Postnatally Acquired Neonatal CMV Infection in Preterm Infants: From a Case Series to a Narrative Review of the Literature

Abstract

Highlights: What are the main findings? In high-risk preterm infants, postnatally acquired CMV can lead to severe disease, including sepsis-like syndrome, pneumonia, cytopenias, hepatitis, and colitis, with the potential for long-term sequelae or death. Clinical management remains highly variable, with substantial differences in diagnostic strategies, therapeutic approaches, and breastmilk handling across centers and countries. What are the implications of the main findings? Postnatal CMV infection remains under-recognized, highlighting the need for further research and clearer clinical guidelines to optimize neonatal outcomes. Harmonized, evidence-based recommendations on diagnosis, treatment, and breastmilk management are needed to improve care for at-risk or affected preterm infants. Background: Postnatal cytomegalovirus (pCMV) infection is a frequent viral condition in early infancy and is primarily acquired through maternal breastfeeding. Although usually asymptomatic in term infants, it can lead to significant morbidity in preterm neonates (gestational age < 32 weeks) and in those with very low birthweight (<1500 g), presenting with sepsis-like syndrome, pneumonia, cytopenia, hepatitis, or colitis. Severe cases may result in long-term sequelae or death. Objectives: To describe a series of cases of pCMV infection and review the current evidence on its epidemiology, clinical manifestations, outcomes, and therapeutic management, aiming to identify gaps in knowledge and propose opportunities for improving the care of preterm infants. Methods: We analyzed clinical presentations of pCMV disease in a case series of preterm infants and reported cases and reviewed the recent literature regarding diagnostic approaches, antiviral therapy, and strategies for breastmilk management. Results: Current data highlight substantial variability in clinical management and outcomes. The lack of consensus on antiviral indications and treatment duration reflects a limited understanding of the disease’s natural history. Approaches to breastmilk handling differ widely among centers and countries, further complicating the standardization of care. Conclusions: pCMV infection remains a relevant yet under-recognized condition in neonatal medicine. Improved diagnostic strategies, clearer therapeutic guidelines, and harmonized recommendations for breastmilk management are needed to optimize the care of preterm infants at risk of or affected by pCMV disease.