Review Reports - How to Provide Breast Milk for the Preterm Infant and Avoid Symptomatic Cytomegalovirus Infection with Possible Long-Term Sequelae

Round 1

Reviewer 1 Report

It's my honor to review this article. It is interesting.

This article is relatively comprehensive, so that we can understand the knowledge related to breast feeding premature infants with CMV.

However, I have a small suggestion that the literatures cited are too old. Of the 65 literatures cited, only 26 were in the last 10 years, and some of them are from the last century. This article would be more meaningful if it could cite the latest literature.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

How to provide breast milk for the preterm infant and avoid symptomatic cytomegalovirus is constantly controversial and unsolved problem. The author approached this issue very detail. The paper has form of review moved many aspects affecting CMV infection and relationships related to breastfeeding and human milk. Dilemmas related to the benefits of the golden standard, which is mother's milk and possibility to be a source of symptomatic CMV infection and neurological sequelae a very important clinical problem. The author cites many studies documenting postnatal CMV infection due to virus transmission into breast milk. In order to make it easier for clinicians to make nutritional decisions in preterm newborns, the author presents the position of the AAP from 2018. AAP recommends for mothers of preterm infants born at less than 32 weeks of gestational age serological CMV screening, and for those being CMV-seropositive short-term pasteurization of breast milk. The presented algorithm seems to be particularly useful clinically. The conclusions are a summary of the presented pointing and indicate that Short-term heat inactivation for 5 seconds at 62C has the benefits of feeding breast milk without the disadvantages of CMV transmission. The author's considerations are based on a very rich literature covering 65 very well selected references.

Author Response

Thank you for the overall positive comments on the manuscript.