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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 reported.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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