母亲巨细胞病毒感染，早产儿可以母乳喂养吗？

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 62.5C for 30 minutes) or high-temperature short pasteurization (72C 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.