From the Guidelines
For a 1-year-old with Congenital (CMV) Cytomegalovirus Immunoglobulin G (IgG) positivity, no specific antiviral treatment is typically recommended, but rather a comprehensive care approach including monitoring for hearing loss, balance, and developmental issues, as outlined in the American Cochlear Implant Alliance position statement 1. The presence of CMV IgG antibodies in a 1-year-old indicates past infection or maternal antibodies passed during pregnancy, suggesting immunity rather than active disease.
- The child should be monitored for symptoms of active CMV infection, such as prolonged fever, fatigue, or enlarged liver or spleen.
- Regular well-child visits should continue, focusing on growth, development, and hearing, as congenital CMV can affect these areas even in asymptomatic children.
- A multidisciplinary team, including otolaryngology, audiology, ophthalmology, speech-language pathology, and possibly infectious disease specialists, may be involved in the child's care to address potential sequelae of congenital CMV, as suggested by the 2025 study 1.
- Antiviral medications like valganciclovir may be considered in certain cases, such as symptomatic cCMV, where a 6-month course has been shown to modestly improve developmental outcomes 1.
- The primary goal is to provide comprehensive care and monitor for potential long-term effects of congenital CMV, rather than treating the IgG positivity itself.
From the FDA Drug Label
The safety and efficacy of valganciclovir tablets have not been established in children for ... in infants with congenital CMV infection A pharmacokinetic and pharmacodynamic evaluation of valganciclovir for oral solution was performed in 24 neonates with congenital CMV infection involving the central nervous system. However, the efficacy and safety of intravenous ganciclovir and of valganciclovir have not been established for the treatment of congenital CMV infection in infants
The treatment for a 1-year-old with Congenital (CMV) Cytomegalovirus Immunoglobulin G (IgG) positivity is not established with valganciclovir tablets, as the safety and efficacy have not been established in this population 2.
From the Research
Treatment for Congenital CMV Infection
The treatment for a 1-year-old with Congenital (CMV) Cytomegalovirus Immunoglobulin G (IgG) positivity depends on the presence of symptoms.
- For symptomatic congenital CMV infection, treatment with oral valganciclovir is recommended for a duration of 6 months, as it has been shown to improve hearing and neurodevelopmental outcomes in some cases 3, 4.
- The effectiveness and tolerability of valganciclovir therapy have been proven for hearing and neurodevelopmental long-term outcomes 4.
- Valganciclovir is typically reserved for congenitally-infected neonates with symptomatic disease at birth, such as microcephaly, intracranial calcifications, abnormal cerebrospinal fluid index, chorioretinitis, or sensorineural hearing loss 4.
- Treatment with antiviral drugs is not routinely recommended for neonates with mildly symptomatic disease at birth, for neonates under 32 weeks of gestational age, or for infants more than 30 days old due to insufficient evidence from studies 4.
Antiviral Medications
Several antiviral medications are available for the treatment of CMV infection, including:
- Ganciclovir and its oral prodrug valganciclovir, which have been the most studied in infant and neonate populations 5.
- Foscarnet and cidofovir, which can also be used to treat CMV infection, but may have significant toxicities and limitations 5, 6, 7.
- Newer compounds, such as maribavir, are being developed and may offer alternative treatment options in the future 6, 7.