Article Text

MANAGEMENT OF CONGENITAL CYTOMEGALOVIRUS INFECTION (CCMV): AN EVIDENCE-BASED APPROACH
  1. J R Fernandez Alvarez1,
  2. R Gandhi1,
  3. C Lawn1,
  4. H Rabe1
  1. 1Department of Neonatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK

Abstract

Objective To develop an evidence-based structured approach to the management of neonates with CCMV.

Materials and methods Medline/OVID databases and the Cochrane Collaboration Library were searched for related papers and graded for their level of evidence.

Results 39 papers were identified including 9 reviews. Neonates with abnormal neurological signs i.e. microcephaly, seizures, abnormal cranial ultrasound, sensorineural hearing loss (SNHL), chorioretinitis or signs of disseminated infection i.e. intrauterine growth restriction (IUGR), thrombocytopenia or abnormal liver function tests should be evaluated for CCMV infection.

Asymptomatic neonates Current evidence does not support treatment of babies who only have positive CMV-PCR.

Symptomatic neonates Evidence recommends treatment of all newborns with positive CMV-PCR and CNS related/sensorineural symptoms to prevent further neurological deterioration. IUGR newborns are thought to have systemic involvement including CNS and could also therefore be considered for treatment. There is evidence to suggest that newborns with no CNS symptoms but other signs of systemic involvement could be treated to avoid neurological sequelae if their viral load in the peripheral blood is high. Neonates with normal neurology but lower viral load should be closely followed up for evidence of SNHL. Treatment should be with intravenous Ganciclovir. Increasing evidence suggests oral Valgancilcovir for 6 weeks as an effective alternative. Close follow-up for evidence of toxicity and neurological deterioration is required.

Conclusion Evidence for neonates who would benefit from treatment is growing. We have tried to formulate this structured protocol in order to treat neonates with signs and symptoms that would affect long-term prognosis.

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