Dear Dani,

Interesting to hear you have seen 4 cases of transmission of CMV from
mother to infant via breastmilk.  How sick were the babies, and what were
the outcomes?

You said your "chief felt that due to the very immature immune system, our
smallest babies perhaps cannot tolerate the CMV being passed through the
milk."  Here's how I understand it:  in a full term pregnancy, maternal
antibodies (to CMV and everything else) begin to cross the placenta in the
third trimester.  The fetus stores them for protection against infection,
protection that lasts at least 3 months after birth.  The longer the baby
stays in the womb, the more antibodies he stores, and the longer his
passive immunity lasts.  When the newborn gets breastmilk, he continues to
get maternal antibodies in a daily dose, which continues the protection
until his own immune system matures.

It is the very young premie (measured by gestational age, not weight) who
misses out on the third trimester, and so is unprepared for the CMV he
receives in breastmilk.  If he gets enough of his mother's milk on a daily
basis, the antibodies in the milk should prevent or reduce the severity of
the disease.  Ruth Lawrence discusses all this in BREASTFEEDING: A GUIDE
FOR THE MEDICAL PROFESSION.  She cites a report of 2 premies developing
CMV meningitis associated with CMV-positive breastmilk (Dworsky M et al:
Cytomegalovirus infection of breastmilk and transmission in infancy.
Pediatrics 72:295, 1983.)

I'll see if I can find anything newer.  And I'm eager to hear more details
about the four babies you know about.  I also hope Lois Arnold sees this
and responds from her human milk banking point of view.

Ginna Wall, MN, IBCLC, Lactation Services Coordinator
University of Washington Medical Center, Mailbox 356153
1959 NE Pacific Street, Seattle WA 98195
Voicemail: (206)548-6368, Fax: (206)548-7665