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