Background and aims: Raw breast milk is the optimal nutrition of premature infants, but it is also the main risk of acquired cytomegalovirus (CMV) postnatal infection. Given the potential severity of postnatal infections (“sepsis-like” clinical picture), many countries, including France, have chosen to contraindicate raw breast milk in premature infants that are under 32 weeks of gestation (GA) or less than 1500 g. The French recommendations have not been updated since 2005. 

Methods: An audit of the current French practices regarding the nutrition through raw breast milk in premature infants was carried out using a survey sent to all French neonatal care units (NICU, GCU). Through this audit, postnatal CMV infections, considered as acquired through raw breast milk, have been listed then confirmed or not, using hospitalisation reports. 

Results: Seventy-five percent of the neonatal departments answered the survey: 24% comply with the French recommendations, and 20% contraindicate raw breast milk under 32 GA, regardless of the maternal serological status against CMV. Other services respect age limits ranging from 28 SA to 34 GA and weight limits from 1000 to 2000 g. Thirty-five cases of children with post-natal CMV infections attributed to raw breast milk have been reported. In only 5 cases, the postnatal character and transmission through raw breast milk are undeniable. 

Conclusion: In France, a high heterogeneity marks medical practices concerning raw breast milk nutrition. The diagnostic approach for breast milk-acquired CMV infection is often incomplete. In this context, updated national and international recommendations seem more than necessary.

NUTRITION OF PRETERM INFANTS AND RAW BREAST MILK-ACQUIRED CYTOMEGALOVIRUS INFECTION: NATIONAL FRENCH AUDIT OF CLINICAL PRACTICES AND DIAGNOSTIC APPROACH.