Observational study of cytomegalovirus from breast milk and necrotising enterocolitis Journal Article


Authors: Patel, R. M.; Shenvi, N.; Knezevic, A.; Hinkes, M.; Bugg, G. W.; Stowell, S. R.; Roback, J. D.; Easley, K. A.; Josephson, C.
Article Title: Observational study of cytomegalovirus from breast milk and necrotising enterocolitis
Abstract: Objective To evaluate the relationship between cytomegalovirus (CMV) exposure from breast milk and risk of necrotising enterocolitis (NEC). Design Secondary analysis of a multicentre, observational cohort study. Maternal breast milk and infant serum or urine were serially evaluated by nucleic acid testing at scheduled intervals for CMV. Infants with evidence of congenital infection were excluded. Competing-risks Cox models, with adjustment for confounders, were used to evaluate the relationship between breast milk CMV exposure or postnatal CMV infection and NEC. Setting Three neonatal intensive care units in Atlanta, Georgia. Patients Infants with a birth weight≤1500 grams. Exposures Maximal CMV viral load in breast milk in the first 14 days after birth or postnatal CMV infection. Two different approaches were used to assess the timing of onset of CMV infection (midpoint or early). Main outcome measures NEC, defined as Bell stage II or greater. Results Among 596 enrolled infants, 457 (77%) were born to CMV seropositive mothers and 33 developed postnatal CMV infection (cumulative incidence 7.3%, 95% CI 5.0% to 10.1%). The incidence of NEC was 18% (6/33) among infants with CMV infection, compared with 7% (37/563) among infants without infection (adjusted cause-specific HR (CSHR): 2.81; 95% CI 0.73 to 10.9 (midpoint); 6.02; 95% CI 1.28 to 28.4 (early)). Exposure to higher breast milk CMV viral load was associated with a higher risk of NEC (adjusted CSHR per twofold increase 1.28; 95% CI 1.06 to 1.54). Conclusions CMV exposure from breast milk may be associated with the development of NEC in very low birth weight infants. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: major clinical study; nonhuman; outcome assessment; follow up; incidence; cohort analysis; risk factor; disease severity; infant; gestational age; multicenter study; virus load; observational study; cytomegalovirus infection; cytomegalovirus; virus transmission; necrotizing enterocolitis; secondary analysis; medical history; maternal age; human; male; female; priority journal; article; birth weight; breast milk; neonatal intensive care unit; urine sampling; very low birth weight; infant feeding; neonatology
Journal Title: Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume: 105
Issue: 3
ISSN: 1359-2998
Publisher: Bmj Publishing Group  
Date Published: 2020-05-01
Start Page: F259
End Page: F265
Language: English
DOI: 10.1136/archdischild-2018-316613
PUBMED: 31326920
PROVIDER: scopus
PMCID: PMC7336338
DOI/URL:
Notes: Article -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Andrea Knezevic
    106 Knezevic