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Andreia Mascarenhas1, Patrícia Rodrigues1, João Brissos1, Anaxore Casimiro1, Maria João Lage1,2, Maria Teresa Neto1,2, Micaela Serelha1.

1 - Neonatal Intensive Care Unit, Dona Estefânia Hospital, Centro Hospitalar de Lisboa Central, Lisbon, Portugal;
2 - Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

- 3rd International Congress of UENPS – 2012. Porto 14-17/11 (Poster).

INTRODUCTION: CMV infected mothers may have viral reactivation during lactogenesis and excrete CMV in the milk. Breastfed preterm infants, without enough serum titers of antibodies, are more likely to have a symptomatic infection. In these infants, postnatal infection is difficult to diagnose because other pathologies related to prematurity may have similar signs and symptoms. Four cases of postnatal CMV infection are reported.

CLINICAL CASES: The median gestational age and birth weight were respectively 27 weeks (23w-34w) and 715g (580g-2500g). All infants were out born and transferred for a surgical treatment; three newborn infants had been fed with human milk; all had received leukodepleted red cells. The median post natal age at the beginning of the disease was 36 days. Three patients had thrombocytopenia, 2 anemia, 1 neutropenia, 3 hepatosplenomegaly, 3 hepatitis, 1 pneumonia, 1 sepsis and 1 atrioventricular block. Three patients had negative PCR for CMV in the Guthrie card. The other one had negative IgG and IgM at the beginning of the disease. Two mothers had positive IgG antibodies. The CMV DNA was detected in the breast milk of just one mother. The only newborn that needed treatment with ganciclovir and imunoglobulin was the one with sepsis and pneumonia. At the present, no CMV related complications were found. Only one infant had died but not related to CMV infection.

DISCUSSION: Postnatal CMV infection may have a severe clinical course in preterm and very low birth weight infants. Mother’s milk is likely to be the main source of infection so measures to inactivate the virus in the milk, should be considered. Other sources of infection like nosocomial infection are speculative.

Key-words: CMV, acquired infection, NICU.