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Question 2: Which infants with congenital cytomegalovirus infection benefit from antiviral therapy?
  1. Amanda Gwee1,2,3,
  2. Nigel Curtis2,3,4,
  3. Suzanne M Garland1,3,5,6,
  4. Tom G Connell2,3,4,
  5. Andrew J Daley1,4,5
  1. 1 Department of Microbiology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  3. 3 Murdoch Children's Research Institute, Parkville, Victoria, Australia
  4. 4 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  5. 5 Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
  6. 6 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Amanda Gwee, Department of Microbiology, The Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052 Australia; amanda.gwee{at}rch.org.au

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Which infants with congenital cytomegalovirus infection benefit from antiviral therapy?

You are referred a 3-day-old infant born to a mother with a history of cytomegalovirus (CMV) seroconversion at 11 weeks gestation. The infant is well with no evidence of microcephaly, petechiae or hepatosplenomegaly. A newborn hearing test reveals bilateral hearing loss. CMV is detected by PCR in urine collected on day 2 of life. You diagnose him with congenital CMV infection and wonder whether antiviral treatment is indicated.

Structured clinical question

In infants with congenital CMV infection (patient), does antiviral treatment (intervention) improve clinical outcome (outcome)?

Search strategy and outcome

Medline and EMBASE were searched using the OVID interface (1996 to current) in June 2013. The following key words were used: (Ganciclovir OR Foscarnet OR Antiviral agents) AND Cytomegalovirus.af. AND (Infant, Newborn OR Infant, Newborn, Diseases OR Newborn* OR Neonat*) and language was limited to English. This identified 228 articles. Case reports and case series that included less than 10 infants and studies of ganciclovir-resistant CMV-infected children were excluded leaving eight relevant articles. The references of all relevant publications were reviewed and no further articles were identified. An additional conference abstract was identified and included (table 1).

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Table 1

Which infants with congenital cytomegalovirus infection benefit from antiviral therapy?

Commentary

Background

Congenital CMV infection occurs as a result of maternal primary CMV infection, reinfection or reactivation during pregnancy. Primary infection is more likely …

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