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Am J Perinatol 2021; 38(10): 1070-1077
DOI: 10.1055/s-0040-1701609
Original Article

Breast Milk and Saliva Lactoferrin Levels and Postnatal Cytomegalovirus Infection

Kristin E. D. Weimer
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
Hunter Roark
2   Duke Human Vaccine Institute, Durham, North Carolina
,
Kimberley Fisher
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
C. Michael Cotten
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
David A. Kaufman
3   Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
,
Margarita Bidegain
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
,
Sallie R. Permar
1   Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
2   Duke Human Vaccine Institute, Durham, North Carolina
› Author Affiliations Funding This work was supported by National Institutes of Health (grant number: NIH 4T32HD043029–14), Duke Children's: Children's Miracle Network Hospitals and Duke Pediatrics Resident Research Grants for Kristin Weimer and National Institutes of Health (grant numbers: 4DP2-HD075699 and 5R21-AI136556) for S.R.P.
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Abstract

Objective Very low birth weight preterm infants are at risk for life-threatening infections in the NICU. Breast milk protects against infections but carries the risk of infection by cytomegalovirus (CMV) shed in mother's milk. Lactoferrin is a breast milk and saliva protein with potent neutralizing activity against CMV.

Study Design VLBW, maternal breast milk fed infants in the NICU and their lactating mothers were enrolled and followed for 3 months/discharge. Breast milk and infant saliva samples were collected biweekly. Maternal CMV status was determined on breast milk. CMV was measured using quantitative polymerase chain reaction and lactoferrin by enzyme-linked immunosorbent assay.

Results In an in vitro neutralization assay, the IC90 of purified human lactoferrin against CMV was 2.08 ng/mL. Bovine lactoferrins were more potent, IC90s > 10-fold higher. Lactoferrin was detected in all breast milk (median: 3.3 × 106 ng/mL) and saliva (median: 84.4 ng/swab) samples. Median CMV load in breast milk was 893 copies/mL. There was no correlation between breast milk lactoferrin concentration and CMV load. Five infants acquired postnatal CMV. There was no difference in saliva or breast milk lactoferrin concentration for mother–infant pairs and postnatal CMV acquisition.

Conclusion Lactoferrin neutralizes CMV in vitro, but concentrations in breast milk and saliva are likely too low for effective neutralization in vivo.

Keywords

postnatal cytomegalovirus - very low birth weight - preterm - lactoferrin - neonatal intensive care unit - breast milk

Supplementary Material



Publication History

Received: 15 August 2019

Accepted: 06 January 2020

Article published online:
18 February 2020

© 2020. Thieme. All rights reserved.

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