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Meta-Analysis
. 2021 Mar 29;36(12):e84.
doi: 10.3346/jkms.2021.36.e84.

Incidence of Postnatal CMV Infection among Breastfed Preterm Infants: a Systematic Review and Meta-analysis

Hye Won Park  1   2 , Myung Hyun Cho  3 , Sun Hwan Bae  1   4 , Ran Lee  1   4 , Kyo Sun Kim  1
Affiliations
Meta-Analysis

Incidence of Postnatal CMV Infection among Breastfed Preterm Infants: a Systematic Review and Meta-analysis

Hye Won Park et al. J Korean Med Sci. .

Abstract

Background: We performed a systematic review and meta-analysis to evaluate the incidence of breast milk-acquired cytomegalovirus (CMV) infection in preterm infants born to CMV-seropositive mothers.

Methods: PubMed, Embase, and Cochrane Library databases were searched using the terms: ("breast feeding" or "breast milk" or "human milk" or "breast") and ("HCMV" or "cytomegalovirus") and ("infant, extremely premature" or "premature birth" or "newborn" or "neonate" or "low birth weight" or "very low birth weight" or "premature" or "preterm infant"). Studies that had information on CMV status and breast feeding were included in the meta-analysis.

Results: A total of 2,502 newborns from 19 studies were included in this meta-analysis. The rate of postnatally acquired CMV infection among breastfed infants with CMV-seropositive mothers was 16.5% (95% confidence interval [CI], 0.10-0.26; P < 0.001). The infection rate was 26% with fresh breast milk, 8% with a combined diet of fresh and freeze-thawed breast milk, and 11% with freeze-thawed breast milk. Among cases where the CMV status of breast milk was determined, CMV shedding into breast milk occurred in 80.5% (95% CI, 0.71-0.87; P < 0.001) of CMV seropositive mothers. The breast milk-acquired CMV infection rate among infants fed CMV-positive breast milk was 20.7% (95% CI, 0.14-0.30; P < 0.001).

Conclusion: This meta-analysis examined the rate of breast milk-acquired CMV infections in preterm infants with CMV-seropositive mothers; the CMV infection rate was higher in preterm infants fed fresh breast milk. Until further data are available, we cautiously suggest the use of freeze-thawed breast milk, rather than fresh breast milk, for preterm infants or very low birth weight infants.

Keywords: Breast Milk; Cytomegalovirus; Neonate; Preterm.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow diagram of the literature selection process.
Fig. 2
Fig. 2. The rate of postnatal acquired CMV infection among breastfed infants with CMV-seropositive mothers.
CMV = cytomegalovirus, CI = confidence interval.
Fig. 3
Fig. 3. The rate of breast milk-acquired CMV infection among infants fed CMV-positive breast milk.
CMV = cytomegalovirus, CI = confidence interval.
See this image and copyright information in PMC

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