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Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting
Viruses ( IF 3.8 ) Pub Date : 2021-09-22 , DOI: 10.3390/v13101897
Nelmary Hernandez-Alvarado 1 , Ryan Shanley 2 , Mark R Schleiss 1 , Jensina Ericksen 1 , Jenna Wassenaar 1 , Lulua Webo 1 , Katherine Bodin 1 , Katelyn Parsons 1 , Erin A Osterholm 1
Affiliation  

Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seroposi-tive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.

中文翻译:

新生儿重症监护病房 (NICU) 环境中极低出生体重 (VLBW) 婴儿母乳获得性感染的临床、病毒学和免疫学相关性

极低出生体重 (VLBW) 婴儿获得的巨细胞病毒 (CMV) 感染的特征不完全。为了检查 VLBW 婴儿的 CMV 传播,我们在新生儿重症监护病房 (NICU) 的 VLBW 婴儿的盲法研究中评估了母体 DNA 乳酸、婴儿 DNA 血症和临床疾病的存在。为了检查这些问题,200 名 VLBW 婴儿参加了一项监测研究,每周收集母乳和婴儿全血样本(如果有的话)。评估了病毒学(母乳和婴儿全血实时 PCR)和免疫学(IgG、IgM 和 IgG 亲和力)相关性。图表审查检查了婴儿是否有与 CMV 疾病相符的症状。在 65/150 (43%) 的哺乳期母亲中发现了 DNAlactia。在 9/75 的 CMV 暴露婴儿(12% 的暴露婴儿)中发现了 9 种 CMV 感染。较高的母乳病毒载量(DNAlactia)中位数与 DNA 血症的可能性增加相关(p = 0.05)。尽管存在与 CMV 感染相符的潜在症状,但临床医生在 6/9 例 (66%) 中未考虑 CMV 的诊断。所有这些婴儿在出院时都患有慢性肺病。IgG 抗体滴度或 IgG 亲和力指数与传播或 CMV 疾病的可能性之间没有相关性。总之,在接受来自血清阳性母亲的乳汁的 VLBW 婴儿中,CMV 感染通常是获得性的,并且经常未被识别。未来的研究需要确定对母乳或婴儿血浆 CMV 的常规监测是否有助于预防或识别感染。尽管存在与 CMV 感染相符的潜在症状,但临床医生在 6/9 例 (66%) 中未考虑 CMV 的诊断。所有这些婴儿在出院时都患有慢性肺病。IgG 抗体滴度或 IgG 亲和力指数与传播或 CMV 疾病的可能性之间没有相关性。总之,在接受来自血清阳性母亲的乳汁的 VLBW 婴儿中,CMV 感染通常是获得性的,并且经常未被识别。未来的研究需要确定对母乳或婴儿血浆 CMV 的常规监测是否有助于预防或识别感染。尽管存在与 CMV 感染相符的潜在症状,但临床医生在 6/9 例 (66%) 中未考虑 CMV 的诊断。所有这些婴儿在出院时都患有慢性肺病。IgG 抗体滴度或 IgG 亲和力指数与传播或 CMV 疾病的可能性之间没有相关性。总之,在接受来自血清阳性母亲的乳汁的 VLBW 婴儿中,CMV 感染通常是获得性的,并且经常未被识别。未来的研究需要确定对母乳或婴儿血浆 CMV 的常规监测是否有助于预防或识别感染。IgG 抗体滴度或 IgG 亲和力指数与传播或 CMV 疾病的可能性之间没有相关性。总之,在接受来自血清阳性母亲的乳汁的 VLBW 婴儿中,CMV 感染通常是获得性的,并且经常未被识别。未来的研究需要确定对母乳或婴儿血浆 CMV 的常规监测是否有助于预防或识别感染。IgG 抗体滴度或 IgG 亲和力指数与传播或 CMV 疾病的可能性之间没有相关性。总之,在接受来自血清阳性母亲的乳汁的 VLBW 婴儿中,CMV 感染通常是获得性的,并且经常未被识别。未来的研究需要确定对母乳或婴儿血浆 CMV 的常规监测是否有助于预防或识别感染。
更新日期:2021-09-22
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