之前我们推荐对于足月儿来说,CMV阳性的母亲,是可以喂养母乳的,但是对于早产儿来说,特别是小于1500g的早产儿,母乳喂养前需要巴氏消毒或者冷冻,但是最新的美国儿科协会的Breastfeeding and the Use of Human Milk(2012)认为,不需要,直接喂养就行。
血清学CMV阳性的母亲,对于足月儿母乳喂养没有禁忌。对于出生体重小于1500个的早产儿,母乳中获得的CMV可能和晚期类似败血症综合征有关联。这种综合征虽然不会导致长期异常,但需要抗病毒治疗。血清学CMV阳性的母亲,对早产儿常规母乳喂养的好处大于风险,尤其是没有长期神经发育异常的报道。冰冻母乳会减少但是不会消除CMV。加热,无论是巴氏消毒(62.5度消毒30分钟)或者高温短消的巴氏消毒法(72度消毒5-10秒)可以消除母乳中的病毒载量,但是同时也会影响生物活性因子和营养成分。因此,对于早产儿,即使母亲CMV阳性,也可以使用新鲜母乳喂养。
以下是文章原文:
There is no contraindication to breastfeeding for a full-term infant whose mother is seropositive for cytomegalovirus (CMV). There is a possibility that CMV acquired from mother’s milk may be associated with a late-onset sepsis-like syndrome in the extremely low birth weight (birth weight <1500 g)="" preterm="" infant.="" although="" not="" associated="" with="" long-term="" abnormalities,="" such="" a="" syndrome="" may="" warrant="" antiviral="" therapy.the="" value="" of="" routinely="" feeding="" human="" milk="" from="" seropositive="" mothers="" to="" preterm="" infants="" outweighs="" the="" risks="" of="" clinical="" disease,="" especially="" because="" no="" long-term="" neurodevelopmental="" abnormalities="" have="" been="">1500>93 Freezing of milk reduces but does not eliminate CMV.94 Heating, either as Holder pasteurization (heating at 62.5°C for 30 minutes) or high-temperature short pasteurization (72°C for 5–10 seconds) eliminates the viral load from the milk but also affects bioactive factors and nutrients.95 Thus, fresh mother’s own milk is preferable for routinely feeding all preterm infants.
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