母乳短期巴氏消毒预防极早产儿产后巨细胞病毒传播。
Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants.
机构信息
Department of Neonatology, University Children's Hospital Tuebingen.
Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen.
出版信息
Clin Infect Dis. 2019 Jul 18;69(3):438-444. doi: 10.1093/cid/ciy945.
BACKGROUND
Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed.
METHODS
To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995-1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine.
RESULTS
Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003).
CONCLUSIONS
Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU.
CLINICAL TRIALS REGISTRATION
NCT01178905.
背景
通过母乳（BM）获得的后天性巨细胞病毒（pCMV）感染可能导致严重疾病甚至死亡，但 BM 对早产儿有益。因此，需要有效的方法来预防 CMV 传播。
方法
评估短期巴氏消毒（62°C 持续 5 秒）在预防早产儿通过 BM 传播 CMV 中的效果。设计：前瞻性干预性双中心队列研究，婴儿于 2010 年 6 月至 2012 年 1 月入组。1995-1998 年图宾根新生儿重症监护病房（NICU）的队列作为历史对照。比较 CMV 传播的差异，参考 CMV 传播的累积风险时间。设置：两家德国 3 级 NICU。纳入 69 例 CMV 免疫球蛋白 G 阳性母亲的 87 例出生体重<1500g 或胎龄<32 周的早产儿和 83 例历史对照。干预：从出生后第 4 天至出院时，对 BM 样本进行短期巴氏消毒。主要终点：通过尿液聚合酶链反应和短期微培养评估出院时的 CMV 状态。
结果
87 例研究婴儿中有 2 例（2.3%）发生 pCMV 传播，而 83 例对照中有 17 例（20.5%）。感染风险总时间为研究组 9.6 年，对照组 10.0 年，感染率分别为 0.21/年（95%置信区间 [CI]，0.03 至 0.75/年）和 1.70/年（95% CI，0.99 至 2.72/年）。Cox 比例风险模型显示，对照组与研究组的风险比为 8.3（95% CI，2.4 至 52.4）（P=.0003）。
结论
短期巴氏消毒可显著降低 NICU 中通过 BM 获得的 pCMV 感染发生率。
临床试验注册
NCT01178905。
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