Severe clinical deterioration in a preterm twin following discordant transmission of cytomegalovirus via breast milk

There is clear evidence that transmission of cytomegalovirus (CMV) to infants occurs via breast milk. The precise risk for development of symptomatic CMV disease in very low birth weight (VLBW; <1500 grams at birth) premature infants following transmission from maternal breast milk is not clear, though severe disease has been described in this setting. We describe discordant transmission of CMV to VLBW twins, with severe clinical deterioration in the affected infant.