Human cytomegalovirus

Experience

Human cytomegalovirus (HCMV) infection is the most frequent congenital infection, affecting 1-3% of newborns. Even more relevant is the postnatal infection, transmitted mainly via breast milk. Of seropositive mothers, 40-96% shed the virus with their milk, reaching a peak 1 month after delivery (survey in Meier 2005, Hamprecht 2001). A reactivated infection in the lactating breast probably explains the frequent detection of HCMV in milk, leading to an infection rate of 10-60% of the infants. Postnatal infection via the breast milk in term infants does not cause illness. Very premature infants, however, develop bronchopulmonary dysplasia and other problems. Approximately 10% of premature infants become severely ill. In up to 50% of the typical problems of premature newborns, such as respiratory distress syndrome, HCMV infection was causative. The virus is killed by pasteurization. Recommendations vary regarding from when (gestational week 28 or week 32, or below a birth weight of 1500g?) and for how long (until 6 weeks of age, or less than 1500 g bodyweight?) pasteurization of breast milk should be carried out. Freezing of the milk has not been shown to be totally protective for the premature infant (Curtis 2005).

Recommendation. Full-term infants may be breastfed by HCMV seropositive mothers. In premature infants, HCMV-positive milk (donor or mother's milk) should be pasteurized. From which stage and for how long milk should be pasteurized should follow updated recommendations.

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