Division of Neonatology and Clinical Futures, Children's Hospital of Philadelphia.
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine.
Curr Opin Infect Dis. 2024 Oct 1;37(5):425-430. doi: 10.1097/QCO.0000000000001047. Epub 2024 Jul 31.
Although there are multiple benefits of mother's own milk feeding for very-low birth weight, low gestation infants, those born to cytomegalovirus (CMV)-seropositive mothers are at risk for acquiring postnatal CMV infection. This review will describe the risk and consequences of postnatal CMV infection among very preterm infants.
Postnatal CMV may manifest as clinically silent infection or as mild to severe and occasionally fatal disease. The risk of disease is balanced by the health benefits of human milk feeding to preterm infants. Postnatal CMV infection has been associated with increased risks of multiple preterm morbidities such as bronchopulmonary dysplasia, necrotizing enterocolitis and neurodevelopmental impairment, but current evidence is limited by the selection bias inherent to reporting in case series and retrospective cohort studies.
Knowledge gaps exist regarding the risk-benefit balance of pasteurization to inactivate CMV in fresh breast milk, as well as the optimal dosing, duration and efficacy of treating infected infants with antiviral medications. Multicenter, prospective studies are urgently needed to accurately determine the true burden that postnatal CMV infection presents to very preterm infants. Such studies will inform the need for preventive strategies and treatment guidance.
尽管母乳喂养对极低出生体重、低胎龄儿有诸多益处，但对于巨细胞病毒（CMV）阳性母亲所生的婴儿来说，他们在出生后仍有感染 CMV 的风险。本文将描述极早产儿出生后 CMV 感染的风险和后果。
CMV 可表现为无症状感染或轻度至重度、偶有致命的疾病。CMV 感染的风险与母乳喂养对早产儿的健康益处相平衡。CMV 感染与多种早产儿并发症的风险增加有关，如支气管肺发育不良、坏死性小肠结肠炎和神经发育障碍，但目前的证据受到病例系列和回顾性队列研究固有选择偏倚的限制。
在巴氏消毒法灭活新鲜母乳中的 CMV 的风险-获益平衡方面，以及抗病毒药物治疗感染婴儿的最佳剂量、持续时间和疗效方面，仍存在知识空白。迫切需要开展多中心前瞻性研究，以准确确定 CMV 感染对极早产儿的真实负担。这些研究将为预防策略和治疗指南提供依据。
