602 - Short-term pasteurization of breast milk to prevent postnatal CMV transmission is associated with an increased rate of NEC in very-low-birth-weight infants (VLBW)

Publication Number: 602.6958

Margit Vogelmann, Department of Neonatology, University Children's Hospital, Tuebingen, Germany, Gaertringen, Baden-Wurttemberg, Germany; christian F. Poets, Tübingen University Hospital, Tuebingen, Baden-Wurttemberg, Germany; Natascha Köstlin-Gille, University Hospital Tübingen, Tübingen, Baden-Wurttemberg, Germany

Background: In preterm infants, postnatal CMV infection can cause sepsis-like symptoms and may also be associated with an adverse long-term outcome. Raw breast milk was identified as the main source of postnatal CMV transmission. In order to prevent postnatal CMV transmission, pasteurization of breast milk has been proven effective. The conventional method is the Holder pasteurization (62.5°C for 30 minutes), but it affects the quality of breast milk, with valuable components being destroyed. It has been reported that Holder pasteurization may be associated with increased rates of BPD and NEC. In order to maintain the benefits of breast milk, we use the gentler method of short-term pasteurization (STP, 5 seconds at 62°C) since 2007.

Objective: The aim of this study was to evaluate if short-term pasteurization of breastmilk is associated with an adverse short-term outcome of VLBW infants.

Design/Methods: We performed a retrospective analysis of patient data from VLBW infants who were admitted to the NICU of the University Hospital of Tuebingen, Germany between January 2009 and December 2022, analyzing associations between STP and adverse outcomes in multivariable logistic regression models. The primary clinical endpoints were necrotizing enterocolitis (NEC) of any stage and bronchopulmonary dysplasia (BPD). Secondary endpoints were NEC requiring surgery, late-onset sepsis (LOS), retinopathy of prematurity (ROP), persistent ductus arteriosus (PDA) and death.

Results: The full data set comprised 1494 VLBW infants of whom 328 were excluded as they did not meet inclusion criteria. Of 1166 infants included in final analysis, 550 (47.2%) had received pasteurized breast milk and 615 infants (52,8%) had been fed raw breast milk. Infants in the STP group had a lower gestational age (median: 28.7 weeks vs 29.6 weeks) and lower birth weight (median 1120g vs 1111g). In multivariate logistic regression, STP was significantly associated with an increased risk of NEC of all stages (OR 2.7). No association was found for STP and BPD or any of the secondary endpoints.

Conclusion(s): In our retrospective analysis, STP was associated with an increased risk of developing NEC. This may indicate that even gentle STP destroys valuable immunomodulatory and/or antibacterial substances in breast milk. Prospective studies are needed to better examine the risks and benefits of STP for preventing CMV transmission to preterm infants.