Predictors of severity for postnatal cytomegalovirus infection in preterm infants and implications for treatment

Abstract

Postnatal cytomegalovirus (CMV) infection is common in neonates and is mostly acquired through infected breast milk from seropositive mothers. In this review, risk factors of postnatal CMV transmission and predictors of severity, preventive measures and treatment of symptomatic postnatal CMV infection in preterm infants are discussed. Several viral, transmission route and host factors have been associated with a higher risk of postnatal CMV transmission from mother to child. Severity predictors of symptomatic postnatal CMV infection may include extreme prematurity (gestational age <26 weeks), timing of postnatal infection as well as comorbidities. Further research in postnatally infected preterm infants at risk for severe symptoms is essential with respect to preventive measures involving the infected breast milk and antiviral treatment.

Keywords::

• postnatal cytomegalovirus infection
• predictor
• preterm infants
• risk factor
• severity
• symptoms
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Postnatal cytomegalovirus (CMV) infection acquired through infected breast milk is common in preterm infants and is mostly asymptomatic.

• Several viral (e.g., CMV load and early shedding of CMV DNA in breast milk), transmission route (e.g., breastfeeding) and host (e.g., gestational age [GA]) factors have been associated with a higher risk of postnatal CMV transmission from mother to child.

• Signs and symptoms of symptomatic postnatal CMV infection include CMV sepsis-like syndrome/CMV sepsis-like symptoms (apnea, bradycardia and gray pallor of the skin), hepatitis, CMV pneumonia, thrombocytopenia, neutropenia and C-reactive protein elevation.

• Long-term neurodevelopmental outcome of postnatal CMV infection in preterm infants seems favorable, although large prospective studies on this subject still have to be performed.

• Extreme prematurity (GA <26 weeks), time of primary infection and probably severe comorbidity seem to be predictors of severity for symptomatic postnatal CMV infection in preterm infants.

• Identification of the preterm infant at risk for severe symptomatic postnatal CMV infection is essential for the application of preventive and therapeutic measures.

• Preventive measures may include freeze-thawing or pasteurization of infected breast milk or, eventually, withholding infected breast milk.

• Severe, life-threatening symptomatic postnatal CMV infection in extremely preterm infants (GA <26 weeks) may be treated using antiviral medications (i.e., ganciclovir and/or valganciclovir) in the absence of other treatment options. However, the efficacy and safety of the antiviral medication has not been established in this population.

Notes