尿液分析，直至12周龄，以进行CMV筛查。

结果

在筛查的婴儿中，2%检测到先天性CMV感染。干预组中喂食CMV-DNA阳性母乳的婴儿CMV传播率为8%（37例中的3例），对照组为6%（33例中的2例）。所有感染CMV的婴儿均无症状。最终符合方案分析包括干预组的56名婴儿和对照组的65名婴儿。两组之间的新生儿死亡率相当（7%对6%）。新生儿发病率相似，但迟发性念珠菌败血症除外，对照组更常见（12%对0%）。