Role of Oral Valganciclovir in Sick Preterm with Cytomegalovirus Virus Infection and Ventilation Dependence

Abstract

Cytomegalovirus (CMV) is the most common congenital viral infection in neonates. Postnatal infection regarding infants rarely has significant clinical consequences. However, preterm may be at higher risk of developing symptomatic postnatal CMV disease. A multipara woman delivered vaginally a male preterm infant at 30 weeks' gestation who was suspected of early-onset sepsis in view of chronic leaking. The baby developed severe hypoxemia, and persistent pulmonary hypertension after delivery, with progressive deterioration and minimal effect of advanced ventilation, antibiotics, and pulmonary vasodilators. Sepsis screen and cultures for bacteria and fungi were negative. The baby was having enlarged liver and spleen which was noticed on day 15 of life. TORCH titer of the baby revealed CMV IgM and subsequently, CMV was isolated in the urine and in the blood plasma by polymerase chain reaction. Oral valganciclovir improved hematological parameters of the baby and respiratory support could be weaned. CMV being the most common intrauterine infection should be considered in differential diagnosis in unusual presentation of suspected sepsis and oral valganciclovir can be considered as good option for treatment.