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

Nelmary Hernandez-Alvarado, Ryan Shanley, Mark R. Schleiss, Jensina Ericksen, Jenna Wassenaar, Lulua Webo, Katherine Bodin, Katelyn Parsons, Erin A. Osterholm

Research output: Contribution to journalArticlepeer-review

Abstract

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 en-rolled 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 in-fants). 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.

Original languageEnglish (US)
Article number1897
JournalViruses
Volume13
Issue number10
DOIs
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This research was funded by the University of South Carolina?s Disability Research and Dissemination Center (DRDC) through its Cooperative Agreement (Number 6U19DD001218) with the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the DRDC or CDC. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The UL1TR002494 funding mechanism also included a CTSA-funded ?Path-ways to Research Scholar? Program (PReP) Award (LW). LW was also funded by a Department of Pediatrics ?SUPER? Award. KP was funded by an Infectious Diseases Society of America IDSA ?Grants for Emerging Researcher/Clinician Mentorship? (G.E.R.M.) program grant, and a University of Minnesota Foundation Medical Student Research Grant. The corresponding authors also acknowledge a UMN Department of Pediatrics ?Cross-Divisional? award which helped support these studies. Acknowledgments: The authors gratefully acknowledge the contributions of the Department of Pediatrics clinical research staff, in particular, Amanda Galster, Elizabeth Ramey, Brian Harvey, Jenna Hullerman Umar, and Michelle Lucio.

Funding Information:
Funding: This research was funded by the University of South Carolina’s Disability Research and Dissemination Center (DRDC) through its Cooperative Agreement (Number 6U19DD001218) with the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the DRDC or CDC. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The UL1TR002494 funding mechanism also included a CTSA-funded “Pathways to Research Scholar” Program (PReP) Award (LW). LW was also funded by a Department of Pediatrics “SUPER” Award. KP was funded by an Infectious Diseases Society of America IDSA “Grants for Emerging Researcher/Clinician Mentorship” (G.E.R.M.) program grant, and a University of Minnesota Foundation Medical Student Research Grant. The corresponding authors also acknowledge a UMN Department of Pediatrics “Cross-Divisional” award which helped support these studies.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • Breast milk
  • CMV antivirals
  • Cytomegalovirus (CMV)
  • Post-natal CMV

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