Muttermilchernährung der sehr unreifen Frühgeborenen von HCMV-seropositiven Müttern

Zusammenfassung

Frühgeborene können durch virushaltige Muttermilch ihrer HCMV(Human Cytomegalovirus)-seropositiven Mütter infiziert werden. 96 % aller seropositiven Mütter reaktivieren das Virus in der Brustdrüse, 37 % der Frühgeborenen < 1500 g Geburtsgewicht infizieren sich, 49 % davon zeigen mindestens ein Symptom dieser Infektion. Zur Beantwortung der Frage, ob die Vorteile der Muttermilchernährung Frühgeborener die Nachteile einer eventuellen HCMV-Infektion aufwiegen, fehlt bislang Datenmaterial, das auch Langzeitergebnisse einschließt. Eine Inaktivierung des Virus in der Muttermilch kann nur die Pasteurisierung leisten, allerdings verbunden mit Qualitätsverlusten in der Zusammensetzung der Milch, deren Konsequenzen auch noch nicht hinreichend bekannt sind.

Die drei beteiligten Kliniken haben auf der Basis der aktuell verfügbaren Daten entschieden, weiterhin auch sehr kleine Frühgeborene mit supplementierter, jedoch nicht behandelter Muttermilch zu ernähren, allerdings nur mit Aufklärung und Einwilligung der Eltern.

Abkürzungen

HCMV:Humanes Cytomegalovirus

VLBW :Very low birth weight

ELBW:Extremly low birth weight

Abstract

Preterm infants can be infected with human cytomegalovirus (HCMV) transmitted via breast milk of their HCMV-seropositive mothers, 96 % of whom reactivate the virus during lactation. 38 % of exposed VLBW infants become infected, with 48 % of these developing at least one symptom. Whether priority should be given to the multiple advantages of breast milk feeding or to the avoidance of a possible HCMV infection by exclusive formula feeding still cannot be decided due to insufficient data on the long-term outcome of infected infants. Inactivation of HCMV in breast milk can be achieved safely only via heat treatment, but the clinical consequences resulting from the use of pasteurized breast milk are unknown. Given the above situation, the authors decided to continue breast-feeding of VLBW and ELBW infants in their units after obtaining informed parenteral consent, until data for an evidence-based decision become available.

Frühgeborene - HCMV - CMV - Muttermilch - Transmission - Infektion

Preterm - infant - HCMV - breast milk - transmission - infection

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