Chapter 3 - When and How to Treat Neonatal CMV Infection

Abstract

Cytomegalovirus (CMV) is the most common perinatal infection worldwide and the leading infectious cause of hearing loss and neurologic deficits, affecting up to 1% of live births worldwide. CMV can be acquired by infants either in utero (congenital infection) or after birth (postnatal infection). Only 10% to 15% of infants with congenital CMV infection are symptomatic at birth, but up to 20% of those who are asymptomatic will develop neurologic impairment, usually hearing loss. Randomized, controlled clinical trials show that congenital CMV infection with central nervous system involvement should be treated with ganciclovir or valganciclovir for 6 months to reduce neurologic deficits and hearing loss. There is evidence to suggest that at least some infants with congenital CMV infection without overt central nervous system involvement would benefit from antiviral therapy. Large, prospective trials are needed to determine which infants with asymptomatic congenital CMV infection are at risk for long-term sequelae and if antiviral treatment reduces this risk. In preterm infants, postnatal CMV infection can cause severe sepsis like illness and may contribute to long-term neurodevelopmental impairment and bronchopulmonary dysplasia. Preterm infants with symptomatic postnatal CMV infection should be strongly considered for antiviral treatment, but there is not enough evidence at this time to recommend treatment for asymptomatic preterm infants that acquire CMV postnatally. Again, large prospective studies are needed to define the risk of postnatal CMV in vulnerable preterm infants and determine if treatment ameliorates this risk.