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Congenital cytomegalovirus infection: Management and outcome

Author
Gail J Demmler-Harrison, MD
Section Editors
Morven S Edwards, MD
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Congenital cytomegalovirus (CMV) infection is the leading cause of nonhereditary sensorineural hearing loss and can cause other long-term neurodevelopmental disabilities, including cerebral palsy, intellectual disability, vision impairment, and seizures. Infants congenitally infected with CMV may benefit from antiviral therapy, especially if treatment is initiated within the first month of life.

The management and outcome of congenital CMV infection are reviewed below. The clinical features and diagnosis of congenital CMV infection, other TORCH infections, CMV in pregnancy, and CMV infections in older infants and children are discussed separately:

(See "Congenital cytomegalovirus infection: Clinical features and diagnosis".)

(See "Overview of TORCH infections".)

(See "Cytomegalovirus infection in pregnancy".)

                         

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Literature review current through: Nov 2016. | This topic last updated: Fri Jul 29 00:00:00 GMT+00:00 2016.
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References
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  1. Kimberlin DW, Lin CY, Sánchez PJ, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 2003; 143:16.
  2. Oliver SE, Cloud GA, Sánchez PJ, et al. Neurodevelopmental outcomes following ganciclovir therapy in symptomatic congenital cytomegalovirus infections involving the central nervous system. J Clin Virol 2009; 46 Suppl 4:S22.
  3. Kimberlin DW, Jester PM, Sánchez PJ, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med 2015; 372:933.
  4. American Academy of Pediatrics. Cytomegalovirus infection. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW. (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.317.
  5. Royackers L, Rector E, Verhaert N, Desloovere C. Long-term audiological follow-up of children with congenital cytomegalovirus. B-ENT 2013; Suppl 21:57.
  6. Michaels MG, Greenberg DP, Sabo DL, Wald ER. Treatment of children with congenital cytomegalovirus infection with ganciclovir. Pediatr Infect Dis J 2003; 22:504.
  7. Schornagel FA, Oudesluys-Murphy AM, Vossen AC. Valganciclovir for Congenital Cytomegalovirus. N Engl J Med 2015; 372:2462.
  8. Duval M, Park AH. Congenital cytomegalovirus: what the otolaryngologist should know. Curr Opin Otolaryngol Head Neck Surg 2014; 22:495.
  9. Lackner A, Acham A, Alborno T, et al. Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up. J Laryngol Otol 2009; 123:391.
  10. Acosta EP, Brundage RC, King JR, et al. Ganciclovir population pharmacokinetics in neonates following intravenous administration of ganciclovir and oral administration of a liquid valganciclovir formulation. Clin Pharmacol Ther 2007; 81:867.
  11. Amir J, Wolf DG, Levy I. Treatment of symptomatic congenital cytomegalovirus infection with intravenous ganciclovir followed by long-term oral valganciclovir. Eur J Pediatr 2010; 169:1061.
  12. Kimberlin DW, Acosta EP, Sánchez PJ, et al. Pharmacokinetic and pharmacodynamic assessment of oral valganciclovir in the treatment of symptomatic congenital cytomegalovirus disease. J Infect Dis 2008; 197:836.
  13. Galli L, Novelli A, Chiappini E, et al. Valganciclovir for congenital CMV infection: a pilot study on plasma concentration in newborns and infants. Pediatr Infect Dis J 2007; 26:451.
  14. Stronati M, Lombardi G, Garofoli F, et al. Pharmacokinetics, pharmacodynamics and clinical use of valganciclovir in newborns with symptomatic congenital cytomegalovirus infection. Curr Drug Metab 2013; 14:208.
  15. Lombardi G, Garofoli F, Villani P, et al. Oral valganciclovir treatment in newborns with symptomatic congenital cytomegalovirus infection. Eur J Clin Microbiol Infect Dis 2009; 28:1465.
  16. Irizarry K, Honigbaum S, Demmler-Harrison G, et al. Successful treatment with oral valganciclovir of primary CMV enterocolitis in a congenitally infected infant. Fetal Pediatr Pathol 2011; 30:437.
  17. Wang Y, Smith KP. Safety of alternative antiviral agents for neonatal herpes simplex virus encephalitis and disseminated infection. J Pediatr Pharmacol Ther 2014; 19:72.
  18. Gwee A, Curtis N, Connell TG, et al. Ganciclovir for the treatment of congenital cytomegalovirus: what are the side effects? Pediatr Infect Dis J 2014; 33:115.
  19. Faqi AS, Klug A, Merker HJ, Chahoud I. Ganciclovir induces reproductive hazards in male rats after short-term exposure. Hum Exp Toxicol 1997; 16:505.
  20. Tawse KL, Baumal CR. Intravitreal foscarnet for recurring CMV retinitis in a congenitally infected premature infant. J AAPOS 2014; 18:78.
  21. Choi KY, Sharon B, Balfour HH Jr, et al. Emergence of antiviral resistance during oral valganciclovir treatment of an infant with congenital cytomegalovirus (CMV) infection. J Clin Virol 2013; 57:356.
  22. Demmler-Harrison GJ. Cytomegalovirus. In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed, Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL (Eds), Saunders, Philadelphia 2009. p.2022.
  23. Oschman A, Murthy V, Kollipara R, et al. Intravitreal ganciclovir for neonatal cytomegalovirus-associated retinitis: a case report. J Perinatol 2013; 33:329.
  24. Britt W. Cytomegalovirus. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.706.
  25. Dreher AM, Arora N, Fowler KB, et al. Spectrum of disease and outcome in children with symptomatic congenital cytomegalovirus infection. J Pediatr 2014; 164:855.
  26. Coats DK, Demmler GJ, Paysse EA, et al. Ophthalmologic findings in children with congenital cytomegalovirus infection. J AAPOS 2000; 4:110.
  27. Townsend CL, Forsgren M, Ahlfors K, et al. Long-term outcomes of congenital cytomegalovirus infection in Sweden and the United Kingdom. Clin Infect Dis 2013; 56:1232.
  28. Boppana SB, Fowler KB, Vaid Y, et al. Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection. Pediatrics 1997; 99:409.
  29. Noyola DE, Demmler GJ, Nelson CT, et al. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001; 138:325.
  30. Rivera LB, Boppana SB, Fowler KB, et al. Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection. Pediatrics 2002; 110:762.
  31. Pinninti SG, Rodgers MD, Novak Z, et al. Clinical Predictors of Sensorineural Hearing Loss and Cognitive Outcome in Infants with Symptomatic Congenital Cytomegalovirus Infection. Pediatr Infect Dis J 2016; 35:924.
  32. Lanari M, Lazzarotto T, Venturi V, et al. Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and asymptomatic congenitally infected newborns. Pediatrics 2006; 117:e76.
  33. Ross SA, Novak Z, Fowler KB, et al. Cytomegalovirus blood viral load and hearing loss in young children with congenital infection. Pediatr Infect Dis J 2009; 28:588.
  34. Walter S, Atkinson C, Sharland M, et al. Congenital cytomegalovirus: association between dried blood spot viral load and hearing loss. Arch Dis Child Fetal Neonatal Ed 2008; 93:F280.
  35. Forner G, Abate D, Mengoli C, et al. High Cytomegalovirus (CMV) DNAemia Predicts CMV Sequelae in Asymptomatic Congenitally Infected Newborns Born to Women With Primary Infection During Pregnancy. J Infect Dis 2015; 212:67.
  36. Bradford RD, Cloud G, Lakeman AD, et al. Detection of cytomegalovirus (CMV) DNA by polymerase chain reaction is associated with hearing loss in newborns with symptomatic congenital CMV infection involving the central nervous system. J Infect Dis 2005; 191:227.
  37. American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007; 120:898.
  38. Bernard S, Wiener-Vacher S, Van Den Abbeele T, Teissier N. Vestibular Disorders in Children With Congenital Cytomegalovirus Infection. Pediatrics 2015; 136:e887.
  39. Stagno S, Pass RF, Thomas JP, et al. Defects of tooth structure in congenital cytomegalovirus infection. Pediatrics 1982; 69:646.