Table 1.
Summary of 17 Studies from Systematic Review and Meta-Analysis
| Infants fed | Study, by year of publication, country |
Methods: Inclusion Criteria |
Infants fed breast milk from CMV- seropositive mothers |
Infants with breast milk-acquired CMV infection |
Infants with CMV- related symptomsa |
Infants with CMV-SLSb |
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|---|---|---|---|---|---|---|---|---|---|---|---|
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| n | n (%) | Onset of CMV viruria | n (%) | n (%) | Onset of CMV viruria |
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| Birth weight, grams |
Gestational age, weeks |
Chronological age, days Median (range) |
Corrected age for gestation, weeks Median (range) |
Corrected age for gestation, weeks Median (range) |
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| Untreated breast milk | Hamprecht, 2001 Germany8 | <1500 | or | <32 | 90 | 33 (37) | 53.5 (27–120) | 34.5 (28.3–47.1) | 16 (18) | 4 (4) | 29.8 (28.3–32.1) |
| Mussi-Pinhata, 2004 Brazil (Subgroup)25 | <1500 | or | <34 | 49 | 13 (27) | 75 (32–140)± | NA | 0 (0) | 0 (0) | - | |
| Meier, 2005 Germany9 | ≤2,010* | <33 | 21 | 5 (24) | NA | NA | 2 (10) | 1 (5) | NA | ||
| Miron, 2005 Israel26 | <1500 | or | <32 | 70 | 4 (6) | 35 (28–49) | 34 (31–35) | 3 (4) | 1 (1) | 31 | |
| Croly-Labourdette, 2006 France10 | ≤2240* | <33 | 7 | 1(14) | 53 | 36.8 | 0 (0) | 0 (0) | - | ||
| Capretti, 2009 Italy 11 | <1500 | and | <32 | 62 | 9 (15) | 51 (36–80) | 36.1 (31–41.4) | 8 (13) | 3 (5) | 33.4 (31–34) | |
|
| |||||||||||
| Overall (n) | 299 | 65 | 29 | 9 | |||||||
| Pooled proportion from meta-analysis, % (95%CI) | 19 (11–32) | 10 (5–17) | 4 (2–7) | ||||||||
| I2 | 77 | 50 | 0 | ||||||||
|
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| Frozen breast milk | Yasuda, 2003 Japan12 | <1200 | or | <34 | 34 | 3 (9) | 54 (42–84) | 33.3 (33.1–39.7) | 0 (0) | 0 (0) | - |
| Jim, 2004 Taiwan13 | <1500 | and | <35 | 40 | 6 (15) | 77§ (21–168) | NA | 6 (15) | 5 (13) | NA | |
| Lee, 2007 USA27 | <1500 | or | <32 | 23 | 2 (9) | 40.5 (37–44) | 33.1 (29.3–33.1) | 1 (4) | 0 (0) | - | |
| Jim, 2009 Taiwan14 | <1500 | and | <35 | 23 | 8 (35) | 63§ (SD=2.6) | NA | 3 (13) | 2 (9) | NA | |
| Buxmann, 2009 Germany28 | <1710* | <31 | 35 | 5 (14) | 73 (43–89) | 35.7 (32.7–39.6) | 2 (6) | 0 (0) | - | ||
| Chiavarini, 2011 Italy15 | <2000 | or | <32 | 57 | 1 (2) | 47 | 35.1 | 1 (2) | 1 (2) | 35.1 | |
|
| |||||||||||
| Overall (n) | 212 | 26 | 13 | 8 | |||||||
| Pooled proportion from meta-analysis, % (95%CI) | 13 (7–24) | 7 (3–14) | 5 (2–12) | ||||||||
| I2 | 62 | 37 | 33 | ||||||||
|
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| Combinations of untreated, frozen, or pasteurized breast milk or non-specified | Mosca, 2001 Italy16 | ≤1380* | <34 | 30 | 5 (17) | 34 (NA) | NA | 0 (0) | 0 (0) | - | |
| Sharland, 2002 UK29 | NA | <32 | 18 | 1(6) | 62 | 32.9 | 0 (0) | 0 (0) | - | ||
| Mussi-Pinhata, 2004 Brazil (subgroup)25 | <1500 | or | <34 | 46 | 8 (17) | 75 (32–140)± | NA | 1 (2) | 0 (0) | - | |
| Doctor, 2005 Canada30 | <1000 | <28* | 61 | 4 (7) | 48–72 | NA | 1 (2) | 1 (2) | NA | ||
| Omarsdottir, 2007 Sweden17 | ≤1166* | <28* | 7 | 2 (29) | 34–46 | 31.3 (29.1–33.4) | 1 (14) | 1 (14) | 31.1 | ||
| Hayashi, 2011 Japan31 | <1000 | or | <28 | 22 | 1 (5) | 70 | 36.7 | 1 (5) | 0 (0) | - | |
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| Overall (n) | 184 | 21 | 4 | 2 | |||||||
| Pooled proportion from meta-analysis, % (95%CI) | 13 (7–20) | 3 (1–8) | 3 (1–7) | ||||||||
| I2 | 26 | 0 | 0 | ||||||||
a
CMV-related symptoms defined as any of the following: neutropenia, thrombocytopenia, petechiae, hepatopathy, hyperbilirubinemia, elevated liver enzymes, jaundice or CMV pneumonia
b
CMV-SLS defined as sepsis-like symptoms, such as bradycardia, apnea or respiratory deterioration, in the absence of bacterial infection and coincident with CMV viruria.
*
The observed upper end of the birth weight and/or gestational age shown for studies that used only one criterion or none.
±
Median and range reported for all study infants, not just those shown in this category of breast milk
§
Mean; SD: Standard deviation
NA: Not available